Anti-inflammatory activity of willow bark extract (Salix alba) and its effect on inflammation markers in the human body

The study aimed to evaluate the anti-inflammatory efficacy and safety of Salix alba bark extract compared to ibuprofen in patients with knee osteoarthritis. A 12-week randomised controlled trial in Ukraine involved 120 patients diagnosed with stage II-III osteoarthritis, divided into two groups: the first received a standardised willow extract (240 mg of salicin per day), the second received ibuprofen (1,200 mg/day). Pain scores on a visual analogue scale decreased from 7.4 ± 1.2 to 3.1 ± 1.5 points (Δ= 4.3; p < 0.001) in the Salix alba group and from 7.6 ± 1.1 to 3.0 ± 1. 4 points (Δ= 4.6; p = 0.12) in the ibuprofen group. Joint function, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, improved by 42% and 45%, respectively (p= 0.24). C-reactive protein levels decreased by 55% versus 60% (p= 0.18), interleukin-6 by 58% versus 60% (p = 0.29), and tumour necrosis factor-α by 50% versus 52% (p = 0.41). Side effects were reported in 10% of patients in the willow group versus 25% in the control group, mainly gastrointestinal in nature. A moderate correlation was found between blood salicin levels and pain reduction (r = 0.45; p < 0.001). The results proved that Salix alba extract has similar efficacy to ibuprofen, but with a lower risk of complications due to its multifunctional action (inhibition of cyclooxygenases, cytokine modulation, antioxidant effect). The data obtained justify the use of the extract as an alternative to synthetic anti-inflammatory drugs in clinical practice, especially for patients with chronic inflammatory diseases, where long-term use of non-steroidal anti-inflammatory drugs is accompanied by an increased risk of side effects. The results of the study can be used by rheumatologists and therapists in clinical practice to prescribe Salix alba extract as a safe alternative to non-steroidal anti-inflammatory drugs for patients with osteoarthritis