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Rheumatoid arthritis (RA) is a chronic disease that affects the joints, often those in a person's wrists, fingers, and feet. (Terms that are underlined are defined "Definitions".)
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).a This report answers some frequently asked questions on this topic and suggests sources for more information.
aCAM 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
CAM.
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 a CAM treatment that is unproven.
- Many CAM therapies 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 CAM therapies discussed in this report have been proven
to be of benefit for RA. Some--such as thunder god vine (which is not
currently available in a safe American-made product), 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 CAM
therapies you are using or considering for RA. This is for your safety
and a comprehensive treatment plan.
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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.
To find out more about RA, contact the National Institute of Arthritis and Musculoskeletal and Skin Diseases (see "For More Information").
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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.
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Why do some people with rheumatoid arthritis use CAM, and what do they use?
Among the many reasons that some people use CAM 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
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What CAM therapies for rheumatoid arthritis are discussed in this report?
Many types of CAM are tried for RA, such asb:
- 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 or massage
It is beyond the scope of this report to discuss the scientific
evidence about all CAM therapies 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.c In reading about them, you
will also see some general points to consider about similar therapies
(for example, other botanicals). You can seek science-based information
on any CAM therapy that interests you through some of the resources
listed in "For More Information."
b Information on these or any other CAM therapies can be obtained from the NCCAM Clearinghouse (see "For More Information").
cReferences for
the discussions on therapies are listed at the end of this report. They
consist of recent peer-reviewed literature in English in the National
Library of Medicine's PubMed database; two evidence-based databases on
natural products; and other Federal Government publications.
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Therapies Discussed in This Report
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About Dietary Supplements
Dietary supplements were defined in a law passed by Congress in
1994. A dietary supplement must meet all of the following conditions:
- It is a product (other than tobacco) intended to supplement the
diet, which contains one or more of the following: vitamins; minerals;
herbs or other botanicals; amino acids; or any combination of the above
ingredients.
- It is intended to be taken in tablet, capsule, powder, softgel, gelcap, or liquid form.
- It is not represented for use as a conventional food or as a sole item of a meal or the diet.
- It is labeled as being a dietary supplement.
Other important information about dietary supplements:
- They are regulated as foods, not drugs, so there could be quality issues in the manufacturing process.
- Supplements can interact with prescribed or over-the-counter medicines, and other supplements.
- "Natural" does not necessarily mean "safe" or "effective."
- Consult your health care provider before starting a supplement,
especially if you are pregnant or nursing, or considering giving a
supplement to a child.
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What are some important points to keep in mind if I have rheumatoid arthritis and am thinking about
using CAM?
- 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
CAM treatment that is 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 CAM therapy. 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. NCCAM has publications on
these topics (see "For More Information").
- The claims for many CAM therapies 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 CAM to treat a child, should use extra caution and be sure to
consult their health care provider.
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What is known from the scientific research about whether these CAM treatments for rheumatoid arthritis are effective and safe?
1. 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.
Thunder God Vine
Thunder god vine (TGV for short; botanical name Tripterygium wilfordii
Hook F) is a perennial vine native to China, Japan, and Korea.
Preparations made from the skinned root of TGV have been used in
traditional Chinese medicine to treat inflammatory and autoimmune
diseases. Interestingly, TGV also has a history of use to kill insects
in farm fields.
Effectiveness and safety
- Some anti-inflammatory and immune-system-suppressing activity for TGV has been seen in laboratory and animal studies. The first clinical trial
on TGV in the United States (the earlier ones were done in China) was
carried out at the University of Texas Southwestern Medical Center and
the National Institutes of Health (NIH). Its results were published in
2002. Twenty-one patients for whom conventional RA treatment had not
worked completed the trial. Eighty percent of those who received a
high-dose TGV extract and 40 percent of those who received a low-dose
TGV extract experienced improvement in RA symptoms and physical
functioning. No one in the placebo group improved. Longer and larger studies are needed to confirm these findings and to find out more about TGV.
- Parts of the TGV plant are dangerous. The leaves, the flowers, the
main stem, and the skin covering the root are poisonous, to a point
that they could cause death. People should never try to make TGV
medications themselves.
- Currently, there are no consistent, high-quality TGV products being
manufactured in the United States. Preparations of TGV made outside the
United States (for example, in China) can sometimes be obtained, but it
is not possible to verify whether they are safe and effective. An
expert from the University of Texas/NIH study advises that consumers
not use TGV until reliable TGV preparations become available.
- If taken for a long time (according to one study, for more than 5
years), TGV may decrease the density of the minerals in women's bones,
which would be of special concern for women who have osteoporosis
or are at risk for it. If taken at high doses, TGV could suppress the
immune system and increase the effects of immune-suppressing drugs.
