Sun
19
Apr
Arthritis (Osteo-)
Rheumatoid arthritis is an autoimmune disease in the general family of lupus.
For reasons that are not understood, in rheumatoid arthritis the immune system
goes awry and begins attacking innocent tissues, especially cartilage in the
joints. Various joints become red, hot, and swollen under the onslaught. The
pattern of inflammation is usually symmetrical, occurring on both sides of the
body. Other symptoms include inflammation of the eyes, nodules or lumps under
the skin, and a general feeling of malaise.
Rheumatoid arthritis is more common in women than in men and typically begins between the ages of 35 and 60. The diagnosis is made by matching the pattern of symptoms with certain characteristic laboratory results.
Medical treatment consists mainly of two categories of drugs: anti-inflammatory drugs in the ibuprofen family (nonsteroidal anti-inflammatory drugs, or NSAIDs) and drugs that may be able to put rheumatoid arthritis into full or partial remission, the so-called disease-modifying antirheumatic drugs (DMARDs).
Anti-inflammatory drugs relieve symptoms of rheumatoid arthritis but do not change the overall progression of the disease, whereas the DMARDs seem to affect the disease itself. A good analogy might be the various options available to "treat" a house "suffering" from a severe termite infestation. You could remove heavy furniture, tiptoe about instead of holding public dances, and put large beams under the joists. However, none of these methods would do anything to stop the gradual destruction of your house. These methods are like NSAIDs and other supportive techniques in that they treat only the symptoms.
A more definitive approach would be to hire an exterminator and kill the termites. In medical terms, this would be described as a disease-modifying treatment. Because medical treatments for chronic diseases are seldom as completely effective as this example, a closer analogy might be spraying a chemical that slows the spread of termites but does not stop them.
In rheumatoid arthritis, the drugs believed to alter the course of the disease (to slow it down or stop it) include gold compounds, D-penicillamine, antimalarials, sulfasalazine, and methotrexate. They are unrelated to one another but work somewhat similarly in practice.
Unfortunately, all the drugs in this category are quite toxic and reliably cause severe side effects. Because of this toxicity, for years a so-called pyramid approach was taken with people with rheumatoid arthritis. Physicians started with NSAIDs to help with the pain and inflammation, and progressed to successively stronger and more toxic medications only when the basic treatments failed. Natural treatments such as those described here might also be useful in early stages.
However, over the last few years, research has found that severe joint damage occurs very early in rheumatoid arthritis. This evidence has caused many authorities to suggest early, aggressive treatment with disease-modifying drugs to prevent joint damage. Nonetheless, this approach has not been universally adopted, and many physicians still prescribe NSAIDs for early stages of rheumatoid arthritis. The treatments described here may be reasonable alternative options.
Rheumatoid arthritis is more common in women than in men and typically begins between the ages of 35 and 60. The diagnosis is made by matching the pattern of symptoms with certain characteristic laboratory results.
Medical treatment consists mainly of two categories of drugs: anti-inflammatory drugs in the ibuprofen family (nonsteroidal anti-inflammatory drugs, or NSAIDs) and drugs that may be able to put rheumatoid arthritis into full or partial remission, the so-called disease-modifying antirheumatic drugs (DMARDs).
Anti-inflammatory drugs relieve symptoms of rheumatoid arthritis but do not change the overall progression of the disease, whereas the DMARDs seem to affect the disease itself. A good analogy might be the various options available to "treat" a house "suffering" from a severe termite infestation. You could remove heavy furniture, tiptoe about instead of holding public dances, and put large beams under the joists. However, none of these methods would do anything to stop the gradual destruction of your house. These methods are like NSAIDs and other supportive techniques in that they treat only the symptoms.
A more definitive approach would be to hire an exterminator and kill the termites. In medical terms, this would be described as a disease-modifying treatment. Because medical treatments for chronic diseases are seldom as completely effective as this example, a closer analogy might be spraying a chemical that slows the spread of termites but does not stop them.
