Arnica Gel Widrig R, Suter A, Saller R, Melzer J. Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomized, double-blind study. Rheumatol Int. 2007; 27:585-591.doi;10:1007/ s00296-007-0304-y

Study Summary What can we learn from this study?

Arnica is usually associated with bruising, but has a traditional use to treat muscle and joint pain

Arnica gel is effective in reducing the symptoms of osteoarthritis in the hand This study is the first to show that pain relief obtained from arnica gel is

comparable with that of ibuprofen gel 5%

Background Osteoarthritis is a common condition and can affect a number of joints, including the

hips, knees and fingers. Current treatment involves use of oral analgesic medication

(usually non-steroidal anti-inflammatories [NSAIDs]) which have well-described side effects including irritation of the stomach lining and stomach ulcers.

The use of topical NSAIDs reduces the side effects of oral medication, but

nevertheless, those affected by osteoarthritis often seek natural treatment in an

attempt to avoid the use of NSAIDs. Over the years, many natural treatments have been used to relieve pain and other symptoms of osteoarthritis. One of these is

arnica extract.

Arnica is usually associated with treatment of bruising, especially as a homoeopathic

medicament. However, there is a tradition of using the herb to relieve pain, but few studies have been done to confirm this historic use by herbalists.

In vitro (in the test tube), arnica extracts have been shown to act as an anti-

inflammatory agent by inhibiting a substance known as NF-κβ.(1) An open study has shown that Arnica gel relieves pain in those suffering from osteoarthritis of the

knee.(2) In addition, tests have shown that the active substances in arnica extract

(sesquiterpene lactones) are able to penetrate the skin.(3)

Study objective To assess the efficacy and tolerability of arnica gel compared to ibuprofen gel 5% in

the treatment of osteoarthritis of the fingers.

Study design This multi-center controlled study was conducted to GCP (Good Clinical Practice)

guidelines. A total of 204 patients with osteoarthritis of the fingers were recruited from

20 clinics in Switzerland. Diagnosis of their condition was confirmed using established and accepted criteria according to the Osteoarthritis Research Society

International (OARSI) guidelines.

Patients were randomised into two treatment groups (ibuprofen and arnica) and

instructed to apply a 4 cm strip of gel over affected joints three times daily for 3 weeks.

Patients were also given a number of paracetamol tablets as ‘rescue medication’ – in

the event that they needed extra pain relief.

Assessment of symptoms was carried out using a number of methods including:

Marking pain scores on a Visual Analogue Scale (VAS) Assessing the ability to use their hands with a validated questionnaire

Results During the 12 week treatment period, pain intensity and function in the hands

improved in a similar level in both treatment groups. In addition, although not statistically significant, the results appear to show that arnica gel performed slightly

better than ibuprofen gel. The researchers were able to conclude that the fresh extract of arnica gel was as effective as ibuprofen gel 5% in the treatment of

osteoarthritis of the fingers.

References 1. Lyss G, Schmidt TJ, Merfort I, et al. Helenalin, an anti-inflammatory sesquiterpene lactone from Arnica, selectively inhibits transcription factor NF-KappaB. Biol Chem. 1997;378:951-961. 2. Knuessel O, Weber M, Siuter A. Arnica monotana gel in osteoarthritis of the knee: an open, multicentre clinical trial. Adv Ther. 2002;19:209-218. 3. Wagner S, Suter A, Merfort I. Skin penetration studies of Arnica preparations and of their sesquiterpene lactones. Planta Med. 2004; 70;897-903.