Arthritis alternative

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

People with the most common form of arthritis, osteoarthritis, frequently turn to complementary or alternative therapies.

In 1997, a national survey, published in the Annals of Internal Medicine, reported that 26 percent of people with self-reported arthritis had used a complementary or alternative therapy within the previous 12 months. The same year, another survey reported that nearly two-thirds of rheumatology patients used complementary or alternative therapies, with osteoarthritis patients constituting the most frequent users.

Patients taking alternative medicine treatments for arthritis are more likely than previously thought to discuss the alternative therapy with their physicians, according to a new study. In addition, very few are afraid their doctors will disapprove.

However, the study found that many patients were justifiably concerned about potential interactions between conventional medicines and alternative treatments, such as herbs or large doses of vitamins.

The study examined 232 patients who saw rheumatologists at six different clinical settings in Indianapolis: a municipal hospital that cares for the poor, a veterans' hospital, a fee-for-service specialty-care practice and three private rheumatology practices. It found that about two-thirds of the patients had used some form of alternative medicine at least once.

One surprising finding was that many patients were using multiple forms of alternative medicine. The study found that 24 percent had used at least three different forms of alternative treatment.

Of those who did not tell their doctor about the alternative treatments, only 15 percent said it was because they feared the doctor would disapprove, the study found. It also found 55 percent said the doctor did not ask and 49 percent said they meant to tell the doctor but forgot.

Among those who did tell their doctor, 71 percent said their doctors told them it was acceptable to keep using the alternative treatments, while 14 percent said their doctors told them to stop.

The study also found that college-educated patients were more likely to use alternative treatments than those without degrees.

One limitation of the study was that it did not examine the attitudes of people who rely exclusively on alternative healing and avoided physicians altogether.

Information from the National Institutes of Health

The most common complementary and alternative remedies are discussed below…

Acupuncture is an integral part of traditional Chinese medicine.

According to traditional Chinese medicine,acupuncture works by restoring the flow of vital energy (qi), which is interrupted by disease. The Western explanation is that acupuncture stimulates endogenous opioid production in the body. One study demonstrated this by showing that acupuncture was ineffective in relieving tooth pain in patients given the opioid antagonist, naloxone.

Acupuncture studies are difficult to perform because of the confounding results arising from the placebo effect.

Based on a systematic review of all published trials from 1966-1999 by J. Ezzo in Arthritis and Rheumatism, it was found that acupuncture was more effective than sham acupuncture for treatment of osteoarthritis knee pain. Another study by S.Y. Junnila showed that acupuncture was more effective for pain relief than piroxicam, a non-steroidal anti-inflammatory drug (NSAID), in the treatment of knee, shoulder, and hip osteoarthritis after two weeks.

Potential adverse effects of this treatment include needle pain, fatigue, bleeding, and rarely pneumothorax. As a result, those patients on anticoagulants and who have bleeding tendencies should avoid acupuncture. Other contraindications include pregnancy (acupuncture can stimulate uterine contractions), implanted defibrillators (avoid electroacupuncture), and patients with active infection.

Acupuncture appears to be a relatively safe method of pain relief for osteoarthritis, and may have its effects potentiated by combining it with NSAIDs or narcotics.

Bee venom therapy, has been used for treatment of a variety of conditions, including osteoarthritis. It involves either having a bee placed near a painful joint and allowing the bee to sting the patient or by injecting purified bee venom near the joint. Bee venom contains phospholipase A and melittin, as well as hylauronidase, apamin, mast cell-degranulating peptide, and adolapin. It has been shown to inhibit neutrophil superoxide and hydrogen peroxide formation, which has been hypothesized to block free radical formation.

The most severe side effect is anaphylactic shock. Anyone engaging in this type of therapy should have an Epi-pen within reach in case an allergic reaction begins.

Used for many years in Europe, glucosamine and chondroitin have gained popularity in the United States. Recent research supports its effectiveness. A study of more than 200 patients with osteoarthritis published in the British journal Lancet in January 2001 reported that people treated with glucosamine had fewer symptoms and exhibited less progressive damage on X-rays than did people treated with placebo. Some experts believe, however, that the improved X-ray findings resulted from flawed radiographic techniques.

Although glucosamine's effect on joint damage is still debated- the GAIT trial from the NIH is widely regarded as a negative study- many medical experts believe this supplement reduces pain and is safe. The usual dose is 500 milligrams three times a day. It may take four to eight weeks to get significant benefit, and like most remedies, glucosamine does not work for everyone. Consider stopping after twelve weeks if there is no improvement.

Another supplement, S-adenosylmethionine (SAM-e), is not as well studied or accepted in the United States as glucosamine/chondroitin. Most studies of this agent are of insufficient quality to draw firm conclusions. One study of SAM-e found the supplement to have similar benefits as naproxen (Naprosyn, Aleve), used to relieve pain and inflammation.

DMSO and MSM are two common substances that are available commercially for the treatment of osteoarthritis. Notably, MSM is an oxidation product of DMSO and is therefore closely related to it.

DMSO is a widely-used industrial solvent. Used in the 1960's for a veterinary ointment as well as a popular "cure all", it is only FDA-approved for treatment of interstitial cystitis.

DMSO is also found in paint thinners and anti-freeze and since it's available to the general public only in industrial form, it is not recommended for human use.

It has been postulated that DMSO may increase free radical scavenging and reduce prostaglandin production, but this has only been shown to work in vitro, not in vivo. In addition, animal models may show reduced C fiber nerve conduction, which would then show pain-relieving properties. It is also available in the topical non-steroidal preparation, Pennsaid. The DMSO helps with the tissue penetration of the active ingredient, diclofenac.

