1. Introduction: The Growing Burden of Arthritis in Nigeria
Arthritis, particularly rheumatoid arthritis (RA), represents a significant and often under-recognised health challenge in Nigeria. RA is a systemic autoimmune disorder characterised by painful joint inflammation that orchestrates destructive bone erosion, produced by several innate and adaptive immune cells, including macrophages, neutrophils, mast cells, monocytes, dendritic cells, B cells, and T cells. The global incidence of RA is approximately 3 cases per 10,000, with a prevalence rate of 1.1%. This condition is common among individuals aged 70 years and above, with women having about twice the risk of developing RA compared to men.
In Nigeria, the prevalence of RA in adults above 65 years living in rural areas ranges from 0.40% to a maximum of 82.7%. The disparity in these figures may stem from the widespread use of complementary and alternative medical approaches and the lack of evidence-based research to properly elucidate the ethnomedicinal benefits of plant resources in Nigeria.
The current pharmacological management of inflammatory diseases primarily relies on non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. While these agents effectively suppress symptoms by targeting specific enzymatic pathways, their long-term use is plagued by significant side effects including gastrointestinal ulcers, cardiovascular events, bone mineral density loss, and hyperglycemia. More advanced treatments like disease-modifying therapies (DMTs) and biologics are often prohibitively expensive and may not be effective for all patients.
The escalating prevalence of chronic inflammatory conditions, coupled with these significant limitations, underscores an urgent need for safer, economically viable anti-inflammatory alternatives—a space where Nigerian traditional herbal medicine holds significant promise. Natural products have historically served as a rich source of therapeutic agents, with a substantial portion of the world’s population still relying on traditional herbal medicine for primary healthcare. This review synthesises available literature on Nigerian medicinal plants utilised for arthritis management, their modes of administration, scientific evidence supporting their use, and the broader context of holistic and complementary approaches.
2. Ethnobotanical Surveys: Documenting Nigeria’s Anti-Arthritic Flora
2.1 Northern Nigeria Survey
A comprehensive survey of traditional medicine practitioners in North-West Nigeria documented ethnobotanical information on plant species used to manage arthritis and rheumatological conditions. The study involved 150 traditional medicine practitioners across 24 local government areas in Kaduna, Kano, Jigawa, and Katsina states. A detailed literature review revealed that 85% of the identified plant species were pharmacologically active, and approximately 66% had similar ethnomedical applications in several other African states.
Generation after generation passed down knowledge about the utilisation of these herbs primarily verbally, and poor documentation could lead to the loss of traditional medical resources and expertise, jeopardising the long-term sustainability of rural healthcare systems.
2.2 Kwara State Survey
A survey in Moro Local Government Area, Kwara State, documented medicinal plants used for inflammatory conditions including rheumatism and arthritis . The study, conducted across six villages (Oloru, Elemere, Gbugudu, Asomu, Malete, and Oloko Tuntun), involved 66 respondents and documented:
| Parameter | Finding |
| Total recipes for rheumatism | 38 |
| Total recipes for arthritis | 24 |
| Total plant species identified | 59 species from 40 families |
| Most represented families | Fabaceae, Anacardiaceae, Apocynaceae |
| Most utilised plant parts | Leaves, roots, and stem barks |
2.3 Gusau, Zamfara State Survey
A survey in Gusau, Zamfara State, documented 12 plant species used for rheumatoid arthritis treatment:
| Plant Name | Common Name | Plant Part Used |
| Allium sativum | Garlic | Bulb |
| Curcuma longa | Turmeric | Rhizome |
| Xylopia aethiopica | African pepper | Fruit |
| Zingiber officinale | Ginger | Rhizome |
| Telfairia occidentalis | Fluted pumpkin | Leaves |
| Moringa oleifera | Moringa | Leaves |
| Eleusine indica | Goosegrass | Various |
| Vernonia amygdalina | Bitter leaf | Leaves |
| Momordica charantia | Bitter melon | Fruit |
| Persea americana | Avocado | Leaves |
| Vitellaria paradoxa | Shea butter | Various |
| Nigella sativa | Black seed | Seed |
The survey documented various preparation methods including grinding, decoction, infusion, herbal mixtures, and blending, with roots, leaves, bulbs, fruits, and stems being the primary plant parts used.
