Experts look at the pros and cons of alternative arthritis therapies.
By Carol Sorgen
Reviewed By Michael Smith, MD
Alternative therapies for arthritis range from A (acupuncture) to Z (zinc sulfate), with much in between -- from copper bracelets to magnets to glucosamine to yoga, to name just a few. But do alternative therapies for arthritis really work?
Many arthritis sufferers are looking into alternative therapies in an effort to find relief from the pain, stiffness, stress, anxiety, and depression that accompany the disease. Indeed, the Arthritis Foundation reports that two-thirds of those suffering from the disease have tried alternative therapies.
Some Work, Many Don't
A survey conducted for Arthritis Today by Leigh Callahan, PhD, reported that the favorite alternative therapies of the 790 arthritis sufferers who responded to the survey included everything from prayer and meditation to glucosamine and magnets. Callahn is associate director of the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill.
Of the 2,146 physicians who responded to the survey, the alternative therapies most recommended were capsaicin, relaxation, biofeedback, meditation, journal writing, yoga, spirituality, tai chi, acupuncture, and glucosamine.
And some of these alternative treatments really work, say leading arthritis specialists, and even have scientific evidence behind them (although most doctors admit that more research is needed). On the other hand, many more of the alternative treatments don't work or need more studies to support anecdotal claims.
Battling Arthritis With Movement
Deborah Litman, MD, a clinical assistant professor in the division of rheumatology at the Georgetown University School of Medicine, is a strong proponent of exercise (though it's not listed as an alternative treatment per se) in the treatment of arthritis.
"Impact-loading" activity, on the other hand, such as jogging or high-impact aerobics, is not recommended, but more gentle exercise, such as swimming or water aerobics, is.
The mind-body practice of yoga may also help arthritis sufferers.
Though there are few studies that look at the effects of yoga on arthritis per se, a 1994 study published in the British Journal of Rheumatology did find that people with rheumatoid arthritis who participated in a yoga program over a three-month period had greater handgrip strength compared with those who did not practice yoga.
The same year, another study published in the Journal of Rheumatology reported that arthritis sufferers who practiced yoga showed a significant improvement in pain, tenderness, and finger range of motion for osteoarthritis of the hands.
Sticking It to Arthritis Pain
Acupuncture is another possibility; it is a therapy that has been studied extensively. As far as we know, says Litman, it doesn't change the course of the illness. But it can be helpful in managing pain and reducing stress associated with living with the chronic condition.
In 1980, the World Health Organization endorsed acupuncture for the treatment of some 40 ailments, including both osteoarthritis and rheumatoid arthritis.
In 1997, an NIH panel also concluded that acupuncture was not only helpful for postoperative pain and nausea, but also could help in the treatment of fibromyalgia and other musculoskeletal conditions, and without the side effects of anti-inflammatory drugs.
The University of Maryland School of Medicine recently completed a four-year NIH-funded study, the largest ever undertaken, to determine how well acupuncture works. The results, published in December 2004 in the Annals of Internal Medicine, found that traditional Chinese acupuncture significantly reduces pain and improves function for patients with knee osteoarthritis who have moderate or more severe pain despite taking pain medication.
Larry Altshuler, MD, is a board-certified internist in Oklahoma City who practices both conventional and alternative medicine. He uses acupuncture on his arthritis patients and says he was "pleasantly surprised" when his patients reported they were getting relief from their pain. "Most of my patients have had beneficial results from acupuncture," says Altshuler.
Helpful, Healthy Supplements?
Glucosamine and chondroitin are nutritional supplements that are also being studied for their effectiveness in treating arthritis.
Jason Theodosakis, MD, says that "first-line therapies" for the treatment of arthritis should always be improving biomechanics, injury prevention, weight control, and low-impact exercise. Theodosakis is an assistant clinical professor at the University of Arizona College of Medicine; he serves on the oversight committee for a $16 million NIH trial on glucosamine and chondroitin.
"But there is also enough scientific evidence -- 42 human clinical trials to date -- to recommend the use of glucosamine and chondroitin," says Theodosakis, also the author of The Arthritis Cure.
An article published in 2001 in the medical journal Lancet, for example, reported the results of a three-year study that followed 212 arthritis sufferers. The survey participants were divided into two groups, with one group given 1,500 milligrams of glucosamine daily for three years; the other group was given a daily placebo for three years.
