Rosa canina, also known as dog rose or wild rose, is a plant species belonging to the rose family (Rosaceae). It is native to various regions of Europe, Asia, and North Africa and prefers to grow in sparse forests, along forest edges, and in hedgerows [1]. The plant has been used in traditional Chinese medicine for centuries. Due to the potential anti-inflammatory and immunomodulatory properties of Rosa canina, its potential to positively influence inflammatory rheumatic diseases warrants discussion. Rosa canina is available over the counter in pharmacies, for example, as rosehip powder or capsules.
Dog rose contains a variety of bioactive compounds responsible for its pharmacological properties. These include flavonoids, polyphenols, vitamin C, carotenoids, and essential oils [1] [2] [3]. Consequently, the literature suggests that Rosa canina has antioxidant effects as well as anti-inflammatory and immunomodulatory properties that influence pro-inflammatory cytokines [4].
Its antioxidant properties are attributed to vitamin C and polyphenols, which are thought to reduce oxidative stress reactions associated with inflammatory processes, such as those seen in rheumatoid arthritis (RA) [4]. In vitro data show that Rosa canina inhibits cyclooxygenase-1 and cyclooxygenase-2 [5], thereby potentially exerting an anti-inflammatory effect [4]. Furthermore, an experimental study demonstrated that Rosa canina inhibits the synthesis of interleukin-1α, interleukin-1β, and tumor necrosis factor [6].
Clinical studies
A PubMed search was conducted using the keywords “rosa canina rheumatic or rosa canina arthritis,” “rosa canina and vasculitis rheumatic,” and “rosa canina and connective tissue disease.” No search results were found in PubMed for the keywords “rosa canina and rheumatic vasculitis” and “rosa canina and connective tissue disease.” The keywords “rosa canina rheumatic or rosa canina arthritis” yielded 19 search results.
Furthermore, the literature review identified placebo-controlled studies for the indications of rheumatoid arthritis (n = 2) and osteoarthritis (n = 6). No study data are available regarding vasculitides and collagenoses
Rheumatoid Arthritis
In a clinical study by Kirkeskov et al., the effect of Rosa canina on RA patients was investigated [7]. The study included 20 RA patients and 10 healthy control subjects, who were gender- and age-matched to the RA group. All study participants received a daily dose of 10.5 g of Rosa canina in powder form over a period of 28 days. The results of the study showed no significant change in C-reactive protein (CRP) levels in either group. Likewise, no significant changes were observed in the measured antioxidant enzymes, suggesting that treatment with Rosa canina had no measurable effect on inflammatory and antioxidant mechanisms in the body [7]. A limitation of the study is that the RA group and the control group were small in size, and clinical parameters for determining disease activity or treatment response (e.g., DAS28 or ACR response) were not assessed.
Willich et al. investigated the effect of Rosa canina rosehip powder on RA patients in a double-blind, placebo-controlled study lasting 6 months [8]. A total of 89 patients were included. The treatment group received 5 g of Rosa canina rosehip powder daily in capsule form. The Health Assessment Questionnaire Disability Index (HAQ-DI) was used to assess the patients’ physical functioning and disability. An improvement of 0.1057 ± 0.346 was observed in the treatment group. The Disease Activity Score 28 (DAS28) was used to determine disease activity. In the active treatment group, an improvement in DAS28 of 0.897 ± 1.32 was observed, while a deterioration (0.347 ± 1.27) was noted in the placebo group. The improvement in DAS28 was not statistically significant. Furthermore, no information was provided on how individual components, such as CRP and the number of painful/swollen joints, fared. Apparently, no rheumatologists were involved in the study. Overall, the study’s results are questionable; a minor improvement in the HAQ of 3–4% does not appear relevant despite the statistically significant result.