3. Scientifically Validated Nigerian Anti-Arthritic Plants
3.1 Bombax buonopozense: Superior to Conventional Treatment
Bombax buonopozense leaves have been used traditionally for arthritis in southwestern Nigeria. A comprehensive study investigated the antioxidant and anti-arthritic activity of B. buonopozense in Complete Freund’s Adjuvant (CFA)-induced arthritic Wistar rats.
Key Findings:
| Parameter | Result |
| Phytochemicals detected | Flavonoids, alkaloids, phenolics, tannins, saponins, steroids |
| Total phenolic content (BBME) | 19.8 ± 0.56 mg GAE/g |
| Total flavonoid content (ethyl acetate fraction) | 173.5 ± 0.05 mg QE/g |
| Antioxidant activity (ethyl acetate fraction) | IC₅₀ = 20.96 ± 0.23 μg/mL |
| Anti-arthritic effect | BBME (400 mg/kg) prevented biochemical changes to a greater extent than Celecoxib (20 mg/kg) |
The crude methanol extract (BBME) significantly reduced paw circumference in arthritic rats, and the study concluded that “Bombax buonopozense leaves could be an effective antiarthritic and holds prospect in the treatment of rheumatoid arthritis” .
3.2 Terminalia superba: Ethno-pharmacological Validation
Terminalia superba is used in Nigerian traditional medicine, particularly in Igbo-speaking communities of southeastern Nigeria, to treat swelling, pain, and inflammation. A comprehensive study evaluated the anti-inflammatory potential of its crude methanol extract and solvent fractions using both in vitro and in vivo models.
Key Findings:
| Parameter | Result |
| Phytochemical profile | Enrichment of nonpolar bioactives in n-hexane fraction; flavonoids dominant in butanol fraction |
| In vitro: hemolysis inhibition (HFTs, 400 μg/mL) | 44.8% under hypotonic stress; 50.6% under heat-induced stress |
| In vitro: albumin denaturation inhibition | 64.9% |
| In vivo: paw oedema reduction (400 mg/kg) | Significant reduction similar to piroxicam |
| In vivo: leukocyte migration inhibition | 50% suppression with HFTs |
The study “validates the ethnopharmacological use of T. superba, particularly its n-hexane-rich fraction (HFTs), as a potent anti-inflammatory agent with consistent effects in mechanistic and animal models”. Advanced multivariate analyses, including hierarchical clustering and principal component analysis, distinctly separated high-dose extracts and fractions from others, confirming their robust anti-inflammatory efficacy.
3.3 Alchornea cordifolia: Scientific Validation of Folkloric Use
Alchornea cordifolia leaves are used by Yoruba herbalists in southwestern Nigeria for the local treatment of ulcers, rheumatic pains, febrile convulsions, and for enhancing physical performance. A study investigated the anti-arthritic effect of its hydroethanolic leaf extract (HEAC) in CFA-induced arthritic rats.
Key Findings:
| Parameter | Result |
| Most effective dose | 100 mg/kg/day produced most significant anti-arthritic effect |
| Reduction in paw oedema | Significant (p < 0.001, p < 0.05, p < 0.01) |
| Antioxidant mechanism | Increased hepatic GSH levels, CAT and SOD activities |
The study concluded that the results “lend credence to the folkloric use of water decoction of Alchornea cordifolia leaves against rheumatoid arthritis”.
3.4 Triumfetta cordifolia: Flavonoid-Rich Anti-Inflammatory Agent
Triumfetta cordifolia is used in traditional medicine to treat inflammation in Bayelsa State, Nigeria. The methanol extract was tested for anti-inflammatory properties using a formalin-induced paw oedema model in rats.
Key Findings:
| Parameter | Result |
| Percentage inhibition (100 and 250 mg/kg) | 13.58% |
| Percentage inhibition (standard aspirin) | 10.69% |
| Major flavonoid compounds identified | Kaempferol, quercitrin, (+)-catechin, luteolin, quercetin, myricetin, hesperidin, narigin, apigenin, rutin |
The study concluded that “the high content of flavonoids may be responsible for the anti-inflammatory activities exhibited by the methanol extract of T. cordifolia” .
