Alternative Rheumatoid Arthritis Treatments

Alternative Rheumatoid Arthritis Treatments

Rheumatoid arthritis (RA) is a chronic disease that affects the joints, often those in a person's wrists, fingers, and feet. The common symptoms of RA are pain, stiffness, fatigue, sleep disturbances, and fever. There are treatments for RA in conventional medicine, but some people also try complementary and alternative medicine (CAM). This page answers some frequently asked questions on this topic and suggests sources for more information.

CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians. Some practitioners of conventional medicine are also practitioners of Alternative Rheumatoid Arthritis Treatments.

Alternative Rheumatoid Arthritis Treatments - Key Points

• It is very important for people with RA to ensure that (1) their RA was diagnosed by a professional with substantial conventional medical training and (2) their condition is being followed by a rheumatologist (a physician who specializes in rheumatic diseases like RA). This is important to minimize damage to the joints and bones, as well as disability.
  
  
• There are many proven conventional treatments for RA. It is important not to replace them with Alternative Rheumatoid Arthritis Treatments that are unproven.
  
  
• Many Alternative Rheumatoid Arthritis Treatments for arthritis are heavily advertised and make attractive claims, often based on personal stories (testimonials). However, it is important to find out whether any high-quality scientific research has been done on a CAM therapy.
  
  
• None of the Alternative Rheumatoid Arthritis Treatments discussed in this site have been proven to be of benefit for RA. Some--such as,  gamma-linolenic acid, fish oil, and mind-body therapies--have shown some possibility of benefit for RA, but further studies are needed to answer this question for sure.
  
  
• It is important to tell your health care provider(s) about any Alternative Rheumatoid Arthritis Treatments you are using or considering for RA. This is for your safety and a comprehensive treatment plan.

Treating Rheumatoid Arthritis With Alternative Medicine

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is what is called an autoimmune disease. In this type of disease, a person's immune system (the system in the body responsible for fighting disease) mistakenly attacks the person's own body. In RA, the parts attacked are the linings of the joints (places in the body where two bones connect). The reasons that this happens are complex and not fully understood. RA causes pain, swelling, and stiffness in a person's joints and problems with functioning. However, RA affects different people in different ways, in terms of the symptoms they have, how serious the symptoms are, and how long the symptoms last. RA is different from other types of arthritis (such as osteoarthritis). For example:

• RA usually occurs in a symmetrical pattern; for example, if one hand is affected, usually the other will be, too.
• RA often affects the wrists and fingers, though it can affect other parts of the body.
• RA is an autoimmune disease affecting the entire body. A person with RA may feel tired and weak, have fevers at times, lose appetite, lose weight, and generally not feel well.

How is rheumatoid arthritis treated in conventional medicine?

There are many proven treatments in conventional medicine for RA. They are used to relieve pain, reduce swelling, slow down or stop the damage to joints, help the person function better, and improve the person's sense of well-being. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biological response modifiers, and corticosteroids. Non-drug treatments include physical therapy; modified exercise programs; devices such as canes, special shoes, and splints (rigid supports that keep a part of the body from moving while it heals); and lifestyle changes--such as balancing activity with rest, eating a healthy diet, and reducing stress. Scientific research is advancing in understanding the many complexities of RA and in uncovering new and promising treatments.

It is important for people with RA to have their condition followed by a rheumatologist (a physician who specializes in diseases of the bones, muscles, and joints). This helps prevent or minimize damage to the joints and disability, which can occur if RA is left untreated over time.

Treating Rheumatoid Arthritis With Alternative Medicine

Why do some people with Rheumatoid Arthritis use Alternative Rheumatoid Arthritis Treatments, and what do they use?

Among the many reasons that some people use Alternative Rheumatoid Arthritis Treatments for RA are:

• Because conventional treatment is not working as well as they would like
• A wish for greater relief of symptoms and/or disability
• Issues with side effects of drug treatment
• A desire to reduce some of the stress that comes from living with a chronic illness and to cope better
• A belief that CAM therapies are safer and more "natural"
• Widespread advertising and attractive claims for many CAM products

What Alternative Rheumatoid Arthritis Treatments for RA are discussed?