Osteoarthritis
The study by More et al. included 92 patients with knee osteoarthritis [9]. The treatment group received a special formulation (MA212 [Rosaxan]) containing extracts of Rosa canina, Urtica dioica , and Harpagophytum procumbens DC. ex Meisn. and Harpagophytum zeyheri Decne (devil’s claw), respectively. The efficacy of the treatment was assessed using the WOMAC pain score (Western Ontario and McMaster Universities Arthritis Index), which measures pain, stiffness, and functional limitations in osteoarthritis. In the active treatment group, a reduction in the WOMAC pain score of 29.87 points on average was observed, compared to only 10.23 points in the placebo group [9]. This suggests that the specific combination formulation of Rosa canina, Urtica dioica, and Harpagophytum may provide pain relief for patients with knee osteoarthritis. It should be noted critically that both the first author and the second author were employed by Herbalist & Doc Gesundheitsgesellschaft mbH in Berlin at the time of publication, the company that distributes the Rosaxan preparation in Germany.
The effect of Rosa canina on knee osteoarthritis and hip osteoarthritis was investigated in a further randomized, placebo-controlled, double-blind crossover study over 3 months [10]. The study lasted a total of 3 months and included 94 patients with knee osteoarthritis and hip osteoarthritis. The treatment group received 5 g of Rosa canina once daily. The results of the study showed a significant reduction (2.1 ± 16.8, p = 0.014) in the WOMAC pain score in the active treatment group compared to the placebo group after three weeks and a non-significant reduction (5.1 ± 18.3, p = 0.125) over the entire three-month study period. With regard to the WOMAC subscales for functional limitation, joint stiffness, and global assessment of disease severity, a significant decrease was observed over the three-month study period [10]. Additionally, a reduction in paracetamol use (40%, p < 0.052) was observed in the verum group. With regard to the use of nonsteroidal anti-inflammatory drugs, no change was observed during the study period [10].
In a randomized, placebo-controlled, double-blind study, patients with radiologically confirmed coxarthrosis or gonarthrosis in the active treatment group (n = 50) were treated with five capsules of 0.5 g rosehip powder twice daily over a period of four months. A placebo group received placebo capsules that looked identical. Mobility of the hip or knee joints was measured at the start and after four months of therapy in both groups. The results showed that hip joint mobility was significantly improved in the treatment group compared to the placebo group (p < 0.033). A significant reduction in pain (64.6%) was also observed in the treatment group compared to the placebo group (p < 0.035). Additionally, a significant decrease in the use of nonsteroidal anti-inflammatory drugs was demonstrated in the treatment group [11].
Rein et al. investigated Hyben Vital® as a herbal medicine derived from Rosa canina, which was administered to patients (n = 112) with osteoarthritis of the hip, knee, or hand, as well as degenerative changes in the cervical spine [12]. The pain response rate was 66% (active treatment group) versus 36% (placebo group) for the entire study cohort. Overall, this study demonstrates that Hyben Vital® has an effect in terms of alleviating osteoarthritis pain [12]. It should be noted that the study was supported by the manufacturer of Hyben Vital.
A meta-analysis examined the efficacy of Rosa canina (rosehip) for the symptomatic treatment of osteoarthritis. It included three randomized clinical trials by Winther et al. [10], Warholm et al. [11], and Rein et al. [12] [13], all of which were sponsored by the manufacturer of the preparation. The meta-analysis demonstrated a mild to moderate, short-term reduction in osteoarthritis pain following the intake of Rosa canina, although the authors note that the efficacy and safety of Rosa canina should be evaluated in large cohorts [13].
Additionally, it should be noted that neither the American College of Rheumatology guidelines for the treatment of hand, hip, and knee osteoarthritis nor the German S2k guidelines for coxarthrosis and gonarthrosis provide recommendations for treatment with Rosa canina [14] [15] [16].
Headaches, gastrointestinal disturbances, difficulty swallowing, colds, urinary tract infections, allergic vasculitis, skin rash or eczema, and weight gain are described as possible side effects of therapy with Rosa canina. Due to the lack of information on relative frequency in the publications [4] [8], no detailed statements can be made on this topic. In some of the studies described above, no significant side effects were reported [11] [10] [7] [9].