3.5 Lasimorpha senegalensis: Superior to Ibuprofen
The leaf of Lasimorpha senegalensis is widely used as a traditional remedy for swellings, oedema, pain, tumours, and other inflammatory problems in southeastern Nigeria.
Key Findings:
| Parameter | Result |
| Paw oedema reduction | Up to 80%, with better activity than ibuprofen |
| Granuloma tissue inhibition | Up to 70% in a dose-dependent manner |
| Active compounds identified (GC-MS) | Terpene-4-ol, palmitoleic acid, n-hexadecanoic acid, octadecanoic acid, 22-stigmasten-3-one |
The study “justifies the local use of the leaf of L. senegalensis in the treatment of inflammatory conditions”.
3.6 Historic Documented Anti-Arthritic Plants
A foundational study from a survey of anti-arthritic remedies used in Igbo tribal ethnomedicine identified three plants that were selected for closer study:
| Plant | Traditional Use |
| Lonchocarpus cyanescens | Anti-arthritic remedy |
| Costus afar | Anti-arthritic remedy |
| Terminalia ivorensis | Anti-arthritic remedy |
Key Findings:
- Twenty-five volunteers were monitored while receiving treatment from two reputable herbalists
- The clinical investigation prompted pharmacological and phytochemical studies
- Differential solvent extracts of the herbs reduced carrageenin-induced oedema of the rat paw, checked diarrhoea due to arachidonic acid and castor oil, and ameliorated all signs associated with adjuvant-induced polyarthritis in rats
3.7 Scoparia dulcis: Bioactive Phytochemical Support
Scoparia dulcis is a well-known medicinal plant in Nigeria with many applications in traditional medicine preparations. The methanol leaf extract was investigated for anti-inflammatory activity on carrageenan-induced paw oedema in Wistar albino rats.
Key Findings:
| Parameter | Result |
| Phytochemicals detected | Carbohydrates, tannins, flavonoids, steroids/triterpenes, saponins, cardiac glycosides, alkaloids |
| Anti-inflammatory effect | Significant reduction at 500 and 1000 mg/kg at 3rd, 4th, and 5th hours |
| Peak inhibition | Observed at the 4th hour |
The study concluded that “the methanol leaf extract of Scoparia dulcis contain bioactive phytochemical with anti-inflammatory activity which explains its use in the treatment of inflammatory conditions in Nigerian traditional medicine”.
4. Mechanisms of Action: How Nigerian Herbs Work Against Arthritis
4.1 Modulation of Inflammatory Mediators
Research has identified key mechanisms by which Nigerian anti-arthritic plants exert their therapeutic effects:
| Plant | Target | Mechanism |
| Bombax buonopozense | Multiple | Phenolic and flavonoid antioxidants; reduces paw circumference, prevents biochemical changes |
| Terminalia superba | Inflammatory cascade | Membrane stabilisation; inhibition of albumin denaturation; suppression of leukocyte migration |
| Alchornea cordifolia | Oxidative stress | Increased GSH, CAT, SOD; possible antioxidant mechanism |
| Lasimorpha senegalensis | Multiple pathways | Inhibition of paw oedema, granuloma formation |
4.2 Key Intracellular Pathways
Studies have validated mechanisms of RA amelioration in human and animal models :
- Suppression of pro-inflammatory cytokines: NF-κB, IL-1β, TNF-α, IL-6, IL-8, IL-17, IL-23, chemokines
- Inhibition of inflammatory enzymes: COX-2, iNOS, arginase
- Suppression of osteoclastogenic factors: RANKL, RANK, NFATC1, TRAP
- Reduction of oxidative stress markers: Decreased ROS, NO, MDA, carbonyl groups, and PGEâ‚‚
- Increased expression of protective molecules: PPAR α/γ; antioxidant and anti-inflammatory molecules
The bioactive compounds present in Nigerian plant botanicals have been shown to protect animals from the development of RA in different experimental models and reduce the toxicity associated with conventional therapies.
