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Humira

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* Black cumin (Nigella sativa)

* Black cumin (Nigella sativa). Constituents in the oil and seeds - in particular, thymoquinine (TQ) - have shown potent anti-inflammatory effects in conditions such as arthritis (Int Immunopharmacol, 2005; 5: 1749-70).

Suggested dosage: 1 tsp/day of black cumin seed oil with meals.

* Omega-3 fatty acids. A review of the literature (randomised con-trolled trials) has shown that dietary supplementation with omega-3s such as fish oils brings "modest symptomatic benefit" to rheumatoid arthritis patients (Semin Arthritis Rheum, 2005; 35: 77-94).

Suggested dosage: at least 3 g/ day of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA).

* Meta050. In an eight-week, open-label, observational trial, this standardised combination of reduced iso-alpha-acids from hops, rosemary extract and oleanolic acid significantly relieved pain (by 40-50 per cent) in patients with arthritis (Phytother Res, 2005; 19: 864-9).

Suggested dosage: the trial used 440 mg of Meta050 three times a day for four weeks, followed by 880 mg twice a day for a further four weeks.

* Ginger (Zingiber officinale). This traditional herbal remedy has properties similar to those of non-steroidal anti-inflammatory drugs (NSAIDs), including interfering with the pathway that leads to chronic inflammation (J Med Food, 2005; 8: 125-32).

Suggested dosage: 2-4 g/day of fresh ginger juice, extract or tea. You can also rub ginger oil directly onto a painful joint, or make a warm poultice or compress of fresh ginger root and apply it to any painful areas.

* Devil's claw (Harpagophytum procumbens, H. radix). Although the scientific evidence is mixed, a review including five randomised controlled trials showed that H. procumbens as a powder (containing 60 mg of the harpagoside) was moderately effective in relieving osteoarthritis of the spine, hip and knee (BMC Complement Alt Med, 2004; 4: 13).

Suggested dosage: 750 mg with at least 3 per cent harpagoside three times a day (or the equiva-lent of 9 g of crude plant material over at least two to three months).

* Spa therapy (balneotherapy). Bathing in mineral waters such as the Dead Sea or in thermal waters at temperatures of about 34o C can significantly relieve arthritis pain (Isr Med Assoc J, 2001; 3: 147-50).

* Chinese herbal medicine. Lei gong teng (thunder god vine or 'three-wing nut'; Tripterygium wilfordii Hook) works against rheumatoid arthritis by inhibiting proinflammatory agents such as tumour necrosis factor (TNF)-alpha and cyclooxygenase (COX)-2 (Semin Arthritis Rheum, 2005; 34: 773-84).

Suggested dosage: 180-360 mg/day.


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