Topical herbal therapies for treating osteoarthritis (review)

Background Before extraction and synthetic chemistry were invented, musculoskeletal complaints were treated with preparations from medicinal plants. They were either administered orally or topically. In contrast to the oral medicinal plant products, topicals act in part as counterirritants or are toxic when given orally. Objectives To update the previous Cochrane review of herbal therapy for osteoarthritis from 2000 by evaluating the evidence on effectiveness for topical medicinal plant products. Search methods Databases for mainstream and complementary medicine were searched using terms to include all forms of arthritis combined with medicinal plant products. We searched electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL, ISI Web of Science, World Health Organization Clinical Trials Registry Platform) to February 2013, unrestricted by language. We also searched the reference lists from retrieved trials. Selection criteria Randomised controlled trials of herbal interventions used topically, compared with inert (placebo) or active controls, in people with osteoarthritis were included. Data collection and analysis Two review authors independently selected trials for inclusion, assessed the risk of bias of included studies and extracted data. Main results Seven studies (seven different medicinal plant interventions; 785 participants) were included. Single studies (five studies, six interventions) and non‐comparable studies (two studies, one intervention) precluded pooling of results. Moderate evidence from a single study of 174 people with hand osteoarthritis indicated that treatment with Arnica extract gel probably results in similar benefits as treatment with ibuprofen (non‐steroidal anti‐inflammatory drug) with a similar number of adverse events. Mean pain in the ibuprofen group was 44.2 points on a 100 point scale; treatment with Arnica gel reduced the pain by 4 points after three weeks: mean difference (MD) ‐3.8 points (95% confidence intervals (CI) ‐10.1 to 2.5), absolute reduction 4% (10% reduction to 3% increase). Hand function was 7.5 points on a 30 point scale in the ibuprofen‐treated group; treatment with Arnica gel reduced function by 0.4 points (MD ‐0.4, 95% CI ‐1.75 to 0.95), absolute improvement 1% (6% improvement to 3% decline)). Total adverse events were higher in the Arnica gel group (13% compared to 8% in the ibuprofen group): relative risk (RR) 1.65 (95% CI 0.72 to 3.76). Moderate quality evidence from a single trial of 99 people with knee osteoarthritis indicated that compared with placebo, Capsicum extract gel probably does not improve pain or knee function, and is commonly associated with treatment‐related adverse events including skin irritation and a burning sensation. At four weeks follow‐up, mean pain in the placebo group was 46 points on a 100 point scale; treatment with Capsicum extract reduced pain by 1 point (MD ‐1, 95% CI ‐6.8 to 4.8), absolute reduction of 1% (7% reduction to 5% increase). Mean knee function in the placebo group was 34.8 points on a 96 point scale at four weeks; treatment with Capsicum extract improved function by a mean of 2.6 points (MD ‐2.6, 95% CI ‐9.5 to 4.2), an absolute improvement of 3% (10% improvement to 4% decline). Adverse event rates were greater in the Capsicum extract group (80% compared with 20% in the placebo group, rate ratio 4.12, 95% CI 3.30 to 5.17). The number needed to treat to result in adverse events was 2 (95% CI 1 to 2). Moderate evidence from a single trial of 220 people with knee osteoarthritis suggested that comfrey extract gel probably improves pain without increasing adverse events. At three weeks, the mean pain in the placebo group was 83.5 points on a 100 point scale. Treatment with comfrey reduced pain by a mean of 41.5 points (MD ‐41.5, 95% CI ‐48 to ‐34), an absolute reduction of 42% (34% to 48% reduction). Function was not reported. Adverse events were similar: 6% (7/110) reported adverse events in the comfrey group compared with 14% (15/110) in the placebo group (RR 0.47, 95% CI 0.20 to 1.10). Although evidence from a single trial indicated that adhesive patches containing Chinese herbal mixtures FNZG and SJG may improve pain and function, the clinical applicability of these findings are uncertain because participants were only treated and followed up for seven days. We are also uncertain if other topical herbal products (Marhame‐Mafasel compress, stinging nettle leaf) improve osteoarthritis symptoms due to the very low quality evidence from single trials. No serious side effects were reported. Authors' conclusions Although the mechanism of action of the topical medicinal plant products provides a rationale basis for their use in the treatment of osteoarthritis, the quality and quantity of current research studies of effectiveness are insufficient. Arnica gel probably improves symptoms as effectively as a gel containing non‐steroidal anti‐inflammatory drug, but with no better (and possibly worse) adverse event profile. Comfrey extract gel probably improves pain, and Capsicum extract gel probably will not improve pain or function at the doses examined in this review. Further high quality, fully powered studies are required to confirm the trends of effectiveness identifed in studies so far

