OsteoLuban a Novel Natural Remedy for Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone [1]. OA is sometimes called degenerative joint disease or degenerative arthritis. OA is the most common chronic condition of the joints, progressive and debilitating. It can affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe. It affects millions of people worldwide [2]. In normal joints, cartilage covers and protects the ending part of the bones, promoting friction and absorbing impacts. The progressive joint destruction leads to lameness, pain, mobility limitations and comprises the overall quality of life [2]. The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips [3]. Joints on one side of the body are often more affected than those on the other [2]. Causes of OA include previous joint injury, abnormal joint or limb development, and inherited factors [3,4]. Risk is greater in those who are overweight, have legs of different lengths, or have jobs that result in high levels of joint stress [3-5]. OA is believed to be caused by mechanical stress on the joint and low-grade inflammatory processes [7]. It develops as cartilage is lost and the underlying bone becomes affected [3] as pain may make it difficult to exercise, muscle loss may occur [3,6]. Worldwide estimation reported over 100 million people globally suffer from OA, which is one of the most common causes of disability [6,7]. As per the WHO report on disability (2011), the prevalence of moderate and severe disability (in millions) due to OA in high-income countries was 1.9 and 8.1 in the age group of 0–59 and above 60 years, respectively. In the lowand middle-income countries, these figures were 14.1 and 19.4 [8]. The worldwide prevalence estimate for symptomatic OA is 9.6% among men and almost double (18%) among women [9].


Introduction
Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone [1]. OA is sometimes called degenerative joint disease or degenerative arthritis. OA is the most common chronic condition of the joints, progressive and debilitating. It can affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe. It affects millions of people worldwide [2]. In normal joints, cartilage covers and protects the ending part of the bones, promoting friction and absorbing impacts.
The progressive joint destruction leads to lameness, pain, mobility limitations and comprises the overall quality of life [2]. The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips [3]. Joints on one side of the body are often more affected than those on the other [2]. Causes of OA include previous joint injury, abnormal joint or limb development, and inherited factors [3,4]. Risk is greater in those who are overweight, have legs of different lengths, or have jobs that result in high levels of joint stress [3][4][5]. OA is believed to be caused by mechanical stress on the joint and low-grade inflammatory processes [7]. It develops as cartilage is lost and the underlying bone becomes affected [3] as pain may make it difficult to exercise, muscle loss may occur [3,6]. Worldwide estimation reported over 100 million people globally suffer from OA, which is one of the most common causes of disability [6,7]. As per the WHO report on disability (2011), the prevalence of moderate and severe disability (in millions) due to OA in high-income countries was 1.9 and 8.1 in the age group of 0-59 and above 60 years, respectively. In the low-and middle-income countries, these figures were 14.1 and 19.4 [8]. The worldwide prevalence estimate for symptomatic OA is 9.6% among men and almost double (18%) among women [9].
Among the factors that can increase your risk of osteoarthritis include:

Abstract
Osteoarthritis (OA) is the most common type of arthritis. It is also known as degenerative arthritis or degenerative joint disease or "wear and tear" arthritis. It occurs when the cartilage or cushion between joints breaks down leading to pain, stiffness and swelling. The most common symptoms of osteoarthritis are stiffness, particularly first thing in the morning or after resting, and pain. Affected joints may get swollen after extended activity. OA is the major cause of disability in both the developed and developing countries. The worldwide estimate for symptomatic OA is 9.6% among men and 18% among women. In USA only OA affects approximately 27 million people. Osteoarthritis has no specific cause, however, there are several factors lead to the development of OA including excess weight, injury or overuse and genes, among others. As far as treatment of OA is concerned, this disease cannot be reversed, but treatment can reduce primary pain. There are several options that can help reduce pain and helps patients move better. It includes using oral non-steroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen, Nabumetone and naproxen. It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects. Further, topical diclofenac topical gel (voltaren) is used to relieve osteoarthritis pain in the knees. It works by stopping the body's production of a substance that causes pain. Among other conventional treatment of OA is surgery, joint injection of glucocorticoids and hyaluronic acid. On the other hand, there are several non-conventional treatments used for treating OA including glucosamine and chondroitin sulfate, curcumin, Boswellia serrata extract and others. In addition, acupuncture, electrostimulation and electromagnetic field and others are also used. We describe in this paper a new oral herbal remedy oral that consists of three monographic herbs with potent anti -inflammatory and analgesic properties that make it a promising treatment for osteoarthritis.

1.
Older age. The risk of osteoarthritis increases with age.

2.
Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.

3.
Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight adds stress to weightbearing joints, such as your hips and knees. Also, fat tissue produces proteins that can cause harmful inflammation in and around your joints.
4. Joint injuries. Injuries, such as those that occur when playing sports or from an accident, can increase the risk of osteoarthritis. Even injuries that occurred many years ago and seemingly healed can increase your risk of osteoarthritis.

