Arnica gel as good as topical ibuprofen.

Because of the well-known and dangerous side effects of oral, non-steroidal anti-inflammatory drugs (NSAIDs), they are increasingly being recommended as topical treatments in the management of osteoarthritis. Results from a randomized, double-blind clinical study comparing this type of treatment with an Arnica (Arnica montana) gel have been recently announced. (1) The study involved 204 patients with multiple osteoarthritis (OA) in the fingers (small joint OA) and compared three weeks' treatment with the Arnica gel against a five-percent ibuprofen gel. The topical Arnica treatment was evaluated by both the patients and their doctors as more effective than the topical NSAID. Of the patients who assessed efficacy as "very good" or "good," more patients in the Arnica group (64%) expressed satisfaction than in the ibuprofen group (58.8%).

This was a high-quality clinical study. The study was planned and performed according to strict international guidelines for studies of multiple osteoarthritis of the fingers: Osteoarthritis Research Group International (OARS) and European Agency for the Evaluation of Medicinal Products (EMEA) guidelines for controlled studies and their statistical evaluation, as well as Good Clinical Practice rules. This is the very first herbal study looking at this condition to be performed according to these strict guidelines.

Commentary

Results from this study suggest that the topical anti-inflammatory activity of Arnica is vastly underestimated. Arnica has been found to inhibit activation of the transcription factor NF-kappaB, which is responsible for the transcription of genes encoding the production of various inflammatory mediators, including COX-2. (2) As well as the traditional uses of Arnica for bruises, contusions, and venous insufficiency, its topical use as a musculoskeletal anti-inflammatory is now backed up by sound clinical evidence and needs to be given greater priority by herbal clinicians.

1. Widrig R, Suter A, Saller R, et al. Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatol Int. 2007; 27(6): 585-591.

2. Bone K. Clinical Guide to Blending Liquid Herbs. Herbal Formulations for the Individual Patient. New York: Churchill Livingstone: 2003: 71.