Oral herbal therapies for treating osteoarthritis (review)

Background Medicinal plant products are used orally for treating osteoarthritis. Although their mechanisms of action have not yet been elucidated in full detail, interactions with common inflammatory mediators provide a rationale for using them to treat osteoarthritic complaints. Objectives To update a previous Cochrane review to assess the benefits and harms of oral medicinal plant products in treating osteoarthritis. Search methods We searched electronic databases (CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, ISI Web of Science, World Health Organization Clinical Trials Registry Platform) to 29 August 2013, unrestricted by language, and the reference lists from retrieved trials. Selection criteria Randomised controlled trials of orally consumed herbal interventions compared with placebo or active controls in people with osteoarthritis were included. Herbal interventions included any plant preparation but excluded homeopathy or aromatherapy products, or any preparation of synthetic origin. Data collection and analysis Two authors used standard methods for trial selection and data extraction, and assessed the quality of the body of evidence using the GRADE approach for major outcomes (pain, function, radiographic joint changes, quality of life, withdrawals due to adverse events, total adverse events, and serious adverse events). Main results Forty‐nine randomised controlled studies (33 interventions, 5980 participants) were included. Seventeen studies of confirmatory design (sample and effect sizes pre‐specified) were mostly at moderate risk of bias. The remaining 32 studies of exploratory design were at higher risk of bias. Due to differing interventions, meta‐analyses were restricted to Boswellia serrata (monoherbal) and avocado‐soyabean unsaponifiables (ASU) (two herb combination) products. Five studies of three different extracts from Boswellia serrata were included. Moderate‐quality evidence from two studies (85 participants) indicated that 90 days treatment with 100 mg of enriched Boswellia serrata extract improved symptoms compared to placebo. Mean pain was 40 points on a 0 to 100 point VAS scale (0 is no pain) with placebo, enriched Boswellia serrata reduced pain by a mean of 17 points (95% confidence interval (CI) 8 to 26); number needed to treat for an additional beneficial outcome (NNTB) 2; the 95% CIs did not exclude a clinically significant reduction of 15 points in pain. Physical function was 33 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 0 to 100 point subscale (0 is no loss of function) with placebo, enriched Boswellia serrata improved function by 8 points (95% CI 2 to 14); NNTB 4. Assuming a minimal clinically important difference of 10 points, we cannot exclude a clinically important benefit in some people. Moderate‐quality evidence (one study, 96 participants) indicated that adverse events were probably reduced with enriched Boswellia serrata (18/48 events versus 30/48 events with placebo; relative risk (RR) 0.60, 95% CI 0.39 to 0.92). Possible benefits of other Boswellia serrata extracts over placebo were confirmed in moderate‐quality evidence from two studies (97 participants) of Boswellia serrata (enriched) 100 mg plus non‐volatile oil, and low‐quality evidence from small single studies of a 999 mg daily dose of Boswellia serrata extract and 250 mg daily dose of enrichedBoswellia serrata. It was uncertain if a 99 mg daily dose of Boswellia serrata offered benefits over valdecoxib due to the very low‐quality evidence from a small single study. It was uncertain if there was an increased risk of adverse events or withdrawals with Boswellia serrata extract due to variable reporting of results across studies. The studies reported no serious adverse events. Quality of life and radiographic joint changes were not measured. Six studies examined the ASU product Piasclidine®. Moderate‐quality evidence from four studies (651 participants) indicated that ASU 300 mg produced a small and clinically questionable improvement in symptoms, and probably no increased adverse events compared to placebo after three to 12 months treatment. Mean pain with placebo was 40.5 points on a VAS 0 to 100 scale (0 is no pain), ASU 300 mg reduced pain by a mean of 8.5 points (95% CI 1 to 16 points); NNTB 8. ASU 300 mg improved function (standardised mean difference (SMD) ‐0.42, 95% CI ‐0.73 to ‐0.11). Function was estimated as 47 mm (0 to 100 mm scale, where 0 is no loss of function) with placebo, ASU 300 mg improved function by a mean of 7 mm (95% CI 2 to 12 mm); NNTB 5 (3 to 19). There were no differences in adverse events (5 studies, 1050 participants) between ASU (53%) and placebo (51%) (RR 1.04, 95% CI 0.97 to 1.12); withdrawals due to adverse events (1 study, 398 participants) between ASU (17%) and placebo (15%) (RR 1.14, 95% CI 0.73 to 1.80); or serious adverse events (1 study, 398 participants) between ASU (40%) and placebo (33%) (RR 1.22, 95% CI 0.94 to 1.59). Radiographic joint changes, measured as change in joint space width (JSW) in two studies (453 participants) did not differ between ASU 300 mg treatment (‐0.53 mm) and placebo (‐0.65 mm); mean difference of ‐0.12 (95% CI ‐0.43 to 0.19). Moderate‐quality evidence from a single study (156 participants) confirmed possible benefits of ASU 600 mg over placebo, with no increased adverse events. Low‐quality evidence (1 study, 357 participants) indicated there may be no differences in symptoms or adverse events between ASU 300 mg and chondroitin sulphate. Quality of life was not measured. All other herbal interventions were investigated in single studies, limiting conclusions. No serious side effects related to any plant product were reported. Authors' conclusions Evidence for the proprietary ASU product Piasclidine® in the treatment of osteoarthritis symptoms seems moderate for short term use, but studies over a longer term and against an apparently active control are less convincing. Several other medicinal plant products, including extracts of Boswellia serrata, have moderate‐quality evidence for trends of benefits that warrant further investigation in light of the fact that the risk of adverse events appear low. There is no evidence that Piasclidine® significantly improves joint structure, and limited evidence that it prevents joint space narrowing. Structural changes were not tested for with any other herbal intervention. Further investigations are required to determine optimum daily doses producing clinical benefits without adverse events

