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- Rose Hip (Rosa canina)
- Osteoarthritis
- Pain
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Date:
07-15-2014 | HC# 031432-500
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Re: Special Danish Rose Hip Powder Reduces Pain and Stiffness of Osteoarthritis of the Hand
Winther
K, Campbell-Tofte J, Hansen P. Rose hip powder that contains the natural amount
of shells and seeds alleviates pain in osteoarthritis of the dominant hand—a
randomized, double-blind, placebo-controlled, cross-over clinical trial. Open J Rheumatol Autoimmune Dis.
2013;3(3):172-180.
Osteoarthritis
(OA) is "essentially a disease of wear and tear of articular cartilage,"
according to the authors of this paper. Seen in about 90% of the population by
age 40, OA is triggered by an inflammatory response to cartilage destruction. Nonsurgical
treatment mainly aims to alleviate the associated pain and stiffness and reduce
the inflammation. Acetylsalicylic acid (aspirin) and various nonsteroidal
anti-inflammatory drugs (NSAIDs) are used to treat the symptoms but often have
toxic and unwanted adverse effects. And, although selective inhibitors of the
proinflammatory cyclooxygenase-2 (COX-2) have shown analgesic and
anti-inflammatory properties without adverse effects, they are expensive and
may negatively affect patients' circulatory systems. In earlier studies,
including trials by these authors, rose hip (Rosa canina) powder (RHP) containing an equal amount of seeds and
shells was shown to be useful for treating patients suffering from OA of the
knee and/or hip1-3 and patients with rheumatoid arthritis.4
In the randomized, double-blind, placebo-controlled, crossover study reported
here, the authors examined whether or not RHP reduces symptoms of OA of the
hand. This is a substudy of a larger study on OA published in 2004.1
Of
the 125 Caucasian outpatients in the larger study,1 40 patients
suffered from mild-to-moderate OA of the hand. Thirty of those patients (4 men
and 26 women) met the criteria for OA of the dominant hand as outlined by the
American College of Rheumatology and were enrolled in the substudy. Their
baseline characteristics – including OA severity, function of the dominant
hand, and use of rescue medications (e.g., NSAIDs) – were similar.
After
a 14-day run-in period, the patients were assigned randomly to take 5 capsules
containing 0.5 g of either RHP or placebo twice daily for 3 months (phase 1;
total RHP daily dosage = 5 g). Then, the patients switched to the alternative
medication and entered phase 2 for 3 months. Group A (RHP then placebo)
included 16 patients; group B (placebo then RHP) included 14 patients.
Before
and after each intervention, blood samples were drawn to determine levels of
the inflammatory marker C-reactive protein, and the patients were evaluated for
OA pain, stiffness, and overall feeling of discomfort. Consumption of all types
of rescue medications was recorded daily.
The
RHP used in the trial, Hyben Vital® (Hyben Vital ApS; Langeland,
Denmark) – marketed as Rose-Hip Vital® in Australia and GOPO®
in the United Kingdom – is prepared from a selected subspecies of the rose
plant and contains the entire seed and shell content of the rose hips.
According to the authors, 100 g RHP contains at least 500 mg vitamin C, 5.8 g
pectin, 5.8 mg β-carotene, 50 mg β-sitosterol, 0.2 mg folic acid, 4.6 mg
vitamin E, 170 mg magnesium, 1 mg zinc, and 10.9 μg copper. Other data from the
manufacturer states that the RHP is standardized to 150 mg/kg of a galactolipid
referred to as "GOPO." (GOPO is reportedly relatively unstable in
heat; the processing method used by the manufacturer employs a patented
technique that maintains a low temperature to maintain GOPO levels.) The
placebo contained a powder similar in color, taste, and odor. Both the RHP and
placebo were supplied by Hyben Vital.
The
primary efficacy measure was reduced joint pain of the dominant hand, which was
calculated as a mean of 16 different activity tests (e.g., pain when waking in
the morning, slowly opening and closing the hand, pouring water from a jug,
using a knife and fork, etc.) using a scale ranging from 1 (no pain) to 10
(almost unbearable pain). Testing was performed at baseline, after 3 weeks, and
again after 3 months of treatment for both treatment phases. Secondary efficacy
measures were changes in joint stiffness, overall feeling of discomfort, and
consumption of rescue medications.
During
the study, 24 patients (10 in group A and 14 in group B) completed the
questionnaires for pain, stiffness, and general well-being. At the end of phase
1, 90% of patients in the RHP group reported reduced pain compared with 36% in
the placebo group (P<0.029). This reduced pain was still evident 3 weeks
after those patients switched to placebo treatment in phase 2. Of the 16
different activities, "handwriting a letter" showed the most
pronounced decline in pain: RHP treatment resulted in a 20% (P<0.03)
reduction in pain after 3 weeks and a 26% reduction after 3 months
(P<0.014). No change was observed in the placebo-treated patients.
Significant
improvements in pain reduction also were seen when using a corkscrew
(P<0.048) and when pressing tablets out of a blister package (P<0.003)
after RHP treatment compared with placebo intervention. After RHP treatment,
stiffness (P<0.02) and general feelings of discomfort from the disease
(P<0.032) decreased as well. No changes were seen in the consumption of
NSAIDs during the study; however, overall consumption of other types of rescue
medications (e.g., acetaminophen, codeine, and tramadol) decreased
significantly during RHP treatment compared with placebo treatment
(P<0.013). No statistically significant differences were seen in C-reactive
protein levels (a marker of systemic inflammation) between the 2 treatments,
probably due to the small number of patients tested (n=8). Only mild adverse
effects were reported.
"The
main outcome of this study is that chronic administration of the standardized
RHP reduces pain and stiffness experienced during manual activity in patients
with OA of the dominant hand," write the authors. "We consider that
the results warrant a large-scale, parallel study of the RHP in patients with
osteoarthritis of the hand."
―Shari Henson
References
1Rein E, Kharazmi A,
Winther K. A herbal remedy, Hyben Vital (stand. powder of a subspecies of Rosa canina fruits), reduces pain and
improves general wellbeing in patients with osteoarthritis―a double-blind,
placebo-controlled, randomised trial. Phytomedicine.
2004;11(5):383-391.
2Warholm O, Skaar S,
Hedman E, Mølmen HM, Eik L. The effects of a standardized herbal remedy made
from a subtype of Rosa canina in
patients with osteoarthritis: a double-blind, randomized, placebo-controlled
clinical trial. Curr Ther Res Clin Exp.
2003;64(1):21-31.
3Winther K, Apel K,
Thamsborg G. A powder made from seeds and shells of a rose-hip subspecies (Rosa canina) reduces symptoms of knee
and hip osteoarthritis: a randomized, double-blind, placebo-controlled clinical
trial. Scand J Rheumatol.
2005;34(4):302-308.
4Willich SN, Rossnagel
K, Roll S, et al. Rose hip herbal remedy in patients with rheumatoid arthritis
– a randomised controlled trial. Phytomedicine.
2010;17(2):87-93.
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