Many types of Alternative Rheumatoid Arthritis Treatments are tried for RA, such as:

• Preparations made from botanicals (plants and their products, including herbs)
• Vitamins and minerals in unconventional amounts
• Other products taken by mouth, such as fish oil
• Dietary approaches
• Preparations applied to the skin, such as balms and liniments
• Hydrotherapy
• Items that are worn (for example, magnetic clothing or copper bracelets)
• Mind-body therapies such as relaxation techniques, meditation, prayer for health purposes, and tai chi
• Whole medical systems, such as Ayurveda (a traditional medicine of India), traditional Chinese medicine, homeopathy, and chiropractic
• Other therapies delivered by CAM practitioners--for example, acupuncture - A family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles through the skin. It is intended to remove blockages in the flow of qi and restore and maintain health or massage

It is beyond the scope of this report to discuss the scientific evidence about all Alternative Rheumatoid Arthritis Treatments used for RA. The therapies listed below were selected because they are among those most frequently discussed in the scientific literature and inquired about at the NCCAM Clearinghouse. In reading about them, you will also see some general points to consider.

Other Therapies Discussed

• Botanical supplements and other dietary supplements
  • Gamma-linolenic acid (GLA)
  • Fish oil
  • Glucosamine and chondroitin
• Special diets
• Acupuncture
• Magnets
• Hydrotherapy
• Homeopathy
• Selected mind-body techniques

Treating Rheumatoid Arthritis With Alternative Medicine

What are some important points to keep in mind if I have rheumatoid arthritis and am thinking about using Alternative Rheumatoid Arthritis Treatments?

• It is important to make sure you have been diagnosed with RA by a health care provider who has substantial conventional medical training and experience with arthritis patients. RA can be hard to diagnose, there is no single test for it, and its symptoms can be similar to those of other conditions.
  
  
• Proven conventional treatments for RA should not be replaced with a Alternative Rheumatoid Arthritis Treatments that are unproven. This is especially important in the early stages of RA, when researchers believe the most damage to joints and bones occurs.
  
  
• Tell your health care provider(s) about any supplements or medications (prescription or over-the-counter) that you are using or considering. Prescribed medicines may need to be adjusted if you are also using a Alternative Rheumatoid Arthritis Treatment. Supplements can interact with medications (whether prescription or over-the-counter) and can affect how the body responds to them. Pharmacists can also be a helpful source of information about dietary supplements (though their advice is not a substitute for that of your provider).
  
  
• If you decide to use supplements, what you see on the label may not reflect what is in the bottle. For example, some botanical supplements have been found to be contaminated with heavy metals or prescription drugs, and some have been found to have much more or much less of the featured ingredient than their label states.
  
  
• The claims for many Alternative Rheumatoid Arthritis Treatments can be attractive, ranging from enhancing well-being, to helping with difficult chronic conditions, to achieving unbelievable results. It is important to know whether scientific research has proven that a therapy works and, if so, why.
  
  
• Women who are pregnant or nursing, or people who are thinking of using Alternative Rheumatoid Arthritis Treatments to treat a child, should use extra caution and be sure to consult their health care provider.

Treating Rheumatoid Arthritis With Alternative Medicine

What is known from the scientific research about whether these Alternative Rheumatoid Arthritis Treatments for rheumatoid arthritis are effective and safe?

Botanical Supplements and Other Dietary Supplements

Overall, there is not much rigorous research available on the effectiveness and safety of botanical and other supplements that people try for RA. It is also important to know that while supplements are regulated by the U.S. Food and Drug Administration (FDA) as a category of foods, supplements made from plants and used for medicinal purposes (sometimes referred to as herbal medicines) can have effects as powerful as those of drugs. In fact, many conventional drugs first came from plants, such as digitalis (from the foxglove plant), used to treat heart failure and heart rhythm, and paclitaxel (from the yew tree), a cancer chemotherapy drug.

It is important to be as informed as possible about the safety of any supplement you are considering or using. Some information already exists from a long history of botanical use outside conventional medicine. This knowledge is being strengthened as NCCAM supports rigorous studies on botanicals and other supplements that have shown promise in early studies to find out more about their molecular structure, their safety, how they may work, and for what diseases or conditions.

Alternative Rheumatoid Arthritis Treatments - Gamma-Linolenic-Acid (GLA)

GLA is an omega-6 fatty acid that is found in the oils of some plant seeds, including evening primrose (Oenothera biennis L.), borage (Borago officinalis L.), and black currant (Ribes nigrum L.). GLA can be used by the body to make substances that reduce inflammation.

• A 2000 Cochrane Collaboration review analyzed seven placebo-controlled studies of GLA (from evening primrose, borage, and black currant oils) for RA. The authors noted there were issues with these studies that made it difficult to draw conclusions. However, they thought the better studies indicated potential relief for RA pain, morning stiffness, and joint tenderness.
  
