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A randomized survey of medicinal plants used by folk medicinal practitioners in six districts of Bangladesh to treat rheumatoid arthritis.

Introduction

Rheumatoid arthritis is a chronic, systemic inflammatory disorder principally attacking the synovial joints (these joints achieve movement at the point of contact of the articulating bones). It is an autoimmune disorder, which cause inflammation of the joints and can cause inflammation of the tissue surrounding the joints. It typically progresses with time leading ultimately to joint destruction and functional disability. The disease has been estimated to affect about 1% of the world's population, with women being three times more affected than men. People within the age group of 40-50 years are the most vulnerable, but the disease can affect people at any age. There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). DMARDs include methotrexate, sulfasalazine, leflunomide (Arava[R]), etanercept (Enbrel[R]), infliximab (Remicade[R]), adalimumab (Humira[R]), abatacept (Orencia[R]), rituximab (Rituxan[R]), anakinra (Kineret[R]), antimalarials, gold salts, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine (Imuran). Other forms of treatment include physical therapy and occupational therapy.

The disease is quite common in Bangladesh. In a study conducted on 101 cases of rheumatic diseases, it was observed that rheumatoid arthritis was the most common being present in 60 cases (Islam, N. and M. Kahn, 1981). Methotrexate, a drug of choice in Bangladesh to treat rheumatoid arthritis, has been reported to give adverse effects in 27 out of the 38 patients studied (Ali, M.L., 1997). The most common adverse reactions associated with sulfasalazine are anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. Leflunomide is an effective disease-modifying agent for rheumatoid arthritis. However, its use has been associated with significant and serious adverse reactions involving haematological, hepatic, immune, dermatological and respiratory systems. Adverse reactions have also been reported for the other drugs used to treat this disease.

Traditional medicinal knowledge has been a means towards the discovery of many modern medicines (Cotton, C.M., 1996). Bangladesh has a rich history of several traditional medicinal systems, among whom the most notable ones are the Ayurvedic, Unani, and the folk medicinal systems. Folk medicine is practiced by Kavirajes who utilize simple formulations of medicinal plants in most of their preparations. In our ongoing ethnomedicinal surveys throughout Bangladesh, we have observed that Kavirajes are visited by a substantial segment of both rural and urban population. It has also been observed that the Kavirajes of various regions use diverse varieties of plants for treatment of different ailments (Hossan, M.S., 2010; Rahmatullah, M., 2010; Rahmatullah, M., 2009; Rahmatullah, M., 2009; Rahmatullah, M., 2009). It was the objective of the present study to conduct a completely randomized survey of Kavirajes in six districts of Bangladesh (where rheumatoid arthritis is quite common) to learn more about medicinal plants used for treatment of this disease. The expectation was that the medicinal plants used by the Kavirajes can prove to be a useful source for further scientific studies leading to discover of more efficacious drugs.

Materials and Methods

The present randomized survey was carried out among Kavirajes of six districts of Bangladesh, namely Brahmanbaria, Bogra, Dinajpur, Khulna, Natore, and Rajshahi. Informed consent was obtained from the Kavirajes prior to the survey. Actual surveys were conducted with the help of a semi-structured questionnaire and the guided field-walk method as described by Martin (1995) and Maundu (1995). Kavirajes were asked specifically as to whether they know about rheumatoid arthritis and whether they treat the disease on a regular basis. Kavirajes were selected based on their affirmative answer to both questions. The Kavirajes mentioned the plants with which they treated rheumatoid arthritis to the interviewers and took the interviewers to spots from where they collected the plants. The plants were shown along with provision of local names and the parts used. Plant specimens were collected and dried in the field and later brought back to Dhaka for complete identification at the Bangladesh National Herbarium.

Results

The Kavirajes of the six districts surveyed were observed to use 32 plants distributed into 23 families for treatment of rheumatoid arthritis. The Araceae and the Solanaceae families were the major contributors with three plants per family. Other families contributing two plants per family included Euphorbiaceae, Meliaceae, Piperaceae, Poaceae, and Rutaceae families. The results are shown in Table 1.

