Alternative Therapies for Arthritis: The Good, the Bad and the Useless

More and more, people seeking alternatives to the conventional medications usually prescribed by physicians for arthritis. so far, there's no cure for most kinds of arthritis. That's disappointing for many of us - particularly given the proven record of conventional medicine in other areas, such as infections, accidents, and many life-threatening conditions. Indeed, it has contributed to a doubling of the average life expectancy in the past hundred years.

The result is that more people are living longer with chronic ailments - including arthritis. And, so far, medical research hasn't done as well with these chronic illnesses - conditions that mostly likely will not kill you but can make some people so miserable that life may not seem worthwhile on some days

There have been major breakthroughs recently in arthritis medications, especially for rheumatoid arthritis. However, many treatments have serious side effects. Methotrexate may cause liver damage, and glucocorticoids (such as prednisone) have many side effects including osteoporosis.

Even over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen can be dangerous: in 1999, 16,500 people in the U.S. died of gastrointestinal bleeding due to NSAIDs, more than died of AIDS in the U.S. that year. And so far, there is no cure for the most common kind of arthritis, osteoarthritis: the wear-and-tear joint degeneration that will affect most of us after age 65.

So it's no surprise people have been looking outside the medical establishment for treatments that promise to be milder, safer, and more natural, especially for pain relief. Pain can be a powerful motivator. And this isn't a fringe population: remember, most alternative therapies are not covered by insurance Users of alternative therapies tend to be middle class, middle aged, with some college education and fairly well-to-do.

For many years the Arthritis Foundation - and physicians -- have been concerned about the use of unproven therapies, and about what to tell the many people who have been pushing for answers. For a long time, the attitude was "don't ask, don't tell." An Arthritis Today survey confirmed that patients don't tell doctors they are experimenting with alternatives for fear of disapproval, and doctors don't ask.

Part of the problem has been that most doctors don't know enough about alternative therapies to be able to give you advice. That's beginning to change. Now, most medical schools have at least a course in alternative therapies, and several have added clinics and departments for complementary therapies. Some therapies are increasingly covered by some health insurers, such as Kaiser Permanente. Hospital for Special Surgery has an Integrative Care Center dedicated to such therapies. And the Arthritis Foundation has supported the research and publication of a book based on facts, not anecdotes - providing the scientific evidence - or lack of it - for a wide range of complementary therapies (The Arthritis Foundation's Guide to Alternative Therapies).

What are Alternative Therapies?

These therapies have long been called "alternative" because they have been defined by what they are not: healing philosophies or approaches not taught widely in medical schools and not generally used in hospitals and most medical practices. But, as described above, this definition is becoming increasingly inaccurate. Many of these therapies are now being taught, recommended and practiced by doctors, including biofeedback, meditation, yoga, and some supplements.

Today these are more likely to be called "complementary" or "integrative" because it's no longer "either/or." Now, they are often used in conjunction with conventional medicine.

Here's what complementary medicine techniques might do for you: ease symptoms such as pain, anxiety, stress, and depression; improve your outlook and attitude toward your arthritis; improve your quality of life; and enhance the effects of conventional medicine.

Here's what complementary medicine won't do: treat most acute illnesses; replace proven medical treatments; or cure chronic diseases such as arthritis. For example, herbs - which have been used for thousands of years, are often milder than conventional drugs although they generally act more slowly. Thus, they can be good for chronic ailments, especially pain, stiffness, inflammation, and depression.

Complementary medicine can help you heal. Remember: healing is not the same thing as curing. In one study, among patients who completed an Arthritis Self-Help Program, pain declined a mean of 20%, visits to physicians declined 40%, and physical disability increased 9%.

So - what works - and what doesn't? And how can you tell the difference?

"The Good"

"The Good" are therapies and modalities with few or no side effects and some evidence that they actually work, which includes some physical and psychological modalities.

Exercise strengthens muscles, helps control weight, aids balance, helps prevent falls, relieves stress, and helps pain management and depression. For example, in a small study at the Korean National University of adults over 64 with osteoarthritis, participants reported significantly less pain and difficulty in daily activities after 12 weeks of Tai Chi.

Mind-body practices include meditation, guided imagery, deep relaxation, and breathing exercise. All can help you reduce stress and ease pain and depression. They may enhance the effects of conventional medicine. Some mind-body practices are also exercise: Yoga, Tai Chi and Qi Gong may be considered forms of "moving meditation"

Prayer is an "alternative" that many people report works best for them. Many of the benefits may come from the meditative and relaxation attributes of prayer, or the benefits of being part of a community. Studies show that people who attend religious services live longer, better, and healthier lives.

Acupuncture is an ancient Asian technique that involves inserting needles into selected areas of the body. It provokes a cascade of physiological responses, including the release of endorphins (our body's natural pain killers). It's used mostly for pain relief, and the evidence for its benefits is strongest for osteoarthritis and fibromyalgia; results have been mixed for rheumatoid arthritis.