  
• There are potential side effects and risks to know about with GLA. First, these plant seed oils may affect certain medical conditions and interact with prescription medications. Specifically:
  • Some borage seed oil preparations contain ingredients called PAs (for pyrrolizidine alkaloids) that can harm the liver or worsen liver disease. Only preparations that are certified and labeled as "PA-free" should be used.
  • Borage oil and evening primrose oil might increase the risk of bleeding and bruising, especially in people taking blood-thinning drugs, such as aspirin, clopidogrel, NSAIDs, or warfarin.
  • Evening primrose oil may cause problems for people taking a class of psychiatric drugs called phenothiazines, such as chlorpromazine or prochlorperazine.
  • Side effects of these oils can include nausea, diarrhea, soft stool, intestinal gas, burping, and stomach bloating.

Alternative Rheumatoid Arthritis Treatments - Fish Oil

• There is some encouraging evidence from a number of laboratory studies, animal studies, and clinical trials about the potential usefulness of fish oil or omega-3 supplementation for various aspects of RA--such as the number of tender joints, morning stiffness, and the need for NSAIDs. However, more research is needed to definitively answer various questions, including what the most effective dosage or length of treatment would be, which patients would benefit most, and whether a placebo effect is at work.
  
  
• In some people, the high amounts of omega-3s that are present in fish oil can increase the risk of bleeding or affect the time it takes blood to clot. If a person is taking drugs that affect bleeding or is going to have surgery, this is of special concern. Fish oil supplements interact with medicines for high blood pressure, so taking them together might lower a person's blood pressure too much.
  
  
• Certain species of fish can contain high levels of contaminants, such as mercury, from the environment. Thus, their oils could pose a health risk, especially for pregnant or nursing women and for children. The fish that the Federal Government has found to have the highest levels of mercury are shark, swordfish, king mackerel, and tilefish. People who decide to use fish oil should look for products made from fish with lower mercury levels. Government information on this topic is available. You may have to contact the manufacturer to find out the type(s) of fish used in a product. Also, it is desirable to find out whether the manufacturer tests the product for contaminating substances and if the results of those tests are available.
  
  
• Another point to note about safety is that a product called fish liver oil can contain more vitamin A than the recommended daily dosage, which could cause problems.
  
  
• Generally, for low doses of fish oil supplements, the side effects are mild and can include a fishy after taste, belching, stomach disturbances, and nausea.

Alternative Rheumatoid Arthritis Treatments - Glucosamine and Chondroitin

Chondroitin is a substance found in the cartilage around joints. As a supplement, it is obtained from sources such as sharks and cattle.

• Both glucosamine and chondroitin have shown anti-inflammatory effects in animal studies. In humans, they have been studied only for osteoarthritis so far, not for RA. Osteoarthritis is a different form of arthritis than RA, with different causes, although the symptoms are similar (such as joint pain and problems with function). One cannot assume that if a treatment is helpful for one type of arthritis, it will also be helpful for another type. The studies of glucosamine and chondroitin for osteoarthritis mostly found a modest benefit. However, some design flaws have been noted in those studies. In sum, there is no evidence that glucosamine and chondroitin are helpful for RA.
  
  
• Glucosamine appears to be safe for most people. However, it might worsen asthma through an allergic reaction. Also, glucosamine might cause higher blood sugar and insulin levels in people with diabetes, and those who decide to use it need to carefully monitor their blood sugar. Glucosamine could possibly decrease the effectiveness of certain medications--acetaminophen, some anticancer drugs, and antidiabetes drugs. Generally, side effects of glucosamine can include mild stomach problems and nausea; less commonly, there can be sleepiness, a skin reaction, or a headache. Some people who are allergic to shellfish are concerned about an allergic reaction to glucosamine. However, most shellfish allergies are to proteins in the meat, not to the shell material from which glucosamine supplements are made.
  
  
• Chondroitin appears to be safe for most people. However, chondroitin may possibly worsen asthma (through an allergic response), blood clotting disorders, and prostate cancer. The side effects of chondroitin can include stomach pain and nausea; less commonly, diarrhea, constipation, swelling, and problems with heart rate.
  
  
• Both supplements could affect the action of the drug warfarin, but this is not definite.

Alternative Rheumatoid Arthritis Treatments - Special Diets

Many people with RA are interested in whether certain foods can affect their symptoms. Examples of foods that are believed to possibly worsen the symptoms of arthritis (including RA) are the nightshade family of plants (white potatoes, tomatoes, eggplant, and peppers), dairy, citrus fruits, acidic foods, sweets, coffee, and animal protein. There are various theories about how foods may affect RA, including:

• The foods one eats and how the digestive system handles them are known to affect the immune system. Because RA is a disease of the immune system, a connection between diet and the disease has been proposed.
  