Leaves constituted the major plant part used (28.8%) followed by fruits (16.9%). Whole plant constituted 13.6% of total uses along with seeds, also at 13.6%. Barks constituted 8.5% of total uses. The results are summarized in Table 2.

The mode of administration was predominantly topical. Usually, juice from macerated whole plant or plant part was applied to affected areas. Use of both single plant part as well as a combination of plant parts was observed. For instance, the fruits of Ricinus communis L. were used alone; on the other hand, a combination of leaves and fruits of Crinum asiaticum L. was used for treatment. Of the 32 names of medicinal plants obtained, 7 were obtained from Khulna district, 16 from Rajshahi district, and 8 from Dinajpur district, suggesting that rheumatoid arthritis was more prevalent in those districts. 8 plant names were also collected from Natore district, which adjoins Rajshahi district.

Discussion

The use of medicinal plants for treatment of rheumatic disorders is not new but is also practiced in the traditional medicinal systems of other countries of the world. A notable success story is that of the plant, Harpagophytum procumbens (Burch.) DC. ex Meisn. [Genus: Harpagophytum, Family: Pedaliaceae, English name: Devil's Claw], which is used in the traditional medicinal system of South Africa and Namibia to treat different forms of rheumatic disorders and back pain. A number of reports attest to the success of this plant in the treatment of the above disorders (Brien, S., 2006; Denner, S.S., 2007; Warnock, M., 2007; Vlachojannis, J., 2008).

The plants obtained in the present survey present considerable potential for discovery of new drugs for rheumatoid arthritis, a debilitating disease affecting millions of people throughout the world. Even if the plants do not prove successful in curing the disease or reversing the degenerative processes but prove successful in treatment of symptoms like severe pain and inflammation that can be considered advancement over the existing drugs, which occasionally give severe adverse effects. Since the Kavirajes have treated patients from ancient times with the medicinal plants obtained in the present survey with claims of success, it is expected that scientific research on these plants can yield fruitful results.

References

Ali, M.L., M.N. Alam, S.A. Haq, K.K. Das and P.K. Baral, 1997. Efficacy of methotrexate in rheumatoid arthritis. Bangladesh Medical Research Council Bulletin, 23: 72-76.

Brien, S., G.T. Lewith and G. McGregor, 2006. Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: a review of efficacy and safety. Journal of Alternative and Complementary Medicine, 12: 981-993.

Cotton, C.M., 1996. Ethnobotany: Principle and Application, John Wiley and Sons, New York, pp: 399.

Denner, S.S., 2007. A review of the efficacy and safety of devil's claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis. Holistic Nursing Practice, 21: 203-207.

Hossan, M.S., A. Hanif, B. Agarwala, M.S. Sarwar, M. Karim, M.T. Rahman, R. Jahan and M. Rahmatullah, 2010. Traditional use of medicinal plants in Bangladesh to treat urinary tract infections and sexually transmitted diseases. Ethnobotany Research and Applications, 8: 61-74.

Islam, N. and M. Kahn, 1981. Rheumatic diseases other than rheumatic fever. Bangladesh Medical Research Council Bulletin, 7: 18-21.

Martin, G.J., 1995. Ethnobotany: a 'People and Plants' Conservation Manual, Chapman and Hall, London, pp: 268.

Maundu, P., 1995. Methodology for collecting and sharing indigenous knowledge: a case study. Indigenous Knowledge and Development Monitor, 3: 3-5.

Rahmatullah, M., D. Ferdausi, M.A.H. Mollik, R. Jahan, M.H. Chowdhury and W.M. Haque, 2010. A Survey of Medicinal Plants used by Kavirajes of Chalna area, Khulna District, Bangladesh. African Journal of Traditional, Complementary and Alternative Medicines, 7(2): 91-97.

Rahmatullah, M., D. Ferdausi, M.A.H. Mollik, M.N.K. Azam, M.T. Rahman and R. Jahan, 2009. Ethnomedicinal Survey of Bheramara Area in Kushtia District, Bangladesh. American Eurasian Journal of Sustainable Agriculture, 3(3): 534-541.