- The TGV extract made for the NIH study discussed above was well
tolerated by study participants. However, side effects can occur and
may include stomach upset, diarrhea, skin rash, changes in menstrual
periods, and hair loss.
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.
Effectiveness and safety
- 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.
Fish Oil
Fish oil contains high amounts of two omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). As with GLA, the body can use omega-3s to make substances that reduce inflammation.
Effectiveness and safety
- 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.d 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 aftertaste, belching, stomach
disturbances, and nausea.
dTwo Federal publications are "Mercury Levels in Commercial Fish and Shellfish" and "What
You Need to Know About Mercury in Fish and Shellfish: Advice for Women
Who Might Become Pregnant, Women Who Are Pregnant, Nursing Mothers, and
Young Children" are available online. They are copublished by the
U.S. Department of Health and Human Services and the U.S. Environmental
Protection Agency.
Valerian
The herb valerian has a history of use for sleep problems and anxiety
disorders. Disrupted sleep has been called a common and often neglected
symptom of arthritis. A large, nationally representative survey of
people over 65 with arthritis in 2000 found that disruption of sleep,
among all the disruptions of arthritis, was the main reason that people
sought a variety of CAM, self-care, and conventional medical
treatments. Valerian has also been taken for other reasons, such as the
intent to relieve muscle and joint pain. The species of valerian most
used in American supplements is Valeriana officinalis.
Effectiveness and safety
- The evidence suggests that valerian has at least mild benefits for sleep problems in the general population, including insomnia.
It has been theorized that valerian may have benefit for people with
sleep problems from RA. However, research on valerian for RA
specifically has not been done to answer this question.
- There is not much evidence on how long it is safe to take valerian and which dose to use.
- There is not enough reliable evidence to declare whether valerian
is effective for muscle and joint pain, including pain from RA. There
may be some biological basis for the theory that valerian could be
beneficial for musculoskeletal pain.
- Valerian is considered generally safe. However, it should not be taken with sedative
drugs (for example, alcohol, benzodiazepines, or narcotics) or other
sedative herbs (such as melatonin, SAMe, or St. John's wort). Valerian
will increase sedative effects. People who are taking antifungal drugs,
statins, or certain anti-arrhythmia drugs should not take valerian.
Valerian may not be safe for people who have a liver disorder or are at
risk for one. After taking valerian, caution should be used in driving
or using dangerous machinery. Side effects of valerian can include
drowsiness in the morning, headache, stomach problems, excitability or
anxiety, and sleeplessness.
Four Other Botanicals
Three of the other botanicals marketed with claims to benefit arthritis pain are:
- Ginger
- Curcumin (a component of the spice turmeric)
- Boswellia (also called Indian frankincense, made from the resin of a tree that grows in India)
These three botanicals have a history of use in Ayurveda to treat
inflammatory conditions. Based on some early findings that may indicate
promise, NCCAM is supporting studies at the University of Arizona on
these three botanicals, to increase scientific knowledge about them and
determine whether they are helpful for chronic inflammatory conditions
such as arthritis and asthma.
A fourth botanical, feverfew, has been used in folk medicine with an
intent to treat arthritis, migraine, and other conditions. One small
published clinical trial was located for this report. It found no more
benefit from feverfew than from the placebo. Overall, feverfew has not
been proven to help RA symptoms.
Safety
- Ginger's possible side effects include stomach upset, diarrhea, and
irritation to the mouth and throat. Ginger is not recommended for
people who have a bleeding disorder, a heart condition, or diabetes.
Ginger may further slow blood clotting when combined with other herbs
and drugs that slow blood clotting; add to the blood-pressure-lowering
effects of drugs for high blood pressure and heart disease; and add to
the blood-sugar-lowering effects of diabetes drugs.
- Curcumin can have side effects of stomach problems, including
nausea and diarrhea. Curcumin could add to the effects of other herbs
and drugs that slow blood clotting. Curcumin can cause gallbladder
contractions and should not be used by people with gallbladder disease
or gallstones.
- Boswellia can have side effects of stomach pain, stomach upset,
nausea, and diarrhea. It is not known whether boswellia interacts with
any drugs, supplements, or diseases and conditions.
- Feverfew appears to be safe for short-term use, but the safety of
long-term use is not known. Feverfew can cause an allergic reaction,
especially in people who are allergic to the daisy family. Side effects
can include diarrhea and other stomach upsets. Chewing fresh leaves of
feverfew may cause mouth irritation and sores. Feverfew might interact
with medications broken down by the liver and increase the actions of
drugs that slow blood clotting. Pregnant women should not take feverfew.
Glucosamine and Chondroitin
Glucosamine sulfate (glucosamine for short) and chondroitin sulfate
(chondroitin) are popular dietary supplements for arthritis. They are
sold separately, in combination with each other, and in other
combinations.