  
• Certain fats (mostly from animal sources, but also from corn and sunflower oils) break down in the body into substances that can cause inflammation.
  
  
• RA and/or medications to treat it may affect the way a person's digestive system handles foods.
  
  
• RA can affect a person's ability to prepare and eat food, leading to nutritional problems.

• There is no strong, reproducible evidence that any foods or diets have a specific role in causing or treating RA.
  
  
• It is important for people who have RA to eat a healthy, balanced diet.
  
  
• If one or more foods are eliminated from the diet, it is possible to miss key nutrients and not get enough calories. It is important to discuss any major dietary changes with your health care provider or a registered dietitian.
  
  
• A true food allergy may exist in a small percentage of patients with RA. Many people think they have food allergies when they do not have them or when they have a different condition called food intolerance.

Alternative Rheumatoid Arthritis Treatments - Acupuncture

Acupuncture is a practice that developed as a part of traditional Chinese medicine. Some people try acupuncture to treat RA pain or to treat the RA itself.

• Good research studies have shown that acupuncture can help relieve pain associated with osteoarthritis. However, not much is known about its effectiveness for symptoms of RA. A handful of small studies have been conducted, and the findings do not clearly answer this question. Issues with the studies have included design problems, a small number of participants, variations in where acupuncture was given on the body, and how many treatments were given and for how long. More and better research is needed.
  
  
• Acupuncture tends to have minimal side effects, if any. Relatively few complications from acupuncture have been reported to the FDA. If a person decides to use acupuncture, it is important to find a licensed and certified practitioner, as any complications have usually occurred from inadequate practitioner training and experience.

Alternative Rheumatoid Arthritis Treatments - Magnets

Magnets are objects that produce a type of energy called magnetic fields. The term "magnets" is also used to refer to consumer products that contain magnets. Examples include shoe insoles, clothing, wraps for parts of the body, and mattress pads. These are of a type called static magnets, because their magnetic fields are unchanging.

• The research so far does not firmly support claims that static magnets are effective for treating pain, including pain from RA. In those cases where some benefit was seen, it has not been proven why; many scientists think it may be due to a placebo effect. If someone does experience a benefit from a magnet, it will tend to occur quickly.
  
  
• Static magnets should not be used by pregnant women; people who have a condition--such as an acute sprain, inflammation, infection, or wound--that could be affected by dilation of the blood vessels; and people who use a device such as a pacemaker, defibrillator, or insulin pump, or who use a medication patch.

The second type of magnets used for health purposes are called electromagnets (EMs), because they produce magnetic fields only when electric current flows through them. EMs are used in conventional medicine to treat bone fractures that have not healed well, and they are being studied in research settings for a number of other conditions (including cancer, epilepsy, RA, and mental disorders). Some consumer products using EMs are available.

• EMs are being studied because there have been some encouraging early findings indicating the possibility of benefits for pain, physical function, and stiffness. However, it is too early to know for sure whether EMs are of benefit for patients with RA.
  
  
• EMs should not be used by pregnant women; people who have a condition--such as an acute sprain, inflammation, infection, or wound--that could be affected by dilation of the blood vessels; and people who use a device such as a pacemaker, defibrillator, or insulin pump, or who use a medication patch. It may be advisable for people who have a history of cancer or seizure disorder to avoid using EMs until more is known about their effects on these medical conditions.

Alternative Rheumatoid Arthritis Treatments - Hydrotherapy

Hydrotherapy is the use of water for therapeutic purposes. A few examples of hydrotherapy include bathing in heated water, as from hot springs or the sea; mineral baths; and water-jet massages. Another term used for hydrotherapy baths is balneotherapy.

Hydrotherapy dates back to ancient Greece and Rome. In recent centuries, it has been a popular treatment in Europe and Israel. Some forms of hydrotherapy are used in conventional medicine in the United States, such as whirlpool baths for athletic injuries and ice for sprains. As CAM, hydrotherapy is often combined with other treatments, such as exercises, massage, diets, herbs, and/or mud packs. It is used with the intent to benefit arthritis, circulation, and various other health issues, and to enhance feelings of relaxation and well-being. Some also claim that hydrotherapy "detoxifies" the body. In this report, the term hydrotherapy refers to external water treatments and not to internal treatments using water, such as colon irrigation or drinking specially treated water.