5. Commonly Used Nigerian Anti-Arthritic Plants
Based on available literature, the following plants are consistently documented for arthritis management:
| Plant Name | Common Name | Plant Part Used | Scientific Evidence |
| Bombax buonopozense | Leaves | High: superior to Celecoxib | |
| Terminalia superba | Leaves | High: validated anti- inflammatory | |
| Terminalia ivorensis | Bark, leaves | Moderate: historic study | |
| Alchornea cordifolia | Christmas bush | Leaves | High: folkloric use validated |
| Triumfetta cordifolia | Leaves | Moderate: flavonoid-rich | |
| Lasimorpha senegalensis | Leaves | High: superior to ibuprofen | |
| Scoparia dulcis | Sweet broomweed | Leaves | Moderate: bioactive phytochemicals |
| Lonchocarpus cyanescens | Historic: Igbo ethnomedicine | ||
| Costus afar | Historic: Igbo ethnomedicine | ||
| Zingiber officinale | Ginger | Rhizome | Documented traditional use |
| Allium sativum | Garlic | Bulb | Documented traditional use |
| Curcuma longa | Turmeric | Rhizome | Documented traditional use |
| Vernonia amygdalina | Bitter leaf | Leaves | Documented traditional use |
| Moringa oleifera | Moringa | Leaves | Documented traditional use |
| Nigella sativa | Black seed | Seed | Documented traditional use |
6. Traditional Preparation and Administration Methods
6.1 Common Preparation Methods
| Method | Description | Prevalence |
| Decoction | Boiling plant material in water | Most common |
| Infusion | Steeping in hot water | Commonly used |
| Grinding | Powdering dried plant material | Documented in Zamfara |
| Herbal mixture | Combining multiple plant species | Documented in Gusau |
| Blending | Mixing fresh plant material | Used for some formulations |
6.2 Plant Parts Used
Based on surveys across Nigeria:
| Plant Part | Usage Frequency |
| Leaves | Most frequently used |
| Roots | Second most used |
| Stem barks | Third most used |
| Bulbs, Fruits, Seeds | Used for specific species |
6.3 Knowledge Transfer
Knowledge about the utilisation of these herbs is primarily passed down orally through generations. The Gusau survey documented a “great level of transfer of these medicinal plants’ knowledge to friends and family members”. However, poor documentation could lead to the loss of traditional medical resources and expertise, jeopardising the long-term sustainability of rural healthcare systems.
7. Holistic and Complementary Therapies
7.1 Lifestyle Modifications
Holistic management of arthritis should address multiple factors:
- Dietary modification: Anti-inflammatory diets rich in fruits, vegetables, and omega-3 fatty acids
- Weight management: Reducing joint stress
- Regular physical activity: Maintaining joint mobility
- Stress reduction: Managing stress to reduce inflammatory flares
- Rest and joint protection: Balancing activity with rest
7.2 Integration with Conventional Care
The current pharmacological management of inflammatory diseases primarily relies on NSAIDs and corticosteroids. While these agents effectively suppress symptoms, their long-term use is plagued by significant side effects. The integration of evidence-based herbal therapies may offer:
- Reduced reliance on NSAIDs: Plants like Bombax buonopozense demonstrated efficacy superior to Celecoxib
- Complementary mechanisms: Herbal therapies modulate multiple inflammatory pathways
- Reduced toxicity: Plant extracts showed favourable safety profiles in animal studies
8. Safety Considerations and Recommendations
8.1 Key Safety Concerns
| Concern | Implication |
| Lack of standardisation | Variable potency and possible contamination |
| Limited clinical trial data | Most evidence from animal models |
| Poor documentation | Traditional knowledge at risk of being lost |
| Potential drug interactions | May interact with conventional arthritis medications |
| Toxicity concerns | Some plants may be hepatotoxic or nephrotoxic at high doses |
8.2 Safety Profile of Validated Plants
| Plant | Safety Profile |
| Bombax buonopozense | Favourable: LC₅₀ ≥ 1000 μg/mL (brine shrimp lethality) |
| Alchornea cordifolia | Favourable in animal studies |
| Terminalia superba | Favourable in animal studies |
8.3 Recommendations
For Patients and Families:
- Consult healthcare practitioners before initiating any herbal regimen, particularly if taking conventional arthritis medications
- Disclose all herbal medicine use to healthcare providers
- Use products from reputable sources, preferably with NAFDAC registration
- Do not replace prescribed medications without medical consultation
- Monitor for adverse effects and report immediately
For Healthcare Providers:
- Ask about herbal medicine use during consultations
