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Rheumatology 2002; 41: 1333
© 2002 British Society for Rheumatology

Letters to the Editor

Reply

E. Ernst

Department of Complementary Medicine, School of Sport and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK

SIR, The study by Chantre et al. [1] was not considered in our review [2] because it was published just after the closing date of our literature searches. This study [1] suggested equivalence between 4 months of treatment of a devil's claw extract and diacerhein. These results are most encouraging but there is a suspicion that, in this particular setting, both treatments may have been equally ineffective or devoid of effects beyond a placebo response (rather than equally effective). Moreover, I would like to see an independent replication of this trial before I fully accept its results. Collectively the data on devil's claw are, as Chrubasik and colleagues point out, promising indeed. We recently tried to weigh its risk and benefits and concluded that devil's claw ‘can be tried in selected cases but the risk of herb/drug interactions must be considered’ [3]. Interactions have been described with anticoagulants and are a theoretical possibility with cardiac drugs [3]. Thus, Chrubasik et al. are right: more work needs to be done.

References

  1. Long L, Soeken K, Ernst E. Herbal medicines for the treatment of osteoarthritis: a systematic review. Rheumatology2001;20:770–93.
  2. Chantre P, Cappelaere A, Leblan D, Guedon D, Vandermander J, Fournie B. Efficacy and tolerability of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine2000;7:177–83.[ISI][Medline]
  3. Ernst E, Pittler MH, Stevinson C, White AR, Eisenberg D. The desktop guide to complementary and alternative medicine. Edinburgh: Mosby,2001.
Accepted 13 May 2002


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