Rosa canina has no significant effect on the disease activity of rheumatoid arthritis and is therefore not recommended for the treatment of this condition.
In cases of osteoarthritis, the use of Rosa canina may provide mild to moderate, short-term pain relief. The lack of manufacturer-independent studies, the small sample size, and the absence of recommendations in clinical guidelines prevent the Commission from issuing a recommendation at this time. However, if a patient wishes to self-medicate, its use for degenerative joint diseases should not be discouraged.
1. Pekacar S, Bulut S, Özüpek B, Orhan DD: Anti-Inflammatory and Analgesic Effects of Rosehip in Inflammatory Musculoskeletal Disorders and Its Active Molecules. Curr Mol Pharmacol 2021, 14(5):731-745.
2. Gruenwald J, Uebelhack R, More MI: Rosa canina - Rose hip pharmacological ingredients and molecular mechanisms counteracting osteoarthritis - A systematic review. Phytomedicine 2019, 60:152958.
3. Rossnagel K, Willich SN: [Value of complementary medicine exemplified by rose hips]. Gesundheitswesen 2001, 63(6):412-416.
4. Chrubasik C, Roufogalis BD, Müller-Ladner U, Chrubasik S: A systematic review on the Rosa canina effect and efficacy profiles. Phytother Res 2008, 22(6):725-733.
5. Jäger AK, Eldeen IM, van Staden J: COX-1 and -2 activity of rose hip. Phytother Res 2007, 21(12):1251-1252.
6. Yeşilada E, Ustün O, Sezik E, Takaishi Y, Ono Y, Honda G: Inhibitory effects of Turkish folk remedies on inflammatory cytokines: interleukin-1alpha, interleukin-1beta, and tumor necrosis factor alpha. J Ethnopharmacol 1997, 58(1):59-73.
7. Kirkeskov B, Christensen R, Bügel S, Bliddal H, Danneskiold-Samsøe B, Christensen LP, Andersen JR: The effects of rose hip (Rosa canina) on plasma antioxidant activity and C-reactive protein in patients with rheumatoid arthritis and normal controls: a prospective cohort study. Phytomedicine 2011, 18(11):953-958.
8. Willich SN, Rossnagel K, Roll S, Wagner A, Mune O, Erlendson J, Kharazmi A, Sörensen H, Winther K: Rose hip herbal remedy in patients with rheumatoid arthritis - a randomized controlled trial. Phytomedicine 2010, 17(2):87-93.
9. More M, Gruenwald J, Pohl U, Uebelhack R: A Rosa canina–Urtica dioica–Harpagophytum procumbens/zeyheri combination significantly reduces symptoms of gonarthritis in a randomized, placebo-controlled, double-blind study. Planta Med 2017, 83(18):1384-1391.
10. Winther K, Apel K, Thamsborg G: A powder made from seeds and shells of a rose-hip subspecies (Rosa canina) reduces symptoms of knee and hip osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. Scand J Rheumatol 2005, 34(4):302-308.
11. Warholm O, Skaar S, Hedman E, Mølmen HM, Eik L: The Effects of a Standardized Herbal Remedy Made from a Subtype of Rosa canina in Patients with Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. Curr Ther Res Clin Exp 2003, 64(1):21-31.
12. Rein E, Kharazmi A, Winther K: A herbal remedy, Hyben Vital (standardized powder of a subspecies of Rosa canina fruits), reduces pain and improves general well-being in patients with osteoarthritis—a double-blind, placebo-controlled, randomized trial. Phytomedicine 2004, 11(5):383391.
13. Christensen R, Bartels EM, Altman RD, Astrup A, Bliddal H: Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients?—a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2008, 16(9):965-972.
14. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol 2020; 72(2):220-233.
15. S2k Guideline on Knee Osteoarthritis. register.awmf.org/de/leitlinien/detail/187-050, last accessed 02/20/2024
16. S2k Guideline on Knee Osteoarthritis. register.awmf.org/de/leitlinien/detail/187-049, last accessed February 20, 2024
Last updates: March 11, 2024