Complimentary & Alternative Therapies / Arthritis

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Complementary And Alternative Therapies For Arthritis

Glucosamine Chondroitin And Sam-e Herbal Remedies Homeopathy Vitamins And Fish Oil Acupuncture And Acupressure Magnet Therapy

Diet Therapy Exercise And Weight Control Self-Help Measures Massage A Positive Outlook The Bottom Line

Facts About Osteoarthritis

There are more than 100 types of arthritis, the most common of which is osteoarthritis .

This "wear and tear" arthritis is seen most frequently in older people. Recent research suggests that genetic effects, weight, diet and injuries are also risk factors for this disease.

At present, there is no cure, but this does not mean there is no relief for the usual symptoms of pain and joint stiffness. Physical therapy, weight loss and exercise are helpful for many patients.

Conventional drug treatment with analgesics (such as acetaminophen) and nonsteroidal anti-inflammatory drugs (such as ibuprofen) is often effective in controlling pain and inflammation, but these agents do not always work well. In addition, side effects may limit their usefulness.

In severe cases, joint injections or joint surgery is appropriate.

People with the most common form of arthritis, osteoarthritis, frequently turn to complementary or alternative therapies in the hopes of getting better without experiencing the side effects associated with prescription drugs. In 1997, a national survey 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. The most common complementary and alternative remedies are discussed below.

Glucosamine

Used for many years in Germany and other parts of Europe, glucosamine has rapidly gained popularity in the United States. Many users swear by its ability to reduce arthritis pain. A study of more than 200 patients with osteoarthritis published in the British journal Lancet in January 2001 appears to support these claims. People treated with glucosamine reported 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 Some experts believe, however, that the improved X-ray findings resulted from outdated radiology techniques.

Although glucosamine's effect on joint damage is still debated, most medical experts believe this supplement reduces pain and is safe. Because glucosamine may affect glucose metabolism, people with diabetes should avoid this supplement until its effects on blood glucose levels are better understood. The usual dose is 500 milligrams three times a day. Twice this amount may be recommended for the first few weeks. It may take four to eight weeks to get significant benefit, and like most remedies, glucosamine does not work for everyone. Because this supplement is relatively expensive, consider stopping after eight to 10 weeks if you do not experience any improvement.

Chondroitin And Sam-e

Two other supplements on the market, chondroitin and S-adenosylmethionine (SAM-e), are not as well studied or accepted in the United States as glucosamine. However, at least one large study of SAM-e found similar benefit to naproxen (a drug prescribed to relieve pain and inflammation) but with fewer side effects. Most other studies on this agent are of insufficient quality to draw firm conclusions.

Herbal Remedies

Many herbs, including evening primrose, ginger, stinging nettle and curcumin, are said to have beneficial effects on arthritis. However, definitive studies have yet to be published.

If you pursue herbal therapies, take your time. If you decide to try herbal remedies, keep in mind that achieving results may take several weeks or more. Always discuss the use of herbs or other supplements with your doctor to check for interactions and side effects. Take herbs one at a time, under the guidance of your doctor and a knowledgeable herbal therapy practitioner.

If seeking an herbal therapy practitioner, first ask your doctor for the name of a local practitioner whom he or she trusts. 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

Homeopathy is a method of treatment based on administering tiny (often undetectable) amounts of a substance that in higher doses might cause symptoms or disease in healthy persons but could cure ill persons. Homeopathic approaches to the treatment of osteoarthritis are advocated by some, but compelling 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."

Vitamins And Fish Oil

The antioxidant vitamins A, C, D and E are commonly recommended for arthritis. However, compelling evidence that antioxidant vitamins can prevent arthritis is lacking. According to some studies, people with rheumatoid arthritis taking fish oil capsules (containing omega-3 fatty acids) experience modest benefits. Based on these studies, some practitioners and patients recommend including fish such as salmon, mackerel, herring or sardines in your diet several times a week. It is not clear, however, if increasing your fish intake has the same benefit as taking moderate to high doses of omega-3 fatty acid supplements. It is also unclear if this treatment will help people with other, more common forms of arthritis, such as osteoarthritis.