- Provide evidence-based guidance on complementary therapies
- Monitor for potential drug interactions with NSAIDs, DMARDs, and corticosteroids
- Document CAM use in patient records
For Researchers:
- Conduct high-quality clinical trials on promising plants like Bombax buonopozense and Terminalia superba
- Evaluate safety profiles for chronic use
- Study drug interactions with conventional arthritis medications
- Isolate and characterise active compounds
For Policymakers:
- Strengthen NAFDAC regulation of herbal products
- Fund research on anti-arthritic plants
- Develop integration guidelines for traditional and orthodox medicine
- Support documentation of traditional knowledge to prevent loss
9. Research Gaps and Future Directions
9.1 Key Research Needs
| Area | Priority |
| Controlled clinical trials | Most evidence from animal models; human data needed |
| Long-term safety studies | Chronic use effects on liver, kidney |
| Drug interaction studies | Interactions with NSAIDs, DMARDs, biologics |
| Standardised dosing protocols | Defined dosing for herbal formulations |
| Pharmacokinetic studies | Understanding absorption, distribution, metabolism, elimination |
| Mechanism of action studies | Cellular and molecular pathways of anti-arthritic activity |
| Bioactive compound isolation | Characterising active molecules from promising plants |
9.2 Opportunities
| Opportunity | Description |
| Novel drug development | Plants with efficacy superior to standard drugs (B. buonopozense) |
| Standardised formulations | Moving from traditional decoctions to pharmaceutical-grade products |
| Integration strategies | Combining evidence-based herbal therapies with conventional care |
| Traditional knowledge preservation | Documenting indigenous knowledge before it is lost |
| Phytopharmaceutical development | Terminalia superba n-hexane fraction (HFTs) merits further development |
10. Conclusion
Arthritis, particularly rheumatoid arthritis, imposes a significant burden on Nigerian populations, with prevalence rates varying from 0.12% to 82.7% depending on age and location. The limitations of conventional therapies—including side effects, high costs, and variable efficacy—have driven continued reliance on traditional herbal medicine across Nigerian communities.
The scientific literature reveals a rich diversity of Nigerian plants with scientifically validated anti-arthritic potential:
- Bombax buonopozense demonstrated anti-arthritic efficacy superior to the standard drug Celecoxib (20 mg/kg) in adjuvant-induced arthritis models, with favourable safety profiles (LC₅₀ ≥ 1000 μg/mL)
- Terminalia superba showed potent anti-inflammatory activity in multiple in vitro and in vivo models, with its n-hexane fraction suppressing leukocyte migration by 50% in a dose comparable to piroxicam
- Lasimorpha senegalensis reduced paw oedema by up to 80%, demonstrating better activity than ibuprofen
- Alchornea cordifolia showed significant anti-arthritic effects, with the 100 mg/kg dose producing the most significant results, likely through an antioxidant mechanism
- Triumfetta cordifolia demonstrated flavonoid-mediated anti-inflammatory activity, with inhibition rates exceeding the standard drug aspirin
- Scoparia dulcis showed significant anti-inflammatory activity at 500 and 1000 mg/kg
Ethnobotanical surveys have documented 59 plant species in Kwara State, 12 species in Zamfara State, and numerous others across Nigeria . However, challenges remain:
- Only a fraction of documented plants have received scientific validation
- Traditional knowledge is at risk of being lost due to poor documentation
- Limited human clinical trial data for most remedies
- Potential drug interactions with conventional arthritis medications
The path forward requires:
- Acknowledging and respecting traditional knowledge while subjecting it to scientific scrutiny
- Strengthening regulatory oversight of herbal products through NAFDAC
- Promoting open communication between patients and healthcare providers
- Investing in clinical research on safety, efficacy, and mechanisms of action
- Developing integration strategies that combine the best of both systems
- Preserving and documenting indigenous knowledge before it is lost
- Supporting cultivation and sustainable harvesting of medicinal plant species
As Nigeria continues to face the growing burden of arthritis, the careful integration of evidence-based traditional medicine into the healthcare system offers promising strategies for improving access to effective, affordable, and safer anti-arthritic therapies.
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