Glucosamine is a substance found in the fluid around the joints. It
can also be obtained from the shells of shrimp, lobster, and crabs, or
made in the laboratory. The body uses glucosamine to make and repair
cartilage, a firm but flexible tissue that covers the ends of bones,
keeps them from rubbing against each other, and absorbs the force of
impact.
Chondroitin is a substance found in the cartilage around joints. As
a supplement, it is obtained from sources such as sharks and cattle.
Effectiveness and safety
- 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.
2. 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.
Effectiveness and Safety
- 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. To find out more, see the National Institute of Allergy
and Infectious Diseases in "For More Information."
3. 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. For more about acupuncture, see NCCAM's fact sheet
"Acupuncture."
Effectiveness and Safety
- 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.
4. 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.
Effectiveness and Safety: Static Magnets
- 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.
Effectiveness and Safety: Electromagnets
- 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.
For more about magnets, see the NCCAM fact sheet "Questions and Answers About Using Magnets To Treat Pain."
5. 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.
Effectiveness and Safety
- 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.
6. Homeopathy
Homeopathy is a whole medical system 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. For more about homeopathy,
see NCCAM's fact sheet "Questions and Answers About Homeopathy."
Effectiveness and Safety
- 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.
7. 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.
Effectiveness and Safety
- 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"e
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.
e In this study, spirituality was
described as something "often viewed as an intrinsic quality of the
individual, a desire for personal connectedness with a transcendence
reality." This was different from religiousness, "an outward practice
of a particular spiritual understanding and/or the framework of
beliefs, values, and rituals," although the authors noted that this
distinction is difficult. Spirituality was measured using a scale
designed to evaluate "the capacity of an individual to stand outside of
his/her immediate sense of time and place and to view life from a
larger, more detached perspective."
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Is NCCAM funding research on CAM therapies for rheumatoid arthritis?
Yes. Examples of recent studies include:
- Fish oil, borage seed oil, or a combination of both, to determine if they affect RA symptoms
- Mindfulness-based stress reduction (a type of meditation), to determine if it affects RA symptoms
- Low-strength electromagnetic fields, to see whether they have an
effect on pain, fatigue, sleep quality, mood, and inflammation in
postmenopausal women with RA
Recently published NCCAM-supported research on RA has included:
- A 2004 review of valerian for sleep disturbances from RA
- A 2003 review of studies on selected CAM therapies for arthritis-related pain, including RA pain
- A 2002 review of studies on mind-body therapies for RA
These and many other reports on NCCAM-supported research may be located in the CAM on PubMed database (See "For More Information").
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Definitions
Acupuncture: A family of procedures that
originated in traditional Chinese medicine. Acupuncture is the
stimulation of anatomical points on the body by a variety of methods,
including the insertion and manipulation of thin steel needles or the
use of pressure from the practitioner's hands. It is intended to remove
blockages in the flow of qi. American practice of acupuncture
incorporates medical traditions from China, Japan, Korea, and other
countries.
Botanical: A plant or plant part that is used for
its flavor, scent, and/or therapeutic properties. Examples include
flowers, leaves, bark, fruits, seeds, stems, and roots; substances
produced by plants; and algae.
Chiropractic: A whole medical system based on the
concept that the body has a powerful self-healing ability, and its
structure (primarily the spine), function, and health are closely
related. The goal of therapy is to correct structural alignment
problems and allow the body to heal itself.
Chronic disease: A disease that lasts a long period of time or comes back frequently.
Clinical trial: A research study in which a treatment
or therapy is tested in people to see whether it is safe and effective.
Clinical trials are a key part of the process in finding out which
treatments work, which do not, and why. Clinical trial results also
contribute new knowledge about diseases and medical conditions.
Herb: A plant or plant part used for its scent,
flavor, and/or therapeutic properties. Also called a botanical. Herbal
supplements are a type of dietary supplement that contains herbs,
either singly or in mixtures.
Inflammation: The body's response to injury or
infection. Chemicals are released from white blood cells to increase
the blood flow to the area, which results in swelling, redness, and
warmth.
Insomnia: A condition in which a person cannot
fall asleep, cannot remain asleep, or wakes up not feeling restored or
refreshed after sleeping.
Joint: The place where two bones meet.
Mind-body therapies: Practices that focus on the
relationships of brain, mind, body, and behavior and how they affect
health. Examples include meditation and yoga.
Omega-3 fatty acids: A group of polyunsaturated
fatty acids that come from food sources, such as fish, fish oil, some
vegetable oils (primarily canola and soybean), walnuts, wheat germ, and
certain dietary supplements. Polyunsaturated fatty acids are one of the
three types of fatty acids. They contain a chain of carbon atoms and
hydrogen and oxygen molecules, with two or more double bonds between
the carbon atoms.
Omega-6 fatty acids: A group of essential fatty
acids found in cereals, vegetable and seed oils, eggs, and poultry.