The group given the glucosamine showed little or no deterioration in joints, while the group given the placebo showed the joint deterioration expected of arthritis sufferers.
After further follow-up, a recent study published in Osteoarthritis and Cartilage, found that those in the glucosamine group had 74% fewer knee replacements.
Erin Arnold, MD, recommends not only glucosamine sulfate for her patients (1,500 milligrams a day, taken in two to three doses a day), but also 400-800 international units of vitamin D. Arnold is a rheumatologist at the Illinois Bone and Joint Institute in Chicago.
"Lower levels of vitamin D in the body are associated with higher levels of pain," she says. She also recommends 1,000 milligrams a day of vitamin C, 200 milligrams of omega-3 fatty acid twice a day, and 2 cups of green tea every day for its anti-inflammatory effects.
One nutritional supplement that has been receiving much attention lately is MSM (methyl sulfonyl methane).
MSM, which can be found in fresh fruits and vegetables, milk, fish, and grains, is destroyed when foods are processed; if your diet is made up of a lot of processed foods, you may be low in MSM levels.
Several animal studies have seemed promising, including one published in 1985 in the journal Immunopathology that reported that MSM eased rheumatoid-arthritis-like effects in mice. In a recent small study of 50 men and women conducted by Leslie Axelrod, ND, of the Southwest College of Naturopathic Medicine in Tempe, Ariz., patients who received MSM reported 12% less pain and 14% more knee function than those who were given a placebo.
Because the quality of herbs and supplements can vary, even some of these treatments might not work, cautions Tod Cooperman, MD, president of ConsumerLab.com.
ConsumerLab.com reviewed supplement products touted for their pain-relieving benefits. It found that one product, claiming to contain 500 milligrams per serving of "chondroitin sulfate complex" actually contained less than 90 milligrams of chondroitin sulfate -- only 18% of the 500 milligrams.
"Fortunately, most products contain what they claim," says Cooperman. "But consumers should choose their supplements wisely. If a product is not working, it may be the product itself that is flawed, and not the approach."
Useless, Dangerous Remedies?
There are a number of other alternative remedies that arthritis sufferers try.
Many of those -- such as copper bracelets or magnets -- may not have much, if any, scientific evidence to back them up or disprove them. Indeed, Kerry Ludlam, a spokeswoman for the Arthritis Foundation, reports that there is a lack of research both for and against the usefulness of alternative therapies.
"There's a void of information," she says. Since many of the alternative therapies cited for the relief of arthritis are considered harmless (other than perhaps to your pocketbook), many doctors say that if you want to try them, go ahead.
Other therapies, however, can be dangerous.
Bee venom could cause a potentially fatal reaction in those allergic to stinging insects. And even glucosamine, generally safe for most people, could be dangerous for people allergic to shellfish. (Shellfish-free glucosamine is now available.) For these reasons, it's important to check with your doctor first before trying any alternative treatment.
It's also important to note that herbs and supplements may have unknown and potentially dangerous interactions with medication. If you're taking medication, it's best to check with your doctor before trying any supplements.
Though more and more doctors are themselves investigating the benefits of alternative therapies and have no objections if their patients try some, most of them still suggest first following the medical guidelines for the treatment of osteoarthritis released by the American College of Rheumatology and the American Pain Society.
"Try the simplest and cheapest regimen first," says Litman. "That should be your first line of defense."
Published Oct. 3, 2005.
SOURCES: Deborah Litman, MD, clinical assistant professor, Georgetown University. Larry Altshuler, MD, board-certified internist. Jason Theodosakis, MD, assistant clinical professor, University of Arizona College of Medicine. Erin Arnold, MD, Illinois Bone and Joint Institute. University of Maryland Medical Center web site: "Osteoarthritis Sufferers Seek Complementary Care." Arthritis Foundation: "Guide to Alternative Therapies." Vignon, E. Arthritis & Rheumatism, September 2003; vol 48: p S77. Reginster, J. Lancet, January 2001; vol 357: pp 251-256. WebMD Medical News: "Modest Arthritis Benefit Seen from MSM." Pavelka, J. Osteoarthritis and Cartilage, October 2004; vol 12: p S74. Tod Cooperman, MD, president Consumerlab.com. Kerry Ludlam, spokeswoman, Arthritis Foundation National Office.
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