If stiff and sore joints bother you only some of the time, you may not have seen a doctor for a diagnosis. But you’ve probably tried some arthritis remedy you heard from a neighbor or friend. And if you’re being treated for arthritis by a doctor, your pain is probably great enough that you’re even more likely to try something outside your conventional treatment.
While arthritis generally means stiff and painful joints, it is not one disease but more than 100. What’s helpful for degenerative osteoarthritis (the most common kind) may not be for rheumatoid arthritis, gout or other forms. And, in many cases, patients suffer persistent pain and activity limitations, regardless of treatment.
To deal with these problems, studies show, more than 60 percent of Americans with arthritis make use of complementary or alternative medicine. Surveys indicate that pain is the primary driver.
Complementary/alternative medicine (CAM) is the term generally used for products and practices that are not considered part of standard medical care. Some of these have been proven safe and effective; others have not.
Actually, the two most effective self help measures, weight loss and moderate exercise, are not considered complementary medicine. Both rank high on any conventional treatment plan based on ample evidence that they may be the most effective thing you can do for sore, aching joints.
Even moderate weight loss helps take pressure off weight bearing joints. But studies show that it also helps relieve symptoms from arthritis of the hand–probably because of metabolic changes.
Physical activity improves circulation, lubricates the joint and strengthens adjoining muscles. Without it, the stiffness, soreness and disability will only get worse. Exercise should be regular, though, and care should be taken not to over-stress or damage the affected joints.
YOGA AND TAI CHI are natural choices to complement whatever treatment is used, particularly for patients with osteoarthritis. Both involve simple, gentle movements that focus on strength, balance and flexibility. With origins in ancient eastern philosophy, they also stress the integration of mind and body in a way that should help mediate and control pain.
More than 75 studies in major medical journals have found yoga to be a safe and effective way to exercise with important psychological benefits.
One study of 17 patients with osteoarthritis of the fingers found that subjects receiving 60-minute group sessions of yoga had decreased pain and improved range of motion compared to control subjects. Grip strength and joint circumference were unchanged, however, after 10 weeks.
A review of five studies found that rheumatoid arthritis patients practicing tai chi reported improvement in disability, mood and vitality but no change in pain or functional ability. Results for fatigue and swollen joints were inconclusive.
Among osteoarthritis patients, a randomized, controlled study by researchers at Tufts Medical Center found that tai chi subjects showed greater improvement in pain, physical function, depression, self efficacy and health-related quality of life compared to a control group.
OTHER MIND-BODY TECHNIQUES such as meditation, biofeedback and relaxation therapy are frequently used to control pain, A 2002 review of research found that they could provide beneficial effects if added to conventional medical treatments. Subjects most likely to benefit were those with a shorter duration of pain.
ACUPUNCTURE is a traditional Chinese practice that has many advocates. The first large randomized, controlled study of acupuncture published in Annals of Internal Medicine [December 21, 2004] found that the procedure relieved pain and improved function of patients with osteoarthritis of the knee.
A more recent study [Arthritis Care and Research, September, 2010] found that patients with osteoarthritis of the knee treated with acupuncture had no greater benefits than those getting a sham acupuncture, or placebo. While subjects reported a small decrease in pain, it was no greater than that reported by the control group.
MAGNETS, in the form of patches, disks, shoe insoles, bracelets and mattress pads are widely marketed for pain control. While they are generally safe for most individuals, studies have provided no convincing scientific evidence that magnets are effective in relieving pain.
Some studies have suggested that magnets might provide some relief from osteoarthritis pain. More rigorous research is required before any conclusions can be made about the role of magnets in pain relief.
HYDROTHERAPY or mineral baths were widely used in the early part of the 20th century and still offer appeal to many patients. A 2008 Cochrane review of seven studies found positive findings from most studies but flaws in methodology that made it impossible to draw conclusions. Some improvements were noted in morning stiffness and grip strength.