Rahmatullah, M., A. Noman, M.S. Hossan, M.H. Rashid, T. Rahman, M.H. Chowdhury and R. Jahan, 2009. A survey of medicinal plants in two areas of Dinajpur district, Bangladesh including plants which can be used as functional foods. American Eurasian Journal of Sustainable Agriculture, 3(4): 862-876.

Rahmatullah, M., A.K. Das, M.A.H. Mollik, R. Jahan, M. Khan, T. Rahman and M.H. Chowdhury, 2009. An Ethnomedicinal Survey of Dhamrai Sub-district in Dhaka District, Bangladesh. American Eurasian Journal of Sustainable Agriculture, 3(4): 881-888.

Vlachojannis, J., B.D. Roufogalis and S. Chrubasik, 2008. Systematic review on the safety of Harpagophytum preparations for osteoarthritic and low back pain. Phytotherapy Research, 22: 149-152.

Warnock, M., D. McBean, A. Suter, J. Tan and P. Whittaker, 2007. Effectiveness and safety of Devil's Claw tablets in patients with general rheumatic disorders. Phytotherapy Research, 21: 1228-1233.

(1) Mohammed Rahmatullah, (1) Rownak Jahan, (1) A.K. Azad, (1) Syeda Seraj, (1) Md. Mahbubur Rahman, (1) Anita Rani Chowdhury, (1) Rahima Begum, (1) Dilruba Nasrin, (1) Zubaida Khatun, (1) Mohammad Shahadat Hossain, (2) Mst. Afsana Khatun, (1) Z.U.M. Emdadullah Miajee

(1) Faculty of Life Sciences, University of Development Alternative, Dhanmondi, Dhaka, Bangladesh.

(2) Present address: Dept. of Pharmacy, Lincoln College, Mayang Plaza, Block A, No 1, Jalan SS 26/2, Taman Mayang Jaya, 47301, Petaling Jaya, Selangor Darul Ehsan, Kuala Lumpur, Malaysia.

Corresponding Author: Professor Dr. Mohammed Rahmatullah, Pro-Vice Chancellor University of Development Alternative House No. 78, Road No. 11A (new) Dhanmondi R/A, Dhaka-1205 Bangladesh Email: rahamatm@hotmail.com Fax: 88-02-8157339

Table 1: Medicinal plants used by folk medicinal
practitioners in the six districts of Bangladesh surveyed
for treatment of rheumatoid arthritis.

Scientific name          Family                 Local Name

Hygrophila auriculata    Acanthaceae            Kulekhara
  (Schumach.) Heine
Crinum asiaticum L.      Amaryllidaceae         Bon piyaz, Dhako-ali
Alocasia macrorrhizos    Araceae                Maan kochu
  (L.) G. Don.
Lasia spinosa (L.)       Araceae                Joka, Kata kochu
  Thwaites
Scindapsus officinalis   Araceae                Takbir gach
  (Roxb.) Schott
Enydra fluctuans Lour.   Asteraceae             Helancha
Cannabis sativa L.       Cannabaceae            Bhang
Carica papaya L.         Caricaceae             Paypay
Terminalia arjuna        Combretaceae           1. Arjun
  (Roxb. ex DC.)
Wight & Arn.                                    2. Arjun
Costus speciosus         Costaceae              Keu
  (J. Konig.) Sm.
Momordica charantia L.   Cucurbitaceae          Korla
Euphorbia neriifolia     Euphorbiaceae          Kuth-raaz
  L.
Ricinus communis L.      Euphorbiaceae          Bella
Anisomeles malabarica    Lamiaceae              Raj-moni
  (L.) R.Br.
Leea macrophylla Roxb.   Leeaceae               Hosti korno polash
  ex Hornem
Gloriosa superba L.      Liliaceae              Ulot chondal
Aphanamixis              Meliaceae              1. Pitraj
  polystachya (Wall.)                           2. Pitraj
  R. Parker
Azadirachta indica A.    Meliaceae              Neem
  Juss.
Stephania japonica       Menispermaceae         Moshi lota
  (Thunb.) Miers
Ficus racemosa L.        Moraceae               Joggo dumur
Moringa oleifera Lam.    Moringaceae            Sajna
Piper chaba W. Hunter    Piperaceae             Mach machunda
Piper cubeba L.f.        Piperaceae             1. Kabab chini
                                                2. Kabab chini
Phragmites australis     Poaceae                Nol-khagra
  (Cav.) Steud.
Zea mays L.              Poaceae                Bottha
Paederia foetida L.      Rubiaceae              Paad pata
Glycosmis pentaphylla    Rutaceae               Dard-brash
  (Retz.) Corr.
Murraya paniculata       Rutaceae               Komla jasmine
  (L.) Jack
Datura metel L.          Solanaceae             Kalo dhutra
Datura stramonium L.     Solanaceae             Shada dhutra
Solanum surattense       Solanaceae             Kontikari
  Burm.f.
Clerodendrum inerme      Verbenaceae            Vana-jhai
  (L.) Gaertn.

