Tasawar Iqbal* Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan *Corresponding author: Tasawar Iqbal* Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan
Abstract Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent synovial inflammation, joint destruction, and systemic complications that significantly impair patient quality of life. Conventional therapeutic strategies, including disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and biologics, offer symptomatic relief but are often associated with limited efficacy, high costs, and adverse effects. This has stimulated growing interest in exploring herbal and complementary remedies as adjunct therapies for RA management. Clove (Syzygium aromaticum), traditionally recognized for its analgesic, anti-inflammatory, and antioxidant properties, has gained attention as a potential therapeutic option. Clove water, a simple aqueous preparation, contains pharmacologically active phytochemicals such as eugenol, flavonoids, tannins, and phenolic acids, which may collectively modulate inflammatory pathways relevant to RA. Preclinical studies suggest that clove extracts exert immunomodulatory effects by inhibiting pro-inflammatory cytokines, downregulating NF-κB activation, and reducing oxidative stress, thereby protecting cartilage and joint integrity. Although direct clinical evidence on clove water in RA patients remains limited, its pharmacological profile supports potential application as a safe, cost-effective, and accessible complementary remedy. This review highlights the phytochemical composition, pharmacological actions, preclinical evidence, safety considerations, and therapeutic prospects of clove water in RA management. Furthermore, it emphasizes the need for well-designed clinical trials to validate efficacy, optimize dosage, and evaluate long-term safety. Overall, clove water represents a promising natural adjunct that could complement conventional therapies, improve patient outcomes, and reduce dependence on synthetic drugs in rheumatoid arthritis care. Keywords: Clove Water, Rheumatoid Arthritis, Eugenol, Anti-Inflammatory, Complementary Therapy, Antioxidant 1. Introduction Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder that primarily affects synovial joints and leads to progressive disability if left untreated. Globally, RA affects approximately 0.5–1% of the population, with a higher prevalence among women compared to men, particularly in the age range of 30 to 60 years. The disease is characterized by persistent synovial inflammation, hyperplasia of synovial tissue, pannus formation, and gradual destruction of cartilage and bone. At the molecular level, RA involves a complex interplay of immune cells and pro-inflammatory mediators such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6), which collectively drive inflammation and joint degradation. Beyond musculoskeletal impairment, RA is associated with systemic complications, including cardiovascular disease, pulmonary involvement, and increased risk of infections, which contribute to reduced life expectancy. Importantly, the disease also imposes a profound psychological and socioeconomic burden, limiting quality of life and work productivity(Hasan et al., 2022) Conventional management of RA relies heavily on pharmacological interventions, particularly disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, and leflunomide. Biologic agents targeting cytokines (e.g., TNF inhibitors, IL-6 receptor blockers) and Janus kinase (JAK) inhibitors have revolutionized treatment outcomes in recent decades. However, these therapies are not curative, and many patients experience incomplete remission or relapse despite aggressive treatment. Moreover, adverse effects such as hepatotoxicity, immunosuppression, gastrointestinal complications, and elevated infection risk limit long-term compliance. High costs associated with biologics and targeted therapies further restrict access, particularly in low- and middle-income countries. Consequently, there is growing recognition of the need for safer, more accessible, and cost-effective complementary strategies that can support conventional treatment(Prasad et al., 2023). Herbal medicine and complementary remedies have emerged as potential adjuncts in RA management due to their multi-targeted pharmacological effects, relatively low toxicity, and cultural acceptance. Natural products derived from plants are often rich in bioactive compounds with anti-inflammatory, antioxidant, and immunomodulatory properties. Among these, clove (Syzygium aromaticum), a spice widely used in culinary and traditional medicine practices, has gained attention for its therapeutic potential. Traditionally, clove has been employed in pain relief, oral health, and respiratory conditions. Recent pharmacological studies highlight that clove extracts possess potent antioxidant activity, suppress inflammatory mediators, and exhibit analgesic effects, making them
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