Massage and bodywork help relieve stress, break the pain cycle, keep muscles flexible - and it feels good. Several studies show massage can help people cope better with pain.

Healthy Nutrition is basic for good health - but fad diets are not. Beware of fasting or any other fad diet that eliminates important nutrients. A wide range of dietary advice has been given to people with arthritis, and much of it is rubbish. There's no evidence that avoiding nightshade foods (tomatoes, eggplants and potatoes) eases arthritis symptoms, for example. The only diet that has any research evidence is a vegetarian diet, such as that proven to help reduce atherosclerosis, which also may help reduce arthritic inflammation.

Dietary Supplements

Dietary supplements fall into all three categories - good, bad and useless - depending on the supplement.

Herbs and other botanicals, vitamins, and minerals are often promoted as being better because they are "natural." It's important to remember that just because it's "natural" doesn't mean its safe. Poison ivy is natural - and so is snake venom. Further, anything strong enough to help you is also strong enough to hurt you.

Also, supplements are not regulated as medicine. They do not have to be proven to be effective or even safe before they are sold. So even if you're considering a supplement that has been shown to be of benefit in arthritis, lack of regulation is a major problem for consumers. There's no quality control and no guarantee that you're getting what it says on the bottle.

Some supplements have been shown to help. Supplements that may be worth trying, in consultation with your physician include:

• for osteoarthritis, glucosamine, chondroitin, SAM-e, and vitamins E, C and D;
• for rheumatoid arthritis, lupus, and other inflammatory types of arthritis - omega-3 oils, GLA oils, ginger, and vitamin E;
• for lupus - vitamin B6 and folic acid and DHEA.

"The Bad" - A Brief Line-Up

A number of dietary supplements are not only useless in the treatment of arthritis but are also potentially dangerous - even life-threatening. Do not take: kava kava, St. John's wort, ephedra (Ma Huang), Tripterygium Wilfordia ("Thunder god vine"), nor DMSO. Kava kava has been linked to liver toxicity, including hepatitis, cirrhosis, and liver failure. St. John's wort can cause photosenstivity and may interact or interfere with many drugs, including oral contraceptives and may drugs for HIV. "Thunder god vine" may lower bone density in women with lupus

Don't take DHEA (dehydroepiandrosterone) unless it has been prescribed for you by a physician. Not only may over-the-counter DHEA be non-biologically available (which means it just passes through your body and out in your urine without doing anything), but even active doses are unreliable.

Also beware of mystery supplements and "miracle" mixtures. You have no idea what's in them - and it could be dangerous supplements or even overdoses of useful drugs, such as corticosteroids.

The Useless

Many products promoted for arthritis are probably safe but are useless - with no benefits supported by research - and are therefore a waste of your money. These include: static magnets, homeopathy, copper bracelets, apple vinegar and cider, many herbs and other dietary supplements, and guaifenesin for fibromyalgia.

Good Advice for Trying Complementary Therapies

Before you try any therapy, find out what's really wrong with you from a physician. Get a diagnosis, and see what the doctor recommends. Then do some research on whatever you are considering. Read some books, check reputable Internet sites (see below), talk to others who have tried it, and discuss it with your doctor. Learn about interactions with your other medical treatments. Ask about side effects, and consider all the costs

If you try any exercise or movement program or other physical modality, such as massage or acupuncture, make sure the instructor or therapist has experience working with people with your type of arthritis. Ask about qualifications and licenses. Practitioners without such knowledge can do more harm than good.

Beware of these "tip-offs to rip-offs:"

• It's a "secret formula;"
• It's an "amazing" or "miraculous" breakthrough;
• The medical establishment supposedly wants to suppress it;
• It's advertised in the back pages of magazines, by direct mail, or in ads that pretend to be news articles;
• The only "evidence" is testimonials.

Although many complementary therapies may be well worth trying, all need more study and none should be undertaken without telling your physician.

Resources: Books

The Arthritis Foundation's Guide to Alternative Therapies, by Judith Horstman
Overcoming Arthritis: How to relieve pain and restore mobility with a unique tai chi program, by Paul K. Lam and Judith Horstman
Strong Women and Men Beat Arthritis, by Miriam E. Nelson, Laurence Linder, Kristin Baker, Ronenn Roubenoff, Lawrence Lindner
Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain and illness, by Jon Kabat-Zinn
The Arthritis Helpbook, by Kate Lorig and James Fries

Websites

The Arthritis Foundation - Information, articles and resources about arthritis and foundation programs. 

The National Center for Complementary and Alternative Medicine - Information about alternative therapies and research.

PubMed - The National Library of Medicine service providing access to millions of scientific article citations and abstracts, some with links to full articles. 

HerbMed.org - An herbal database of scientific data on use of herbs for health.

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posted 9/20/2002

Adapted from a lecture by Judith Horstman by Diana Benzaia.