Osteoarthritis (OA) is the most common degeneration or progressive wear among types of arthrosis (Chow and Kok-Yong, 2020). OA affects all movable joint structures, typically affecting the knee, hip, spine, hands, and feet, being more common in weight-bearing joints, and with a high prevalence of polyarticular involvement (Hawker, 2019, Santana et al., 2022).

This disorder is linked to the progressive loss of articular cartilage and thickening of the underlying subchondral bone, related to changes in cartilage restoration and bone remodelling (Samvelyan et al., 2021). Although its aetiology is multifactorial and has not been fully elucidated, it is noted that biochemical, metabolic, and ageing-related changes may contribute to its appearance (Chow and Kok-Yong, 2020), making it endemic worldwide (Abramoff and Caldera, 2020). Current pathophysiological studies on osteoarthritis point to processes such as chondrocyte apoptosis, autophagy of senescence, and injury caused by oxidative stress as causes. These processes are related to several inflammatory protease mediators and the activation of inflammatory signalling pathways (Kulkarni et al., 2020).

According to data from the World Health Organisation, it is estimated that around 343 million individuals have OA worldwide (Wang et al., 2022), being about 10% men and 18% women over 60 years old (Samvelyan et al., 2021). The most common characteristics of osteoarthritis are severe joint pain, morning stiffness, crackles, muscle atrophy, and reduced mobility (Arliani et al., 2022), leading to a decrease in quality of life and productivity, as well as an increase in economic expenses, impairing the viability of health resources (Chow and Kok-Yong, 2020, Whittaker et al., 2021).

Current therapies include oral administration of medications, intra-articular injection of medications, intravenous administration of medications, surgical procedures (Hu et al., 2021), or rehabilitation with exercise therapy, considered the first line of treatment (Whittaker et al., 2021). However, commonly used pharmaceutical treatments have relatively small effects and are uncertain regarding their long-term efficacy and safety. A number of concerns about the safety of these drugs are portrayed, from the risk of liver failure to gastrointestinal, cardiovascular, and renal adverse events (Latourte et al., 2020).

Osteoarthritis will become the leading cause of disability in the elderly by 2030; therefore, with the aim of reducing pain and disease progression by safely delaying or stopping these symptoms, the development of natural medicines derived from medicinal plants has been touted as a logical strategy for the treatment of OA. These plant-derived compounds have been traditionally used over the years, mainly by the elderly population, and although the mechanisms of action are unknown, it is suggested that natural extracts may interfere with the regulation of inflammatory pathways, such as the NF-kB pathway, inhibition chondrocyte apoptosis, and autophagy (Lee et al., 2021, Wang et al., 2022).

About 42% of the new bioactive molecules incorporated into drugs approved by the United States Food and Drug Administration in the period from 1981 to 2014 have their origin traced to natural products, manifesting themselves both directly and indirectly (Newman and Cragg, 2016). The use of botanical extracts appears as an advantageous and economically plausible alternative in the context of the prevention and treatment of inflammatory conditions. This approach is supported not only by the accessibility and low cost of these sources but also by their intrinsic ability to mitigate concerns associated with the adverse effects of conventional therapeutic interventions (Da Silva et al., 2023). However, although several natural extracts have been discovered, it is necessary to review these compounds in order to provide an overview of the use of new candidate agents to regulate osteoarthritis. Thus, this review aims to determine the effectiveness of medicinal plants and natural products derived from them on pain and inflammation in individuals with OA, as well as to characterise whether they can be safe therapeutic options.