An ashy septingentenarian: the Kaharoa tephra turns 700 (with notes on its volcanological, archaeological, and historical importance)

Most of us are aware of the basaltic Tarawera eruption on 10th June 1886: the high toll on life (~120 people), landscape devastation, and loss of the Pink and White Terraces. But this was not the first time that Mt Tarawera produced an eruption of importance both to volcanology and human history. This edition of the GSNZ Newsletter marks the 700th anniversary of the Kaharoa eruption – its septingentenary to be precise – which occurred at Mt Tarawera in the winter of 1314 AD (± 12 years) (Hogg et al. 2003) (Fig. 1). The importance of the Kaharoa eruption is at least threefold. (1) It is the most recent rhyolite eruption in New Zealand, and the largest New Zealand eruption volumetrically of the last millennium. (2) The Kaharoa tephra is an important marker horizon in late Holocene stratigraphy and geoarchaeology (Lowe et al. 1998, 2000), and in particular helps to constrain the timing of settlement of early Polynesians in North Island (Newnham et al. 1998; Hogg et al. 2003; Lowe 2011). (3) There is a link between the soils that developed on the Kaharoa tephra, the animal ‘wasting’ disease known as ‘bush sickness’, and the birth of a government soil survey group as an independent organisation (Tonkin 2012)