Essential fatty acids are needed for human health and cannot be made by
the body.
Osteoporosis: A condition in which bones become thin and brittle and more likely to break.
Placebo: A placebo is designed to resemble as
much as possible the treatment being studied in a clinical trial,
except that the placebo is inactive. An example of a placebo is a pill
containing sugar instead of the drug or other substance being studied.
By giving one group of participants a placebo and the other group the
active treatment, the researchers can compare how the two groups
respond and get a truer picture of the active treatment's effects. In
recent years, the definition of placebo has been expanded to include
other things that could have an effect on the results of health care,
such as how a patient and a health care provider interact and what the
patient expects to happen from the care.
Placebo effect: The physical or psychological
benefits that can occur with the use of an inert or sham treatment (a
placebo), such as a sugar pill.
Relaxation techniques: Use of methods such as guided
imagery to help calm the mind and release the muscles. It is used to
reduce physical tension and promote emotional well-being.
Rheumatic disease: A type of disease in which
inflammation and loss of function are present in one or more connecting
or supporting structures of the body. These diseases especially affect
the joints, tendons, ligaments, bones, and muscles. Common symptoms are
pain, swelling, and stiffness, and some rheumatic diseases can also
involve internal organs.
Rheumatologist: A medical doctor who specializes in treating conditions that affect the joints and muscles, such as rheumatoid arthritis.
Sedative: A substance used for medicinal purposes
(such as a drug or herb) that depresses the central nervous system,
producing feelings of calmness, relaxation, and drowsiness.
Tai chi: An exercise program that is part of
traditional Chinese medicine. The exercises consist of a series of
slow, gentle movements coordinated with breathing and meditation.
Traditional Chinese medicine: A whole medical system
that was documented in China by the 3rd century B.C. Traditional
Chinese medicine is based on a concept of vital energy, or qi, that is
believed to flow throughout the body. It is proposed to regulate a
person's spiritual, emotional, mental, and physical balance and to be
influenced by the opposing forces of yin (negative energy) and yang
(positive energy). Disease is proposed to result from the flow of qi
being disrupted and yin and yang becoming unbalanced. Among the
components of traditional Chinese medicine are herbal and nutritional
therapy, restorative physical exercises, meditation, acupuncture, and
remedial massage.
Whole medical systems: A general term for medical
and health care systems that employ practices from among the following
four domains: mind-body medicine, biologically based practices,
manipulative and body-based practices, and energy medicine. To find out
more, see the NCCAM Web site.
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*Links to a PubMed abstract.
1The PDF file requires a viewer such as Adobe Reader, which you can download free of charge from the Adobe Web site.
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For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on CAM and on NCCAM,
including publications and searches of Federal databases of scientific
and medical literature. The Clearinghouse does not provide medical
advice, treatment recommendations, or referrals to practitioners.
Examples of publications available include "What's in the Bottle? An Introduction to Dietary Supplements," "Herbal Supplements: Consider Safety, Too," "Questions and Answers About Homeopathy," and "Acupuncture."
Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
NIAMS supports research on these diseases, training of scientists,
and information (including publications on RA) based on scientific
evidence.
Toll-free in the U.S.: 1-877-22-NIAMS
Web site: www.niams.nih.gov
PubMed
A service of the National Library of Medicine (NLM), PubMed contains
publication information and (in most cases) abstracts of articles from
biomedical journals. CAM on PubMed, developed jointly by NCCAM and NLM,
is a subset of NLM's PubMed system and focuses on the topic of CAM.
Web site: www.ncbi.nlm.nih.gov/entrez
CAM on PubMed: www.nlm.nih.gov/nccam/camonpubmed.html
National Institute of Allergy and Infectious Diseases
A brochure, "Food Allergies: An Overview," is available.
In the U.S.: 301-496-5717
Web site: www3.niaid.nih.gov
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Acknowledgments
NCCAM thanks the following people for their technical expertise and
review of this publication: Carol Pontzer, Ph.D., and Richard L. Nahin,
Ph.D., M.P.H., NCCAM; Barbara Mittleman, M.D., and Peter E. Lipsky,
M.D., National Institute of Arthritis and Musculoskeletal and Skin
Diseases; Diana M. Taibi, M.S.N, R.N., and Cheryl Bourguignon, Ph.D.,
R.N., University of Virginia School of Nursing; Donald M. Marcus, M.D.,
Baylor College of Medicine; Barbara N. Timmermann, Ph.D., University of
Arizona College of Pharmacy; and Robert Zurier, M.D., University of
Massachusetts Medical School.
NCCAM has provided this material for your information. It is not
intended to substitute for the medical expertise and advice of your
primary health care provider. We encourage you to discuss any decisions
about treatment or care with your health care provider. The mention of
any product, service, or therapy in this information is not an
endorsement by NCCAM.
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