The adverse effects seen with DMSO (used topically) is skin redness and warmth. Also, even with topical use, one may develop a funny taste in the mouth and body odor similar to that after ingesting garlic or oysters.

MSM is an oxidation product of DMSO and is therefore felt to have many of the same properties as DMSO.

MSM is synthesized from DMSO and is available in many commercially prepared compounds.

MSM was studied in one placebo-controlled trial conducted by R.M. Lawrence in The International Journal of Anti-Aging Medicine. It was shown that pain reduction was 80% at six weeks in the MSM group and 18% in the placebo group. The dose of MSM was 1225 mg twice per day.

MSM's adverse effects include gastrointestinal upset and diarrhea.

Some herbs, including evening primrose, ginger, stinging nettle and curcumin, have also been used for arthritis pain. Well-controlled studies supporting their use are sparse.

Always discuss the use of herbs or other supplements with your doctor to check for interactions and side effects.

Before seeking an herbal therapy practitioner, first consult with your doctor. Another source of information is the National Center for Complementary and Alternative Medicine. Search their Web site to find research centers at universities and medical schools throughout the United States that are conducting studies on complementary and alternative therapies. Try to find the name of a researcher near you who is conducting an herbal study; find out if that person provides guidance to patients as well.

Homeopathy is based on administering tiny (often undetectable) amounts of a substance that in higher doses might cause symptoms or disease in healthy persons. Scientific evidence of benefit is lacking. A recent review in a British homeopathic journal identified only four methodologically sound studies and concluded that the available studies "do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis."

Evidence that antioxidant vitamins can prevent arthritis is lacking. Fish oil capsules (containing omega-3 fatty acids) may decrease pain and swelling in some people with rheumatoid arthritis. Fish oil for osteoarthritis cannot be recommended yet, although there are many people who take it regardless. Omega-3 fatty acids have other health benefits, most notably related to heart disease. Fish that are especially rich in omega-3 fatty acids include salmon, mackerel, herring and sardines. But there is no proof that eating more fish to treat rheumatoid arthritis makes any difference.

Magnet therapy is popular, but again the scientific evidence of its benefit is lacking. Magnets are sold in various strengths, but there is no proof that one strength is better than the next. Or if any strength magnet really helps. A word of caution, keep them away from your computer, cell phone, and credit cards!

Efforts to find food allergies that cause arthritis have not yielded definitive results. The most common approach is to eliminate vegetables from the nightshade family: white potatoes, tomatoes, peppers and eggplant. Tobacco also belongs to this family. (Of course, there are more compelling reasons to avoid tobacco than its effect on arthritis.) Some people with arthritis also feel that dairy products aggravate their symptoms.

If you suspect food allergies may be affecting your arthritis (for example, if your symptoms become worse after you eat certain foods), keep a record of what you eat for several weeks, along with notes about your arthritis symptoms. Eliminate from your diet foods that seem to cause trouble; after a period of time, gradually reintroduce these foods one at a time, noting any change in symptoms. Research-based evidence on the value of this approach is lacking, but diet therapy still may be worth a try. Consider a food allergy test if still unsure.

While not considered true "alternative therapies", exercise and weight control are among the most effective self-help measures for alleviating the symptoms of osteoarthritis (and perhaps other types of arthritis). The objective is to improve or maintain cardiovascular fitness, range of motion and muscle tone while avoiding excessive stress or injury to joints. Walking, biking, cross-country skiing and swimming are the best choices.

In one study, 33 adults with arthritis reported being better able to manage their disease symptoms and enjoyed better health after a three-month tai chi program; another study found improved balance and abdominal muscle strength. Other studies of moderate, low-impact exercise have suggested a benefit in arthritis symptoms. Guidelines for appropriate exercise may be obtained from the Arthritis Foundation (800-283-7800). If you have arthritis, consider setting up an exercise program with the advice of a physician or physical therapist. He or she can also suggest effective weight control measures if needed.

Many arthritis sufferers find that warm showers and baths -- particularly whirlpool baths -- are often helpful in reducing pain and stiffness, especially first thing in the morning. For arthritis in the hands, the simple act of squeezing a sponge in a basin or sink full of warm water provides gentle exercise and relief of stiffness. Warm, wet compresses, especially castor oil compresses (available where specialty health products are sold), may provide comfort for sore joints.

Massage by an expert in therapeutic massage can contribute to an overall feeling of relaxation and well-being. There are many types of massage, including Western, Swedish, deep-tissue and neuromuscular. A massage therapist can teach you some do-it-yourself techniques.

You can find a qualified practitioner by asking your physician or by contacting a professional massage therapy association.

Yoga comes from the teachings of Patanjali, an eastern philosopher who stated that health is achieved through harmony of mind, body, and spirit. In Westernized yoga, the focus is on strength, flexibility, and relaxation.

In one randomized controlled trial conducted by Garfinkel, et al in The Journal of Rheumatology, yoga performed for hand osteoarthritis regularly for 10 weeks yielded statistically significant decreases in finger joint tenderness, range on motion, and hand pain with activity. Notably, this study was very small (30 patients total) and lacked an active intervention control (i.e. "sham yoga"). Adverse effects are rare, but extreme yoga positions should be avoided.

Some people find that meditation and other stress-reduction techniques help them to relax and better adjust the pace of their lives to the limitations imposed by their arthritis.

Studies now underway should shed light on which treatments are helpful and which are a waste of time, money and faith. In addition, the reasons a treatment may work -- including the possibility of a placebo effect -- may also be sorted out in the next few years when the results of carefully performed studies are published. Even if it turns out that patients are better because of a placebo effect (in which the expectation of benefit from an inactive treatment somehow induces improvement), learning how to harness that effect may prove highly useful and safe.

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