5.
Repeated stress on the joint. If your job or a sport you play places repetitive stress on a joint, that joint might eventually develop osteoarthritis.

6.
Genetics. Some people inherit a tendency to develop osteoarthritis.

7.
Bone deformities. Some people are born with malformed joints or defective cartilage.

8.
Certain metabolic diseases. These include diabetes and a condition in which your body has too much iron (hemochromatosis).
Diagnosis is made with reasonable certainty based on history and clinical examination [10,11]. X-rays may confirm the diagnosis.
The typical changes seen on X-ray include: joint space narrowing, subchondral sclerosis (increased bone formation around the joint), subchondral cyst formation, and osteophytes [12]. Usually other imaging techniques are not necessary to clinically diagnose osteoarthritis. In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissue enlargement and swelling of certain joints [13]. These criteria were found to be 92% sensitive and 98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis and spondyloarthropathies [13]. On the other hand, analyzing blood or joint fluid can help confirm the diagnosis. Concerning treatment of OA, there are several options that can be categorized as follows:

By mouth
The first line of treatment for OA by mouth is pain medication which is a NSAIDs drug represented by paracetamol (acetaminophen) [14,15]. Pain relief does not differ according to dosage [16]. For mild to moderate symptoms effectiveness of acetaminophen NSAIDs such as naproxen, though for more severe symptoms NSAIDs may be more effective [14]. NSAIDs are associated with greater side effects such as gastrointestinal bleeding [14]. Another class of NSAIDs, COX-2 selective inhibitors (such as celecoxib) are equally effective when compared to nonselective NSAIDs [17]. Opioids by mouth, including both weak opioids such as tramadol and stronger opioids, are also often prescribed. Oral steroids are not recommended in the treatment of osteoarthritis [15].

Topical
There are several NSAIDs available for topical use, including diclofenac the use of topical capsaicin to treat osteoarthritis is controversial, as some reviews found benefit [18,19] while others did not [20].

Joint injections
Joint injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months [21]. Injections of hyaluronic acid have not produced improvement compared to placebo for knee arthritis [22,23].

Surgery
Includes joint replacement surgery or resurfacing.

Glucosamine and chondroitin
The effectiveness of glucosamine is controversial [24]. Reviews have found it to be equal to [25,26] or slightly better than placebo [27,28]. A 2015 Cochrane review of clinical trials of chondroitin found that most were of low quality, but that there was some evidence of short-term improvement in pain and few side effects; it does not appear to improve or maintain the health of affected joints [29].

Other remedies
Avocado-soybean unsaponifiables (ASU) is an extract made from avocado oil and soybean oil [30] that is sold under many brand names worldwide as a dietary supplement [31] and as a drug in France. A few high-quality studies of Boswellia serrata show consistent, but small, improvements in pain and function [30]. Curcumin [32], phytodolor [18], and s-adenosyl methionine (SAMe) [18], may be effective in improving pain.
On the other hand, there is little evidence supporting benefits for some supplements, including:

Willow bark
There is insufficient evidence to make a recommendation about the safety and efficacy of these treatments [18,33].

Acupuncture and other interventions
While acupuncture leads to improvements in pain relief, this improvement is small and may be of questionable importance [34].
Waiting list-controlled trials for peripheral joint osteoarthritis do show clinically relevant benefits, but these may be due to placebo effects [35,36]. Acupuncture does not seem to produce long-term For in vivo studies, the activity of the product was studied in albino rats using two different pharmacological screening tests,

Healing Paradigm
The healing paradigm of OsteoLuban as shown below (Figure1&2), is that its uses encourage a person to maintain a healthy joint by using natural supplement.

Properties of OsteoLuban
OsteoLuban is a unique natural health product composed of an extract obtained from Boswellia sacra gum resin using special extraction procedure [38] and was characterized using HPLC/ MS/MS [39]. The pharmacological action of this extract showed potential anti-inflammatory and analgesic effects when compared with standard drugs used in clinics. Further, it contains willow bark with salicin which hydrolyzed in the gastrointestinal tract to give salicyl alcohol and D-glucose which upon absorption, salicyl alcohol oxidized into salicylic acid (Aspirin) and other compounds. Finally, it contains ginger which helps in pain relief from both osteoarthritis and rheumatoid arthritis, migraine headache and prevent nausea.
Therefore, the medicinal ingredients in OsteoLuban work in an effective and synergistic way to support each of the claims, which on the other hand, support the healing paradigm.

Side effects
No serious side effects were reported from using this product.
Some more than 25% patients using this product experienced minor to moderate stomach pain.

Contraindications
OsteoLuban is contraindicated in patients with stomach ulcers, kidney disease and hypothrombinemia. Also, it is contraindicated to patient sensitive to aspirin and willow bark. Not to be used during pregnancy.

Direction for use
Three capsules daily in three dividing doses with meals.