Devil's claw

Devil’s Claw: Efficacy of Anti-inflammatory Properties in Arthritis Tara Chapman, William Coleman, Lauren Copeland, Brittany DeGonia, Peter Huang and Jeeah Kim Medical College of Virginia Campus of Virginia Commonwealth University School of Pharmacy Abstract Purpose: To determine, based on previous research, if the herbal substance Devil’s Claw is an effective treatment for arthritis related symptoms. Method: Researching and evaluate the clinical trials featured in the references on the efficacy of Devil’s Claw in the treatment of arthritic symptoms. Results: Based on the research, in short term use, the data shows a positive correlation between the use of Devil’s Claw and treatment of arthritic symptoms. However, one study claims that the herb is not clinical effective for the treatment of arthritis symptoms. Conclusion: Overall, it was concluded from the reviewed data that Devil’s Claw was an effective short-term therapy for treating arthritis symptoms. However, a study of the long-term efficacy of Devil’s Claw on arthritis symptoms would need to be performed before any concrete conclusion could be made. Background Information Method Results Results Conclusion Contact information “ World-wide, arthritis and other rheumatic conditions are leading the cause of disability.” 6 As a result, questions concerning the efficacy of herbal supplements, claiming to help prevent and/or treat this debilitating disease, have been raised. Even though there is little regulation of such substances enforced by the FDA and limited proof of product content uniformity by the USP, many people still desire herbal product use because of their strong belief in “natural” treatment and avoiding professional medical attention. Accordingly, Devil’s Claw is reported as a herbal substance that can be used in the treatment of arthritis related symptoms and other related disorders. It is suggested that the herb can improve joint motility and reduce pain and swelling associated with arthritis through its anti-inflammatory activity; resulting from the plant’s content of harpagoside, which has been shown to inhibit COX-2 expression. 4 This substance is extracted from the roots of Harpagophytum procumbens , a plant that originated in the desert regions of South and Southeast Africa. 5 References Acknowledgments Hypothesis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],It was hypothesized that Devil’s Claw, used as an herbal supplement, will be significantly effective in the treatment of arthritis related symptoms; pertaining mainly to joint motility and reduction of pain and swelling related to inflammation. A literature search was conducted on the PubMed/Medline database featuring the search terms “Devil’s Claw,” “Harpagophytum procumbens,” “Arthritis,” and “Efficacy.” From that search, five articles were thoroughly evaluated to determine an ultimate conclusion of the effectiveness of Devil’s Claws in relieving arthritis symptoms. Of the five articles investigated, two articles were literature reviews and three were reviews of primary clinical trials. Each of the articles were assessed for appropriateness to the topic, relevance, type of research performed, validity of the research performed, and date of research completed. The literature and clinical reviews, summarized in Table 1 , showed a general sense of safety and efficacy in patients with each respective dosing regimen, although there was no general consensus on the optimum dosing regimen for pain or arthritis. There are no signs of any major adverse reactions when Devil's Claw is taken with accordance to the respective trials' dosing regimen. Ulbrict stated the optimum dosing for Devil's Claw for osteoarthritis is 50 to 100 mg of harpagoside, the proposed active ingredient in Devil's Claw, by mouth three times a day, whereas Warnock found that 480 mg twice daily was an effective dose. 8, 9 Wegner dosed two 400 mg tablets, with concentration of harpagoside unknown, three times a day, and the results showed only 4 adverse events at 13 different sites of pain in 75 patients. 10 Common side effects reported include diarrhea, flatulence, gastritis, epigastric discomfort, and possible hypoglycemic effects. 1, 8, 9 There is evidence from each source reviewed to show that there is positive support in the short-term efficacy of Devil's Claw in the treatment of arthritis, although Brien summarized that there is no definitive answer regarding the efficacy of Devil's Claw. 1, 8, 9, 10 In-vitro rat studies showed positive efficacy mid to long-term effects in rat cells only. 3 There is approximately a 50% efficacy rate of patients who used Devil's Claw for the treatment of arthritis or pain associated with arthritis with an 80% tolerance. The mode of action of Devil's Claw is suspected to inhibit interleukin (IL)-1, IL-6, and TNF-α production by macrophage and inhibition of the COX-2 pathway to reduce inflammation. 