Scientific name          Part(s) used           District where
                                                information was
                                                collected

Hygrophila auriculata    Whole plant            Khulna
  (Schumach.) Heine
Crinum asiaticum L.      Leaf, fruit            Dinajpur
Alocasia macrorrhizos    Whole plant            Khulna
  (L.) G. Don.
Lasia spinosa (L.)       Tuber                  Natore
  Thwaites
Scindapsus officinalis   Leaf                   Dinajpur
  (Roxb.) Schott
Enydra fluctuans Lour.   Whole plant            Natore
Cannabis sativa L.       Leaf, root             Rajshahi
Carica papaya L.         Whole plant            Khulna
Terminalia arjuna        1. Bark                1. Dinajpur
  (Roxb. ex DC.)
Wight & Arn.             2. Bark, fruit         2. Natore, Rajshahi
Costus speciosus         Leaf, stem             Dinajpur
  (J. Konig.) Sm.
Momordica charantia L.   Root, fruit, seed      Rajshahi
Euphorbia neriifolia     Whole plant            Natore
  L.
Ricinus communis L.      Fruit                  Brahmanbaria
Anisomeles malabarica    Whole plant            Khulna
  (L.) R.Br.
Leea macrophylla Roxb.   Leaf                   Dinajpur
  ex Hornem
Gloriosa superba L.      Leaf                   Dinajpur
Aphanamixis              1. Seed                1. Bogra
  polystachya (Wall.)    2. Leaf, bark, seed    2. Rajshahi
  R. Parker
Azadirachta indica A.    Leaf, bark             Rajshahi
  Juss.
Stephania japonica       Stem                   Brahmanbaria
  (Thunb.) Miers
Ficus racemosa L.        Fruit                  Brahmanbaria
Moringa oleifera Lam.    Leaf, bark, seed       Rajshahi
Piper chaba W. Hunter    Leaf                   Dinajpur
Piper cubeba L.f.        1. Leaf, fruit, seed   1. Rajshahi
                         2. Leaf, stem          2. Dinajpur
Phragmites australis     Whole plant            Khulna
  (Cav.) Steud.
Zea mays L.              Root, fruit            Rajshahi
Paederia foetida L.      Whole plant            Natore
Glycosmis pentaphylla    Stem, fruit            Rajshahi
  (Retz.) Corr.
Murraya paniculata       Leaf, flower           Khulna
  (L.) Jack
Datura metel L.          Leaf, fruit, seed      Natore
Datura stramonium L.     Leaf, root, seed       Natore
Solanum surattense       Leaf, fruit, seed      Rajshahi
  Burm.f.
Clerodendrum inerme      Leaf, flower           Khulna
  (L.) Gaertn.

Table 2: Percentage use of plant parts by the Kavirajes of the
surveyed districts for treatment of rheumatoid arthritis.

Plant part           Percent (%) use

Whole plant          13.6
Leaf                 28.8
Stem                 6.8
Bark                 8.5
Fruit                16.9
Flower               3.4
Seed                 13.6
Tuber                1.7
Root                 6.8
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Title Annotation:Original Article
Author:Rahmatullah, Mohammed; Jahan, Rownak; Azad, A.K.; Seraj, Syeda; Rahman, Mahbubur; Chowdhury, Anita R
Publication:Advances in Natural and Applied Sciences
Article Type:Report
Geographic Code:9BANG
Date:May 1, 2010
Words:2164
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