In rheumatoid arthritis, the drugs believed to alter the course of the disease (to slow it down or stop it) include gold compounds, D-penicillamine, antimalarials, sulfasalazine, and methotrexate. They are unrelated to one another but work somewhat similarly in practice.
Unfortunately, all the drugs in this category are quite toxic and reliably cause severe side effects. Because of this toxicity, for years a so-called pyramid approach was taken with people with rheumatoid arthritis. Physicians started with NSAIDs to help with the pain and inflammation, and progressed to successively stronger and more toxic medications only when the basic treatments failed. Natural treatments such as those described here might also be useful in early stages.
However, over the last few years, research has found that severe joint damage occurs very early in rheumatoid arthritis. This evidence has caused many authorities to suggest early, aggressive treatment with disease-modifying drugs to prevent joint damage. Nonetheless, this approach has not been universally adopted, and many physicians still prescribe NSAIDs for early stages of rheumatoid arthritis. The treatments described here may be reasonable alternative options.
Treatment
Principal Proposed Treatments:
Rheumatoid arthritis is a difficult disease, and no alternative approach solves it easily. Even if you choose to use alternative methods, you should maintain regular visits to a rheumatologist to watch for serious complications. Finally, keep in mind that medical treatment may be able to slow the progression of rheumatoid arthritis. It is not likely that any of the alternative options have the same power.
Fish Oil
Fish oil is the only natural treatment for rheumatoid arthritis with significant documentation. According to the results of 13 double-blind placebo-controlled studies involving a total of over 500 participants, supplementation with omega-3 fatty acids can significantly reduce the symptoms of rheumatoid arthritis. However, unlike some of the standard treatments, fish oil probably does not slow the progression of rheumatoid arthritis.
For more information, including dosage and safety issues, see the full fish oil article.
Flaxseed oil has been offered as a more palatable substitute for fish oil, but it doesnt seem to work.
Eating a lot of fish may also be helpful.
Other Proposed Treatments:
Boswellia
Boswellia serrata is a shrub-like tree that grows in the dry hills of the Indian subcontinent. It is the source of a resin called salai guggal, which has been used for thousands of years in Ayurvedic medicine, the traditional medicine of the region. It is very similar to a resin from a related tree, Boswellia carteri, which is also known as frankincense. Both substances have been used historically for arthritis.
Recent research has identified boswellic acids as the likely active ingredients in boswellia. In animal studies, boswellic acids have shown anti-inflammatory effects, but their mechanism of action seems to be quite different from that of standard anti-inflammatory medications.
An issue of Phytomedicine that was devoted to boswellia briefly reviewed previously unpublished studies on the herb. A pair of placebo-controlled trials involving a total of 81 people with rheumatoid arthritis found significant reductions in swelling and pain over the course of 3 months. Furthermore, a comparative study of 60 participants over 6 months found the boswellia extract relieved symptoms about as well as oral gold therapy. However, keep in mind that while gold shots can induce remission in rheumatoid arthritis, we have no evidence that boswellia can do the same.
Another double-blind study found no difference between boswellia and placebo. The bottom line is that we need more research to know for sure whether boswellia is an effective treatment for rheumatoid arthritis.
For more information, including dosage and safety issues, see the full boswellia article.
Devils Claw
The herb devils claw may be beneficial in rheumatoid arthritis. One double-blind study followed 89 people with rheumatoid arthritis for 2 months. The group given devils claw showed a significant decrease in pain intensity and an improvement in mobility.
Another double-blind study of 50 people with various types of arthritis showed that 10 days of treatment with devils claw provided significant pain relief.
For more information, including dosage and safety issues, see the full devils claw article.
Curcumin
Curcumin, an extract of the kitchen spice turmeric, is often suggested as a treatment for rheumatoid arthritis because it appears to possess anti-inflammatory properties. However, the one, small, double-blind study often cited as evidence for its effectiveness in this disease actually provides no such evidence at all.
For more information, including dosage and safety issues, see the full turmeric article.
