Monday, April 09, 2007

Honey Injections Used to Treat Rheumatoid Arthritis

Honey Therapy for Rheumatoid Arthritis: A Case Study

Presented at: 5th German Apitherapy Congress, March 23-25, 2007, Passau, Germany

Mamdouh Abdulmaksoud Mohamed Abdulrhman, Professor of Pediatrics,
Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt

Among honey benefits are its anti-inflammatory, antimicrobial, antioxidant, and wound healing effects. Therefore it is worthwhile to try honey in treating the disease.

Case study:

A 33 year-old woman, working as a nurse assistant, has had rheumatoid factor positive rheumatoid arthritis of 5 years duration. She had been on non-steroidal anti-inflammatory drug (diclofenac sodium 50 mg twice daily) and steroids for the first 3 years and thereafter she started to receive the antimetabolite methotrexate IM every week + folic acid and steroids were stopped. She presented to my clinic on November 30, 2005 seeking for an alternative treatment because of poor response to the medicines in addition to its side effects (e.g., hair falling). Upon presentation she had pain and stiffness of the small joints of the hands (metacarpophalangeal, proximal and distal interphalangeal) and feet (metatarsophalangeal). The wrists, elbows, shoulders, knees, and ankles were also affected. The patient was feeling tired and unwell and the pain and stiffness were significantly worse in the morning. The temporomandibular joints were also involved. The weight was 83 kg and height 153 cm (body mass index = 35.5). Blood pressure was 100/70. Both rheumatoid factor (RF), antinuclear antibody (ANA) and anti smooth muscle antibody (ASMA) were positive. The RF was 256 IU/ml (reference range = 0-8 IU/ml).The erythrocyte sedimentation rate (ESR) was 90 and 130 in the 1st and 2nd hour respectively. The anti-double stranded DNA was negative. The TLC = 5061/mm3, Hb = 11.5 g/dl, platelets = 193000/mm3, BUN = 8(N = 7-18), serum creatinine = 0.7 mg/dl, AST (SGOT) = 52 IU/L (N = 10-42), ALT (SGPT) = 64 IU/L (N =10-40), ASOT = 400 IU/ml. HBsAg and HCV-Ab were negative. Urinalysis was normal. Echocardiography showed mild mitral regurge. Clinically the murmur was not heard and there were no signs of heart failure.

The following plan of management was discussed with the patient and her husband and they agreed:

1. Stoppage of all medicines
2. Bee honey therapy (BHT) both orally and intravenously.

Oral honey was started in doses of 50 ml dissolved in water and given before meals two times daily. Intravenous honey was started by a 5% solution and gradually increased by 5% every week up to 20% concentration. The solution was given by slow IVI in a peripheral vein over 3 minutes. The dose of oral honey was reduced to 75 ml/day when the concentration of IV honey reached 20%.

The management was started on 3/12/05. After stoppage of medicines and start of BHT the joint pains increased and after 10 days the patient started to feel improvement in all joints except the knees and ankles. The back pain was still present but the morning stiffness disappeared. On 24/12/05 she developed intercostal myositis and costochondritis which improved after one week without modification in the plan of management. Thereafter the pains improved. As the work performance also improved the frequency of work absences significantly decreased.

On 30/1/06, i.e. after 2 months of BHT she was found to be 8 weeks pregnant. The BHT was continued both orally and intravenously. The leg and back pains recurred at variable intervals (for a few days every one to two weeks) but they were less severe and much more tolerable than before. On 8/4/06 she developed mild pitting edema in the dorsa of feet. The blood pressure was 105/70 and urinalysis did not show proteinurea. Throughout pregnancy the pitting edema showed little increase and the blood pressure and urinalysis remained normal. The last injection during pregnancy was given on 22/7/06 and on 15/8/06 she delivered a girl of 3.25 kg. The baby was in a good general condition and examination did not show any abnormality…

Reactions to Honey Injections:

The first injection given to the patient was on 3/12/06 and it was 5 ml bee honey solution 5%. About 2 hours after this injection she developed low grade fever (37.8 °C) and shivering which lasted for about 30-60 minutes and disappeared spontaneously. Thereafter she felt generalized body aches and increase in the joint pains which lasted for about 8-12 hours and resolved also spontaneously. The 2nd injection was 10% solution and was not followed by fever or rigors but body aches and increased joint pains occurred in the same manner as after the 1st injection. The 3rd injection was 15% and was followed by reactions similar to the 1st injection. Since 24/12/05 to the present she has been receiving 20% concentration. Transient body aches and joint pains followed nearly every injection but transient fever and chills followed only some injections. On the other hand few injections were followed by pain and hotness along the course of injection and they disappeared spontaneously after a few minutes. A total of 46 honey injections were given to the patient since the start of BHT. Neither anaphylaxis nor other life threatening reaction followed any injection.


Three in four women with rheumatoid arthritis experience significant improvement in symptoms when pregnant, usually with a recurrence after delivery. In this patient the onset of bee honey therapy was nearly coincident with the onset of pregnancy. So the improvement which followed honey therapy might be due to honey or/and pregnancy. The patient was lucky as she stopped methotrexate before pregnancy because methotrexate may have a teratogenic effect on the fetus. Thirty four honey injections were given during pregnancy without adverse effects on the mother or fetus, as she delivered a 3.25 kg full term normal baby. The reactions followed honey injections were both specific and non specific16. When she stopped honey therapy for two months (two weeks before delivery and 6 weeks after), the symptoms recurred and she presented with heart failure. This recurrence might be due to stoppage of honey therapy or/and the natural course of the disease. However the improvement noticed after resumption of honey indicates, on clinical grounds, that honey may have beneficial effects in both rheumatoid arthritis and heart failure. The patient remained on honey therapy for nearly 6 months after delivery with nearly normal life style and without complications. Treatment should be guided by individual clinical response to various interventions. Changes in hemoglobin, ESR, and CRP may serve as helpful indicators of response to treatment, but platelet count and rheumatoid factor levels tend not to correlate well. In this patient the ESR and CRP are still high despite clinical improvement. Therefore ESR and CRP may not serve as helpful indicators of response to honey therapy.

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