Re: Rose Hip Powder Improves Rheumatoid Arthritis Disability Scores
Willich SN, Rossnagel K, Roll S, et al. Rose hip herbal remedy in patients with rheumatoid arthritis - a randomised controlled trial. Phytomed. 2010 Feb;17(2): 87-93.
Clinical
studies have examined the efficacy of rose (Rosa canina) hip powder in the treatment of osteoarthritis, but only a
single exploratory study has assessed rose hip powder and rheumatoid arthritis
(RA). 1 This randomized, double-blind, clinical trial evaluates rose
hip powder (i-flex®/LitoZin®; HybenVital ApS; Langeland, Denmark)
in the treatment of RA symptoms.
Patients
over the age of 18 who met the American Rheumatism Association criteria for RA
were randomized using computer-generated blocks of 4 to receive either placebo
or rose hip powder capsules. The patients were recruited between April 2005 and
August 2006 from outpatient clinics in Berlin, Germany and Denmark. The patients took 5 g of
rose hip powder per day in 2 divided doses for 6 months. The placebo had a
similar taste, appearance, and smell to the rose hip capsules.
The Health
Assessment Questionnaire disability index (HAQDI) was the primary outcome
measure. The HAQDI is comprised of 8 subscales encompassing dressing, arising,
eating, walking, reaching, gripping, hygiene, and ability to perform common
activities. The degree of disability is rated on a scale of 0-3, with a higher
score showing a greater degree of disability. In addition, the HAQDI uses Visual
Analogue Scales (VASs) to assess the patients' pain and a global scale on a
range of 0 to 100. The researchers also used the disease activity score
(DAS-28) to assess swollen and tender joint counts, erythrocyte sedimentation
rate (ESR) as an inflammatory marker, and the patient's self-assessment of
disease activity on a scale of 0-10, with higher scores reflecting greater
disease activity. The physicians evaluated disease activity on a VAS of 0-100.
The researchers measured health-related quality of life (QOL) using the Short
Form (SF-12) and the RA QOL questionnaires. The SF-12 has physical and mental
components, with higher scores reflecting better health-related QOL. The RA QOL
has 30 questions, with lower scores reflecting better outcomes. The patients
continued to take their regular medications, and medication use was recorded in
patient diaries and the physicians' case report forms.
At
baseline, 89 patients were enrolled in the study, including 44 in the rose hip
group and 45 in the placebo group. By the end of the study, 15 patients had withdrawn
from the study, leaving 33 patients in the rose hip group and 41 in the placebo
group. In the rose hip group, reasons for withdrawal included personal reasons
(n=3), relocation (n=1), vomiting (n=1), vasculitis allergica (skin eruptions) (n=1),
difficulty swallowing capsules (n=3), diarrhea (n=1), and nausea (n=1). In the
placebo group, the withdrawal reasons were difficulty swallowing capsules
(n=1), personal reasons (n=1), stomach problems (n=1), and ineffective
treatment (n=1). The drop-outs were included in the intention to treat (ITT)
analysis.
The HAQDI
scores improved in the rose hip group and were significantly better than the
placebo group scores at 3 and 6 months of treatment (P=0.014 and P=0.032, respectively).
There were no significant differences between the groups in the HAQ patient
pain and global scales. The rose hip group experienced a greater improvementin DAS-28 scores compared to the
placebo group with a trend towards statistical significance (P=0.056) at 6
months. The physician's global assessments indicated a greater improvement in
the rose hip group compared to the placebo group at 6 months (P=0.012). At 6 months,
the SF-12 physical and RA QOL scores were also significantly better in the rose
hip group compared to the placebo group (P=0.013 and P=0.043, respectively). There
was not a significant difference in the SF-12 mental component scores. ESR
values declined significantly in the rose hip group compared to the placebo
group in both the ITT analysis and the per protocol analysis that included
patients enrolled for at least 3 months (P=0.060 and P=0.045, respectively). No
changes in medications were noted for either group. There were 14 adverse side
effect reports in the rose hip group and 28 reports in the placebo group. In
the rose hip group, 1 patient experienced a serious adverse event (vasculitis
allergica), where the authors write, "it was not clear whether this event
was related to the study medication as the patient was also taking a number of
other medications." The authors also note the same rose hip powder has not
been linked to any other serious adverse events in previous studies in
osteoarthritis patients.
The authors
conclude, "this study suggests some benefit of patients with RA treated
with the present rose hip powder." Due to the small size of the study, the
authors comment that these results should be viewed with caution. Additional
studies with larger samples of patients are needed to confirm these results and
provide adequate power for multivariate analysis. The authors write that dose-finding
studies and research on different rose hip formulations are also needed.
—Marissa Oppel-Sutter, MS
References
1.Henson
S. Review reveals therapeutic indications for rose hip. HerbClip. Feb 27, 2009 (No. 090384-371). Austin, TX:
American Botanical Council. Review of A systematic review on the Rosa canina effect and efficacy profiles by
Chrubasik C, Roufogalis BD, Müller-Ladner U, Chrubasik S. Phytother Res. 2008;22: 725-733.