Additional Natural Treatments
The Chinese herb Tripterygium wilfordii, also called thunder god vine, has a long history of use for arthritis and skin diseases. A preliminary, double-blind, placebo-controlled crossover study of 70 individuals suggests that an extract of Tripterygium wilfordii may be beneficial in the treatment of rheumatoid arthritis. Benefits were also seen in a smaller double-blind, placebo-controlled trial.
Note: This herb is believed to be unsafe for pregnant or nursing women.
One preliminary and rather unimpressive double-blind study suggests that the herb yucca can help relieve the pain of rheumatoid arthritis.
In addition, preliminary evidence suggests that a mixture of poplar, ash, and goldenrod might be helpful for rheumatoid arthritis.
The essential fatty acid gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, may help relieve symptoms of rheumatoid arthritis.
Zinc supplements have been evaluated as a treatment for rheumatoid arthritis, but overall the results have not been encouraging.
Vitamin E may reduce pain in rheumatoid arthritis, although it does not improve inflammation, and may possibly help prevent rheumatoid arthritis. Some evidence suggests that adding vitamin E, or vitamin E plus other antioxidants, to standard rheumatoid arthritis therapy might improve results.
Very weak evidence suggests that the supplement MSM might be helpful as well.
The following treatments are also sometimes proposed as effective for rheumatoid arthritis, but there is as yet little scientific evidence to turn to: beta-carotene, betaine hydrochloride, boron, burdock, cats claw, cayenne, chamomile, copper, feverfew, folate, ginger, L-histidine, horsetail, magnesium, manganese, molybdenum, pantothenic acid, D-phenylalanine, pregnenolone, proteolytic enzymes, sea cucumber, vitamin C, white willow, and Chinese herbal combinations.
Adopting a vegetarian diet may help mild rheumatoid arthritis. Identifying and avoiding food allergens has been tried; however, a double-blind trial found no clear evidence of benefit with a low saturated fat, hypoallergenic diet.
A 16-week double-blind placebo-controlled trial of 182 individuals with active rheumatoid arthritis evaluated the effectiveness of a combination herbal extract containing ashwagandha, boswellia, ginger, and turmeric. The herbal extract showed no more effectiveness than placebo in nearly all measurements of disease severity; joint swelling alone showed improvement.
Although oral collagen has been recommended for the treatment of rheumatoid arthritis, a small double-blind placebo-controlled trial did not find any evidence of benefit. Selenium supplements also appear to be ineffective, according to most studies.
Rheumatoid arthritis is a difficult disease, and no alternative approach solves it easily. Even if you choose to use alternative methods, you should maintain regular visits to a rheumatologist to watch for serious complications. Finally, keep in mind that medical treatment may be able to slow the progression of rheumatoid arthritis. It is not likely that any of the alternative options have the same power.
Fish Oil
Fish oil is the only natural treatment for rheumatoid arthritis with significant documentation. According to the results of 13 double-blind placebo-controlled studies involving a total of over 500 participants, supplementation with omega-3 fatty acids can significantly reduce the symptoms of rheumatoid arthritis. However, unlike some of the standard treatments, fish oil probably does not slow the progression of rheumatoid arthritis.
For more information, including dosage and safety issues, see the full fish oil article.
Flaxseed oil has been offered as a more palatable substitute for fish oil, but it doesnt seem to work.
Eating a lot of fish may also be helpful.
Other Proposed Treatments:
Boswellia
Boswellia serrata is a shrub-like tree that grows in the dry hills of the Indian subcontinent. It is the source of a resin called salai guggal, which has been used for thousands of years in Ayurvedic medicine, the traditional medicine of the region. It is very similar to a resin from a related tree, Boswellia carteri, which is also known as frankincense. Both substances have been used historically for arthritis.
Recent research has identified boswellic acids as the likely active ingredients in boswellia. In animal studies, boswellic acids have shown anti-inflammatory effects, but their mechanism of action seems to be quite different from that of standard anti-inflammatory medications.
