A Review on Herbal Ointment as a Potential Alternative to Methotrexate for the Management of Rheumatoid Arthritis

And therapeutic potential of herbal formulations in the treatment of rheumatoid arthritis. Rheumatoid Arthritis (RA) is a chronic autoimmune and inflammatory disorder characterized by persistent joint inflammation, pain, swelling, and progressive destruction of cartilage and bone. If left untreated, RA can lead to severe joint deformity, reduced mobility, and involvement of other organs. The prevalence of RA continues to increase globally, including in India, where millions of individuals are affected. Early diagnosis and effective management are therefore essential to prevent disease progression and improve the quality of life of patients. Conventional treatment strategies primarily include disease-modifying anti-rheumatic drugs (DMARDs) such as Methotrexate, which is considered the anchor drug in RA therapy. Methotrexate acts by inhibiting folate metabolism and modulating inflammatory pathways, thereby reducing immune-mediated joint damage. However, long-term use of methotrexate may lead to several adverse effects including hepatotoxicity, gastrointestinal disturbances, and bone marrow suppression. These limitations have encouraged researchers to explore safer and more effective alternative therapies. Herbal medicines have gained considerable attention due to their natural origin, lower toxicity, and multiple therapeutic actions such as anti-inflammatory, antioxidant, and immunomodulatory effects. Several medicinal plants including Azadirachta indica, Allium sativum, Aloe vera, Vitex negundo, and Boerhavia diffusa contain bioactive phytochemicals that help reduce inflammation and alleviate joint pain associated with RA. Herbal formulations, particularly topical ointments, may provide localized therapeutic effects with fewer systemic side effects compared to synthetic drugs. This review paper discusses the pathophysiology, prevalence, and current treatment strategies for Rheumatoid Arthritis, along with the mechanism and limitations of Methotrexate therapy. Furthermore, it highlights the potential role of selected medicinal plants and herbal ointment formulations as alternative or complementary approaches for the management of RA. The review emphasizes the need for further scientific studies to validate the safety, efficacy.