Chronic joint pain is caused by inflammatory and degenerative diseases.
Osteoarthritis and rheumatoid arthritis are considered chronic joint inflammatory disorders that can lead to progressive histological abnormalities and disabling symptoms.
Joint pain is a major clinical problem. Rheumatoid arthritis can cause joint pain at a younger age while elder people mainly suffering from pain due to osteoarthritis (OA).
The most commonly affected joints by arthritis are weight-bearing joints such as feet, knees, hips, spine and other joints that finally result in mainly inflammation, pain, joint stiffness and loss of movement.
Arthritis not only affects the weight-bearing joints, but also affects peri-articular bone, synovial joint lining and adjacent supporting connective tissue element.
Osteoarthritis is one of the most common musculoskeletal disorders which affects approximately 15% of the population.
In the United Kingdom, it was estimated that up to 8.5 million people could be affected by chronic joint pain which can be attributed to osteoarthritis.
It can cause irreversible destruction of articular cartilage and bone erosion induced by pro-inflammatory cytokines e.g., interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α).
There are several factors that increase the risk of OA which include: –
- Advanced age.
- Increased body mass index (BMI).
- Certain physical activities that imply biomechanical stress (e.g., pressure, load-bearing) across the joints.
Rheumatoid arthritis (RA) is a chronic, inflammatory and progressive systemic autoimmune disease that causes disability and increases the risk of heart disease, lymphoma and death, usually associated with high levels of oxidative stress and inflammatory mediators.
According to the WHO, rheumatoid arthritis affects 0.3-1% of the world’s population of which women are three times more likely to be affected than men.
The exact pathological mechanism is not yet known, it was suggested that but the release of certain free radicals, such as nitrous oxide and superoxide radicals, which are generated as by-products of cellular metabolism.
The release of such free radicals may stimulate the production of interleukins (IL) and tumor necrosis factor (TNF-α) from T cells, which ultimately influence the production of growth factors, cytokines and adhesive molecules on immune cells. These factors can cause tissue destruction and inflammation.
The primary symptoms of RA are pain, swelling and destruction of cartilage and bone that can lead to permanent disability.
The worsening condition of arthritis requires proper therapy for arthritis and taking into account the economical consideration for chronic treatment. Although synthetic drugs for the treatment of arthritis are available in the market, their use is limited due to the serious side effects upon long-term use.
In this article, we will discuss the use of herbal therapy in the treatment of chronic joint pain due to osteoarthritis and rheumatoid arthritis.
Herbal Therapy for Chronic Joint Pain and/or Arthritis 
Traditionally, herbal plants have been used externally and internally to treat inflammatory conditions such as arthritis.
The positive impact of herbal medicine in modifying the pathophysiology of arthritis has resulted in a substantial increase in their use as a treatment for arthritis.
- Aloe Vera 
Aloe vera has been used by humans for centuries for medicinal purposes, including the treatment of burns, as an anti-viral, for inhibition of tumor cells and for treatment of arthritis.
Aloe vera contains more than 75 different compounds and including: –
- Vitamins (Vit. A, C, E, and B12).
- Enzymes i.e. amylase, catalase, and peroxidase.
- Minerals i.e. zinc, copper, selenium, and calcium.
- Anthraquinones (aloin and emodin).
- Fatty acids i.e. lupeol and campesterol.
- Hormones such as auxins and gibberellins.
- Other ingredients (salicylic acid, lignin, and saponins).
It can be used to treat chronic non-cancerous pain, especially those caused by osteoarthritis (OA).
Aloe vera is used as an anti-inflammatory agent and also as a prophylactic against the gastrointestinal irritant effects of non-steroidal anti-inflammatory drugs (NSAIDs).
- Boswellia Serrata (BS) 
The gum-resin extract of BS has been used for centuries in folk medicine to treat different chronic inflammatory diseases.
A poly-herbal formulation that contains (the root of Zingiber officinale, the stem of Tinospora cordifolia, the fruit of Phyllanthus emblica and the oleoresin of Boswellia serrata) can stop cartilage degradation in the knee which is associated with anti-inflammatory activity.
There is a combination of three herbs (Uncaria tomentosa, Boswellia, and Lepidium meyenii) and an amino acid (l-leucine), this combination can reduce the inflammation and protect the articular cartilage.
The resinous part of Boswellia serrata possesses the following: –
- Tetracyclic triterpenic acids.
- Four major pentacyclic triterpenic acids
- β-boswellic acid.
- Acetyl-β-boswellic acid.
- 11-keto-β-boswellic acid.
- Acetyl-11-keto-β-boswellic acid.
Researches have shown that a mixture of Curcuma longa and Boswellia serta is more effective in the treatment of osteoarthritis than the standard dose of celecoxib (a nonsteroidal anti-inflammatory drug).
- Ginger 
For over 5000 years Indians and Chinese have been producing ginger as a tonic root for the treatment of many ailments, and this plant is now cultivated throughout the humid tropics, India is the largest producer.
Even before history was officially recorded, it has been used as a flavoring agent
At least 115 constituents have been identified in fresh and dried ginger varieties.
Gingerols are the main constituents in fresh ginger, which is slightly reduced in dry ginger.
Researches have suggested that ginger can be effective against inflammation, osteoarthritis and rheumatism, and may be used to relieve pain and inflammation in patients suffering from general muscular discomfort, rheumatoid arthritis and osteoarthritis.
- Uncaria tomentosa Willd (Cat’s Claw) 
It has been used for many years to treat many diseases such as intestinal disorders, wounds, fever, ulcers, cancer and diabetes.
Bark and roots are normally used for medicinal purposes as they contain many chemical constituents including: –
- Oxindole alkaloid.
- Quinovic acid.
- Plant sterol and catechins.
The ability of Cat’s claw for the treatment of arthritis is mainly due to anti-inflammatory activity.
The Inhibitory activity against cytokines interleukins (IL-1β) and tumor necrosis factor alpha (TNFα) are more prominent during arthritis, also it can promote the cartilage repair by stimulating insulin production like growth factor.
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