An issue of Phytomedicine that was devoted to boswellia briefly reviewed previously unpublished studies on the herb. A pair of placebo-controlled trials involving a total of 81 people with rheumatoid arthritis found significant reductions in swelling and pain over the course of 3 months. Furthermore, a comparative study of 60 participants over 6 months found the boswellia extract relieved symptoms about as well as oral gold therapy. However, keep in mind that while gold shots can induce remission in rheumatoid arthritis, we have no evidence that boswellia can do the same.
Another double-blind study found no difference between boswellia and placebo. The bottom line is that we need more research to know for sure whether boswellia is an effective treatment for rheumatoid arthritis.
For more information, including dosage and safety issues, see the full boswellia article.
Devils Claw
The herb devils claw may be beneficial in rheumatoid arthritis. One double-blind study followed 89 people with rheumatoid arthritis for 2 months. The group given devils claw showed a significant decrease in pain intensity and an improvement in mobility.
Another double-blind study of 50 people with various types of arthritis showed that 10 days of treatment with devils claw provided significant pain relief.
For more information, including dosage and safety issues, see the full devils claw article.
Curcumin
Curcumin, an extract of the kitchen spice turmeric, is often suggested as a treatment for rheumatoid arthritis because it appears to possess anti-inflammatory properties. However, the one, small, double-blind study often cited as evidence for its effectiveness in this disease actually provides no such evidence at all.
For more information, including dosage and safety issues, see the full turmeric article.
Additional Natural Treatments
The Chinese herb Tripterygium wilfordii, also called thunder god vine, has a long history of use for arthritis and skin diseases. A preliminary, double-blind, placebo-controlled crossover study of 70 individuals suggests that an extract of Tripterygium wilfordii may be beneficial in the treatment of rheumatoid arthritis. Benefits were also seen in a smaller double-blind, placebo-controlled trial.
Note: This herb is believed to be unsafe for pregnant or nursing women.
One preliminary and rather unimpressive double-blind study suggests that the herb yucca can help relieve the pain of rheumatoid arthritis.
In addition, preliminary evidence suggests that a mixture of poplar, ash, and goldenrod might be helpful for rheumatoid arthritis.
The essential fatty acid gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, may help relieve symptoms of rheumatoid arthritis.
Zinc supplements have been evaluated as a treatment for rheumatoid arthritis, but overall the results have not been encouraging.
Vitamin E may reduce pain in rheumatoid arthritis, although it does not improve inflammation, and may possibly help prevent rheumatoid arthritis. Some evidence suggests that adding vitamin E, or vitamin E plus other antioxidants, to standard rheumatoid arthritis therapy might improve results.
Very weak evidence suggests that the supplement MSM might be helpful as well.
The following treatments are also sometimes proposed as effective for rheumatoid arthritis, but there is as yet little scientific evidence to turn to: beta-carotene, betaine hydrochloride, boron, burdock, cats claw, cayenne, chamomile, copper, feverfew, folate, ginger, L-histidine, horsetail, magnesium, manganese, molybdenum, pantothenic acid, D-phenylalanine, pregnenolone, proteolytic enzymes, sea cucumber, vitamin C, white willow, and Chinese herbal combinations.
Adopting a vegetarian diet may help mild rheumatoid arthritis. Identifying and avoiding food allergens has been tried; however, a double-blind trial found no clear evidence of benefit with a low saturated fat, hypoallergenic diet.
A 16-week double-blind placebo-controlled trial of 182 individuals with active rheumatoid arthritis evaluated the effectiveness of a combination herbal extract containing ashwagandha, boswellia, ginger, and turmeric. The herbal extract showed no more effectiveness than placebo in nearly all measurements of disease severity; joint swelling alone showed improvement.
Although oral collagen has been recommended for the treatment of rheumatoid arthritis, a small double-blind placebo-controlled trial did not find any evidence of benefit. Selenium supplements also appear to be ineffective, according to most studies.