2,8 Additional review of literature may be useful in determining the overall safety and efficacy of Devil’s Claw. At the beginning of our literature review, we hypothesized that devil’s claw will be significantly effective in the treatment of arthritis related symptoms, specifically those symptoms pertaining to the reduction of pain and swelling related to inflammation. Of the five articles we reviewed to evaluate this hypothesis, four studies show evidence to support the short-term efficacy of devil’s claw for the treatment of arthritis, with overall reduction in pain, swelling related to inflammation, and improvement in overall general function. 1,3,8,9,10 However, Brien et al. suggest no definitive claim on the efficacy of devil’s claw can be made. 1 As far as safety of devil’s claw for the treatment of arthritis, devil’s claw does appear to be safe in this patient population. As shown in Figure 1 , the majority of trials reviewed show only 1% of study populations displaying any adverse reactions to the herbal product. These reactions were mild and include mainly gastrointestinal complaints. 1,8,9 Limitations of these studies were numerous and should be taken into account when attempting to determine the efficacy of devil’s claw in patients with arthritis. Nearly all of the studies reviewed, excluding the controlled animal study, contained only short-term data on efficacy of devil’s claw, and do not provide any evidence for the efficacy of the herbal product for long-term use. Additionally, dosing and actual amount of active ingredient in each formulation varies amongst all reviews, so standardization is needed between formulations. Finally, many of these studies are also limited in the size and methodology. Based on the limitations of these studies, no significant claim can be made about the efficacy of devil’s claw for the treatment of arthritis, although a benefit does seem to exist for short-term treatment. Therefore, we suggest a need for better controlled, larger scale trials in order to significantly determine the efficacy of devil’s claw for the treatment of arthritis related symptoms. A hypothesis was made that stated Devil’s Claw, when used as an herbal supplement, will be significantly effective in the treatment of arthritis related symptoms; pertaining to joint motility and reduction of pain and swelling related to inflammation. The studied research involved animals and humans. From the controlled animal study alone, Devil’s Claw was proven to be effective in the short-term and over an extended period of time. In the various other human studies a clear conclusion was not fully determined. This occurred due to the insufficient long-term human data, errors, and omissions in the examined studies. Overall, it was concluded from the reviewed data that Devil’s Claw was an effective short-term therapy for treating arthritis symptoms. However, a study of the long-term efficacy of Devil’s Claw on arthritis symptoms would need to be performed before any concrete conclusion could be made. We would like to give a special thanks to the authors who’s work is featured in this research poster. Without their hard work, none of this would have been possible. We would also like to thank Dr. Zhang for allowing us the opportunity to gain insight into the work and commitment required to design and create a research poster. School of Pharmacy Medical College Discussion Figure 1. Percentages of adverse reactions reported in patients throughout 27 Clinical Trials Table 1. A summary of 5 clinical trials researched in this project. Figure 2. Overall Short-Term Effectiveness of Devil's Claw Figure 1 displays the reported adverse reaction of the twenty seven studies from the literature reviews and primary clinical trials. Majority of the reported adverse reactions were mild to moderate in severity and primary gastrointestinal complaints. The adverse reactions were collected over short and long term use of Devil’s Claw and mainly depended on the length of each study. Figure 2 displays the the results of the twenty-seven studies reviewed by the literature on the short-term effectiveness of Devil's Claw. The majority of the studies revealed that Devil's Claw was effective for short-term use. Additional long-term data must be collected before any conclusions may be made regarding the effects of Devil's Claw over longer periods of time. Pharmacy.vcu.edu Virginia Commonwealth University, School of Pharmacy 410 North 12th Street P.O. Box 980581 Richmond, Virginia 23298 T: 804.828.3000 F: 804.828.1815 TF: 1.800.330.0519 E: pharmacy@vcu.edu Review Source Study Design Date of Study Sample Type Number of Samples Safety Efficacy Inaba, 2010 3 Controlled Animal Study 2001 In-vitro Rat 96 Not Reported Yes Brien, 2006 1 Literature Review 1966 - 2006 14 Human Trials Reviewed 43 –1026 Some Side Effects No Definitive Answer Wegener, 2003 10 Open Clinical Study 1999 - 2000 In-Vivo Human 75 4 Adverse Events Yes Warnock, 2007 9 Open Clinical Study 2003 - 2004 In-Vivo Human 259 No Major Adverse Events Yes Ulbricht, 2006 8 Literature Review 1980 - 2001 11 Human Trials Reviewed 13 – 675 Likely Safe Yes, Short Term

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