**1. Introduction**

Osteoarthritis (OA) is a progressive degenerative joint disease that has a major impact on joint function and quality of life. OA is a painful condition caused by a gradual loss of cartilage from the joints and, in some people, joint inflammation [1]. Pain, stiffness, and difficulty moving the joint easily are common symptoms of OA. Non-drug treatments for osteoarthritis have gained popularity according to the American College of Rheumatology (ACR) [2] and can often reduce the symptoms. Therefore, there is a significant need to improve current osteoarthritis therapies and to search for novel therapies. Nutraceuticals and dietary supplements derived from herbs have long been used in traditional medicine. Though they aren't recognized as drugs, herbal and natural remedies are used for a drug-like effect, and they can potentially cause the same reactions and complications prescription drugs can cause. There is considerable evidence that nutraceuticals may play an important role in inflammation and joint destruction in OA. The World Health Organization (WHO) [3] has taken an interest in the indigenous system of medicine; particularly, plant remedies. Ginger is widely used as a spice, an antiemetic and carminative agent, and for its essential oils. Gingerols, in particular 6-gingerol, are the active components of ginger. Proposed mechanisms include direct stimulation of the gastrointestinal tract, or serotonin antagonism in the gut or central nervous system [4, 5]. A study on 6-gingerol was shown to significantly inhibit the production of nitric oxide, a highly reactive nitrogen molecule that quickly forms a very damaging free radical called peroxynitrite and greatly lessened depletion of glutathione [6]. Other reports suggest that ginger produces its

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anti-inflammatory effect by inhibiting arachidonic acid metabolism [4, 7], induce apoptosis in HL-60 leukemia [8], non-small cell lung cancer cells [9] and against acute monocytic leukemia [10]. It is also reported to be chemopreventive and anti-inflammatory [11, 12]. The antioxidant, antimicrobial and cytotoxic activities of Zingiber officinale displayed specific inhibition on Escherichia coli was also studied [13]. Gingerols also promoted significant reduction in mRNA transcription of TNF-α, IL-2 and INF-γ [14]. Ginsenoside Rg5 (Rg5), an abundant natural compound in Panax ginseng, has been found to be beneficial in treating AD [15]. Pharmaco‐ logic studies in the last decades have shown that ginsenosides (ginseng saponins) are primarily responsible for the actions of ginseng [16]. In diabetes ginger supplementation in oral admin‐ istration reduced inflammation in type 2 diabetic patients [17]. Other studies have shown that ginger may benefits musculoskeletal disorder treatment [18] nausea and vomiting [19], inflammation or inflammatory states [20, 21] such as osteoarthritis [20-22], migraine [23], cancer [24], hyperlipidemia and hyperglycemia [25, 26]. In vitro studies suggest that ginger produces its anti-inflammatory effect by inhibiting arachidonic acid metabolism4 , 7 . This chapter intends to give a brief outline of ginger health benefit and to investigate the ability of ginger tablets to reduce postoperative pain in patients with osteoarthritis.

rapidly progressive interstitial renal fibrosis after taking Chinese herbs prescribed by a

Pharmacological and Clinical Effectiveness of *Zingiber officinale* and *Alpinia galanga* in Patients with Osteoarthritis

http://dx.doi.org/10.5772/58417

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Fourthly patients with OA of the knee and moderate-to-severe pain were enrolled in a randomised, double –blind, placebo-controlled, two-center, parallel group, 12-week study. The primary efficacy variable was the proportion of responders experiencing a reduction in

The study was approved by the ethics committee of the Latvian Institute of Cardiology for clinical and physiological research, drug and pharmaceutics product clinical investigation.

Only those willing to participate and after getting their informed consent will be involved in

Elderly patients with clinical diagnosis of osteoarthritis (OA) of the knee, defined as knee (articular and not periarticular or referred) pain for most days of the prior month and radio‐ graphic osteophytes at the tibiofemoral joint margins were involved in the study. All involved patients had a baseline pain score > 40 mm and < 90 mm on a 100-mm Visual Analogue Scale (VAS) at the time of randomization, when evaluating pain on standing during the last 24 hours.

**•** No NSAID's or other medication before intervention start-or consider including one week

slimming clinic

**2.1. Method**

the investigation

**2.2. Subjects**

**2. Method and subjects**

"knee pain on standing" using a visual analog scale.

Both men and women were included.

Exclusion Characteristics

wash-out period.

**•** History of allergy to ginger;

**•** History of rheumatoid disease;

**•** Treatment with intra-articular corticosteroids;

**•** History of asthma, if the patient needs treatment with steroids;

**•** Other investigational drugs within one month prior to screening;

**•** History or clinical signs of impaired kidney function;

**•** Treatment with oral corticosteroids within four weeks prior to screening;

**•** Treatment with intra-articular hyaluronic acid within 6 months prior screening;

**•** Prior treatment with immuno-suppressive drugs, cytostatic drugs, gold or peniciilamine;

#### **1.1. History**

The earliest evidence of humans' use of plants for healing dates back to the Neanderthal period [27]. In the 16th century, botanical gardens were created to grow medicinal plants for medical schools [28]. Herbal medicine practice flourished until the 17th century when more "scientific" pharmacological remedies were favoured [29]. The use of plants for healing purposes predates human history and forms the origin of much modern medicine. Many conventional drugs originate from plant sources: a century ago, most of the few effective drugs were plant based. Examples include aspirin (from willow bark), digoxin (from foxglove), quinine (from cinchona bark), and morphine (from the opium poppy). The development of drugs from plants contin‐ ues, with drug companies engaged in large scale pharmacological screening of herbs.

#### **1.2. Therapeutic scope**

Although herbal preparations are widely used as self-medication for acute conditions, practitioners of herbal medicine tend to concentrate on treating chronic conditions. A typical caseload might include asthma, eczema, premenstrual syndrome, rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue, irritable bowel syndrome and lately to treat mental or musculoskeletal disorders.

#### **1.3. Safety**

Many plants are highly toxic. Herbal medicine probably presents a greater risk of adverse effects and interactions than any other complementary therapy. There are case reports of serious adverse events after administration of herbal products. In most cases the herbs involved were self-prescribed and bought over the counter or obtained from a source other than a registered practitioner. In the most notorious instance, several women developed rapidly progressive interstitial renal fibrosis after taking Chinese herbs prescribed by a slimming clinic