• A small number of controlled studies have been done on hydrotherapy for RA, most based on sea-bath treatments given in Israel's Dead Sea area. Most of these studies reported benefit. However, there have been quality issues noted with these studies, and it is not considered proven that the hydrotherapy itself provided the benefits for RA claimed in these studies. Larger and better studies are needed to answer this question. Study authors have noted that there could be other reasons for any benefit, such as traveling to a spa, being removed from one's daily routine, relaxation, socializing, etc.
  
  
• The safety of hydrotherapy has not been well studied. Overall, it appears to be a low-risk practice for most people if common-sense precautions are taken, such as not exposing the body to too much heat or cold or for too long a time, and being sure to drink enough fluid. However, hydrotherapy is riskier and could even be dangerous for certain people:
  • Those who have a condition that could be worsened by exposure to extremes of heat or cold (for example, heart disease, lung disease, circulation disorder, Raynaud's phenomenon, or chilblains) or by strong motions from water jets
  • Those who have difficulty perceiving temperature (for example, from neuropathy, or damage to the nerves)
  • Women who are pregnant
  • People who have implanted medical devices such as pacemakers or pumps
    
    
• Some people may get a skin irritation or infection from hydrotherapy water, either as a reaction to something in the water or if the water is not in sanitary condition.

Alternative Rheumatoid Arthritis Treatments - Homeopathy

Homeopathy is a whole medical system (examples of whole medical systems include traditional Chinese medicine, Ayurvedic medicine, homeopathy, and naturopathy) that was developed in Germany and brought to the United States in the 19th century. Homeopathy involves giving very small doses of substances called remedies that would produce the same or similar symptoms of illness in healthy people when given in larger doses. This approach is called "like cures like." The remedies are diluted very highly, often to a point where not one molecule of the original substance remains.

• Little rigorous research has been done on homeopathy for RA. The results have been mixed. It appears from some studies that homeopathy might be more effective than a placebo for rheumatic diseases and syndromes (including RA), but this evidence is not strong. Larger, better-designed studies are needed to resolve this question.
  
  
• Homeopathic remedies are considered safe and unlikely to cause severe side effects. The FDA has learned of a few reports of illness associated with the use of these remedies, but determined that the remedies were not likely to be the cause. Homeopathic remedies are not known to interfere with conventional drugs.

Alternative Rheumatoid Arthritis Treatments - Selected Mind-Body Techniques

Mind-body techniques draw upon the interactions that exist in health and disease between the mind, the emotions, the body as a whole, and various body systems (such as the immune, nervous, and endocrine systems). Some mind-body techniques are part of ancient healing traditions, others have emerged in recent times. Examples of mind-body techniques include meditation, tai chi, relaxation techniques, and spirituality for health purposes.

• Mind-body therapies have been applied to and studied for various types of pain. Results from clinical trials indicate that mind-body therapies may be effective additions to the treatment and management of arthritis, including RA and its pain.
  
  
• One analysis of clinical trials on mind-body therapies for RA has been published. These authors, who evaluated 25 trials and published their findings in 2002 also concluded that mind-body approaches may be effective additions to RA treatment. They noted that mind-body practices led to significant improvements in RA pain, disability, overall psychological state (psychological status), coping, and belief in one's own ability to handle situations (self-efficacy). Mind-body therapies appeared to be more helpful for people who had RA for a shorter period of time, not a longer period.
  
  
• There are still questions about mind-body therapies and RA that need to be answered by research, such as which among these therapies are most effective and, if they work, how they work.
  
  
• Spirituality may help people with RA in their quality of life, coping, and how they feel about their health, although the research so far has been limited, and often it has not looked at RA only. A 2003 study at Johns Hopkins University of people with moderate RA found that those who had "spiritual transcendence" had more happiness, joy, and positive perceptions of their own health. This was regardless of how severe their RA was or how well they could function.
  
  
• There have been some small studies on tai chi for RA. Tai chi is a practice from traditional Chinese medicine that uses specific postures along with gentle, slow movements; meditation; and coordinated breathing. These studies on RA have had conflicting results; some found improvement in daily functioning and certain symptoms, others did not. NCCAM is co-sponsoring a clinical trial that compares tai chi chih (a type of tai chi) to relaxation therapy for symptoms of RA. An earlier clinical trial by this team found tai chi chih improved physical functioning and immunity in healthy older adults. Other research as well has supported benefit from tai chi to older people on such outcomes as balance, postural stability, frailty, and prevention of falls. Tai chi is a relatively safe practice. It is done slowly and at low impact to the body.
  
  
• In mind-body therapies, there are relatively few physical and emotional risks, if any. A helpful aspect of most mind-body therapies is that they can be taught to users and practiced by them at times and places of their choice.

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Alternative Rheumatoid Arthritis Treatments