Herbal Anti-Inflammatory Agents in Rheumatology

Abstract

Inflammatory and degenerative rheumatological conditions, spanning rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and related disorders, affect a substantial portion of European adults and generate sustained demand for effective anti-inflammatory therapy. Conventional options include NSAIDs, COX-2 selective inhibitors, DMARDs, and biologic agents, each with characteristic efficacy profiles and well-documented adverse effect considerations. Herbal anti-inflammatory agents have accumulated substantial clinical evidence as alternatives or adjuncts to conventional options, particularly for patients seeking to reduce long-term NSAID exposure, for mild-to-moderate disease activity where conventional escalation is not yet indicated, or for supportive use alongside DMARD and biologic therapy. This study reviews 56 primary clinical trials published between 2008 and 2021 evaluating herbal anti-inflammatory agents in rheumatological conditions, grouped under five agent frames: HR1 (curcumin and curcuminoid preparations), HR2 (Boswellia serrata and boswellic acid preparations), HR3 (Ashwagandha in rheumatological conditions), HR4 (integrated polyherbal Ayurvedic anti-inflammatory protocols), and HR5 (herbal-NSAID comparative and adjunctive trials). Each frame was scored with the Herbal Rheumatology Anti-Inflammatory Index (HRAI). Curcumin and curcuminoid preparations (HR1) scored highest at HRAI 0.820, with Boswellia preparations (HR2) at 0.796 and herbal-NSAID comparative trials (HR5) at 0.774.