Last resting place and legacy of Charles Heaphy, VC

Charles Heaphy is now recognised as a significant figure in the early European settlement of New Zealand and he also has an interesting geological connection that deserves wider recognition. Heaphy arrived in New Zealand on the Tory together with Ern(e)st Dieffenbach on 18th August, 1839, aged around 19. Employed then by Wakefield's New Zealand Company as a draughtsman, Heaphy was described by Sharp (2008. p. 25) as being a "general roustabout, explorer, surveyor, assistant naturalist, courier and verbal as well as visual propagandist". He went on to become best known as an excellent watercolour landscape artist (his early work showing "sensitivity to the clarity of the New Zealand light") (Sharp, 2008, p. 205), an explorer and surveyor, a parliamentarian, and for winning the Victoria Cross for his actions in the New Zealand (Maori land) wars

Freedom of information and ‘vexatious’ requests — The case of Scottish local government

This paper investigates the cost and incidence of Freedom of Information (FOI) requests within local authorities in Scotland and in particular, the cost and incidence of requests which have been defined as ‘vexatious’ in order to investigate if the negative perceptions surrounding the cost and misuse of the legislation are justified. Additionally, the criteria and guidelines that local authorities are using to define ‘vexatious’ are also examined. The approach taken to the research in this study is a survey of the 32 local authorities in Scotland using freedom of information requests as the data collection method. The findings from the survey revealed that none of the local authorities were keeping records of costs relating to FOI requests. However, 80% were keeping records of numbers of requests. One third of authorities that kept records of ‘vexatious’ requests had experienced such a request. However, the actual number of ‘vexatious’ requests received were extremely low. The findings highlight the difficulties in recording cost data and the general lack of record keeping within organisations. The findings also indicate a very low incidence of ‘vexatious’ requests and suggest that the ‘vexatious’ definition may be applied inappropriately by public authorities

The LSE identity project. House of Lords : All party briefing : "Nothing to hide, nothing to fear”

The original amendment on cost information, put forward in the House of Lords, sought to address a widely held concern about the government’s unwillingness to be open about the likely costs associated with implementing the identity cards scheme. These concerns are shared by some in the Lords, industry and by the LSE, whose initial alternative costings fuelled the concerns of the Lords over the limited information made available to them. The proposed amendment for the House of Commons does not seek to address this underlying issue and, indeed, the provisions of clause 4, are likely to repeat the same, unnecessary secrecy that the Lords were seeking to explore

Seeking out non-public information : sell-side analysts and the freedom of information act

A number of sell-side healthcare analysts gain access to information outside the purview of management through Freedom of Information Act requests to the Food and Drug Administration for records on factory inspections, complaints, and drug and medical device applications. Using a difference-in-differences methodology, we find that buy (sell) recommendations and upgrades (downgrades) earn higher (lower) stock returns over the year following the receipt of FDA records. We also examine the type of information revealed in FDA factory inspection reports, and find that analysts are less likely to downgrade and are less pessimistic in their recommendations than the consensus recommendation when the information contained in the FDA report is not particularly severe. Our findings are consistent with a subset of analysts utilizing non-public information channels independent of management to gain value-relevant information about their covered firms

Meeting the information challenge: exploring partnerships with Africa

Africa suffers from the disadvantages of marginality within the global technical system and a legacy of externally driven infrastructure. Developments in information and communication technologies now offer the chance to redress these but the technologies require skills and capacities which are scarce. The technologies themselves can be used to leverage existing resources so that the necessary skills can be developed. However this process needs to take account of African priorities and requirements if the current inequitable situation is not to be reproduced in a new global infrastructure. The key to this is a balance between external partnership and internal collaboration. The African diaspora offers a means of moderating such relationships