Acupuncture And Acupressure

Acupuncture is an ancient Chinese treatment for many conditions, including arthritis. By inserting hair-fine needles into the skin along defined tracts called meridians, practitioners believe they can stimulate the flow of "qi," or vital life energy.

Acupressure and shiatsu, a Japanese form of acupressure, use no needles but involve pressure applied to certain points on the body. You can be taught to perform these techniques on yourself by a qualified practitioner.

Although medical experts do not understand how acupuncture and acupressure work, many people with arthritis have found these techniques helpful. A large National Institutes of Health-funded multisite clinical trial to be completed in June 2001 will evaluate the efficacy, safety and cost-effectiveness of acupuncture for osteoarthritis.

Magnet Therapy

Magnet therapy has become popular for alleviating symptoms of arthritis and for improving sports performance and general well-being. However, scientific evidence of its benefit is lacking. Therapeutic magnets of various strengths can be purchased in many products, from jewelry to mattress pads. Just keep them away from your computer!

Diet Therapy

Efforts to find food allergies that cause arthritis have not yielded definitive results. The usual 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.

Exercise And Weight Control

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. Water offers support and gentle resistance; if possible, water temperature should be 83 to 88 F or warmer.

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.

Self-Help Measures

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.

Helpful suggestions abound in books and magazines and on the Internet about joint-sparing techniques for ordinary activities. For example:

Pick up a coffee cup with both hands instead of thumb and finger. Open doors with the side of your arm and body. Open a car door with both hands.

Your doctor may refer you to an occupational therapist who can teach these and many more helpful techniques.

Massage

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. Each type uses a slightly different approach, but all have similar emotional and physical benefits. A massage therapist can teach you some do-it-yourself techniques.

Massage therapists are required to be licensed in at least 28 states and the District of Columbia. You can find a qualified practitioner by asking your physician or by contacting a professional massage therapy association.

Other types of bodywork, as established by The National Certification Board for Therapeutic Massage and Bodywork or The American Massage Therapy Association, include Feldenkrais, a system of gentle body movements that offers improvement in strength and flexibility, and the Technique. Classes and individual instruction can be found in many locations.

A Positive Outlook

Like any person with a chronic disease, a person with osteoarthritis may be more prone to depression. You may worry about becoming increasingly unable to perform activities of daily living or doing things you enjoy. The capacity to adapt, cope and continue full function varies greatly among patients. Some patients feel disabled by their symptoms, but only a very small percentage will ever become severely disabled. A positive outlook, focusing on what you are able to do rather than what you are unable to do, can be immensely helpful. 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.

The Bottom Line

Recognize that for many unproven approaches, uncertainty about benefit and risk must be accepted before pursuing treatment. For example, small studies may find benefit for a particular approach, but if the patients in the study were highly selected (for example, taking no other medications and having no other major health problems besides their arthritis), that same approach may not work for others. A particular source of concern is that the treatment may interact with another medication, something the small studies cannot predict. Finally, keep in mind that herbs and supplements such as glucosamine are not regulated by the Food and Drug Administration; active ingredients, purity and quality vary greatly.

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.

In the meantime, whatever treatment you pursue, whether conventional or complementary or alternative, follow the guidance of a qualified practitioner and inform all of your health care providers. Be prepared to share your sources of information with your providers so they can help you assess the risks and benefits.

For more information on complementary and alternative medicine, visit the InteliHealth Complementary And Alternative Medicine Area .

Last updated December 03, 2001

Martha Murdock, DirectorNational Silicone Implant Foundation | Dallas Headquarters"Supporting Survivors of Medical Implant Devices"4416 Willow LaneDallas, TX 75244-7537