GLUCOSAMINE AND CHONDROITIN are substances naturally found in and around the cells of cartilage. Supplements, usually combining the two, are commonly isolated from shellfish and used as a complementary treatment for osteoarthritis based on the belief that these substances can strengthen cartilage.
The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) is the first large-scale study to test the effectiveness of these supplements in reducing the pain and diminishing the structural damage of osteoarthritis of the knee. Results from June of 2010 [Annals of Rheumatic Diseases] found that patients taking glucosamine (1,500 milligrams daily), chondroitin (1,200 milligrams daily) or both had similar results as those taking placebo. For a small subset of subjects with moderate to severe pain, however, the supplements did provide pain relief.
OTHER SUPPLEMENTS used as complementary treatment include fish oil, gamma linolenic acid (GLA), tumeric, ginger, valerian, feverfew and thunder god vine–all believed to have antiinflammatory properties. All have their advocates, but scientific evidence of their effectiveness is either weak or inconclusive.
One major reason not to use dietary supplements is that they are unregulated. You cannot be sure that what you’re getting is what the package claims. In many cases these supplements interact negatively or reduce the effectiveness of prescription medications.
Most doctors have no quarrel with complementary medicine. In fact, many recommend yoga, tai chi or certain dietary supplements in addition to conventional therapy. They prefer, however, to know about these self treatment measures so they can be sure the patient is not doing or taking anything that could be risky or work against the doctor’s treatment plan.
REFERENCES:
“Acupuncture not superior to sham acupuncture in knee osteoarthritis,” Arthritis Care Research News Alerts, September 3, 2010.
“Acupuncture relieves pain and improves function in knee osteoarthritis,” National Center for Complementary and Alternative Medicine, December 21, 2004.
D. Lonnie Anderson, Pharm.D., et al, “Prevalence and patterns of alternative medication use in a university hospital outpatient clinic serving rheumatology geriatric patients,” Pharmacotherapy, August, 2000.
Arthritis Care, “Complementary therapy,” last modified August 18, 2011.
Majid Artus, et al, “The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain,” BMC Family Practice, July 26, 2007.
Arthritis Foundation, “Alternative therapies.”
Sarah Brien, et al, “Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy,” Rheumatology, 2011;50(6):1070-1082.
Allison Gandey, “Patients in pain more likely to choose alternative medicine,” Medscape Medical News, October 19, 2005 (Arthritis and Aging, October 15, 2005).
Martin Garfinkel, EdD, “Yoga as a complementary therapy,” Geriatrics and Aging, 2006;9(3):190-194.
“Glucosamine/chondroitin arthritis intervention trial (GAIT): primary and ancillary study results,” National Center for Complementary and Alternative Medicine, June, 2010.
Steffany Haaz, MFA, RYT, “Yoga for people with arthritis,”Johns Hopkins Arthritis Center, updated June 23, 2009.
Steffany Haaz, MFA, RYT, “Complementary and alternative medicine for patients with rheumatoid arthritis,” Johns Hopkins Arthritis Center, updated December 19, 2008.
Nancy A. Melville, “Chondroitin sulfate shows efficacy for hand osteoarthritis,” Medscape Medical news, September 8, 2011.
National Center for Complementary and Alternative Medicine, “Magnets for pain,”“Cat’s claw,”“Evening primrose oil,” “Feverfew,” “Ginger,”“Thunder god vine,”“Tai chi may benefit older adults with knee osteoarthritis.”
Richard S. Panush, M.D., MACP, MADCR, et al, “Patient information: complementary therapies for rheumatoid arthritis,” uptodate.com, last literature review version, January, 2012.
Vijitha de Silva, et al, “Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis,” Rheumatology, 2011;50(5):911-920.
“Supplements for your condition,” Arthritis Today.
“Two-year study of knee osteoarthritis pain reports similar outcomes with glucosamine and chondroitin, celecoxib, and placebo,” National Center for Complementary and Alternative Medicine, June 4, 2010.
W. Zhang, Ph.D., et al,/ “OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines,” Osteoarthritis and Cartilage, 2008;16:137-162.
2/28/2012
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