Evidence Level
Moderate
Devil's claw is one of the most extensively studied herbal anti-inflammatories in Europe, with approval from German Commission E and ESCOP for degenerative musculoskeletal disorders. The landmark Chrubasik et al. (2003) trial found it comparable to rofecoxib (Vioxx) for acute low back pain. A systematic review by Oltean et al. (2014) confirmed benefit for OA across multiple trials. The Leblan et al. (2000) open study showed 61% of patients could reduce NSAID use. Harpagosides are the primary active compounds, inhibiting COX-2 and multiple pro-inflammatory cytokines. The extract has a favorable safety profile compared to NSAIDs, though GI effects occur in some users and it should be avoided in peptic ulcer disease.