Complementary and Alternative Therapies for RA

While the main forms of treatment for rheumatoid arthritis (RA) continue to be medications (especially disease-modifying anti-rheumatic drugs, or DMARDs) and physical therapy, many people with RA also turn to complementary or alternative therapies to help manage their symptoms.¹

Complementary and alternative medicine (CAM) includes a wide variety of medical interventions or treatments that currently lie beyond the scope of mainstream Western medicine. CAM services are generally provided by specialists who have been trained in different treatment modalities not typically covered in medical school. Practitioners of CAM modalities may or may not be certified in their area of expertise. Many CAM treatments have not been systematically evaluated in randomized, controlled clinical trials, and that can make it difficult to determine the effectiveness and safety of some CAM treatments.

Common CAM modalities which may be used by people with rheumatoid arthritis include:²

• Acupuncture
• Chiropractic
• Herbal remedies
• Massage
• Mind-body medicine
• Tai Chi
• Yoga

Acupuncture

Acupuncture is the use of thin needles inserted through the skin at strategic points on the body. It is a key component of traditional Chinese medicine and is most often used to reduce or relieve pain, although it may be used for many other conditions or for general well-being.³

Chiropractic

Chiropractic therapy focuses on the body’s alignment, particularly the spine, to alleviate pain, improve the body’s mobility and function, and allow the body to naturally heal. Most practitioners engage in moving, stretching and manipulating the spine to make “adjustments.”⁴ While chiropractic care has shown some benefit in treating low back pain and osteoarthritis, the Arthritis Foundation cautions that people with RA should not get a chiropractic adjustment during periods of active inflammation.⁵

Herbal remedies

Herbal remedies refer to the use of plant and plant extracts. There are some herbal remedies that are used topically, including aloe vera and capsaicin. Others are taken orally, including turmeric, willow bark and traditional Chinese medicine. Some herbal remedies have shown promise in relieving symptoms of RA like pain and inflammation. It’s important to discuss all vitamins, supplements, and medications (prescription and over-the-counter) with a healthcare professional to understand any risks or safety precautions, as many supplements can interfere with other medications a person may be taking, causing unwanted side effects or making the medication less effective.

Massage

Massage is a general term that describes using touch to press, rub or manipulate the skin, muscles, tendons, and ligaments. Massage is used for a variety of health conditions and provides many health benefits, including reducing stress, pain, and muscle tension. In addition to the health benefits, many people find massage produces feelings of caring, comfort, and connection.⁶

Mind-body medicine

Mind-body medicine focuses on how the mind and emotions affect physical well-being. There are many mind-body practices, including biofeedback, yoga, meditation, and relaxation therapies.⁷

Tai Chi

Tai Chi is a Chinese martial art that has been practiced for centuries for both self-defense and health benefit. It involves a system of movements and postures designed to approach the mind and body in a holistic manner as an interconnected system. Tai Chi is believed to provide health benefits for the body, including increased strength, flexibility, coordination, and improved posture, and the mind, including reduction in stress, improvement in memory and concentration, and decrease in anxiety.⁸

Yoga

Yoga is a form of exercise that originates from India that focuses on bringing awareness through body postures and breathing to achieve harmony in the body, mind, and spirit. Yoga has been associated with a variety of health benefits, including reducing blood pressure, reducing heart rate, and increasing mood.²

What do the terms ‘complementary’ and ‘alternative’ refer to?

CAM approaches can be divided into two broad groups: those that are complementary, or used alongside conventional medical treatments, and those that are alternative, or used instead of conventional treatments. Some complementary approaches, such as dietary interventions, are commonly recommended by physicians to promote general health in complement to prescribed medications or treatments. Alternative approaches, which replace conventional medicine, are less common in the U.S. and often have not been rigorously studied. Integrative medicine is another term which refers to a combination of traditional and alternative or complementary medicine.

Importance of letting your doctor know about CAMs

You may be hesitant to discuss a CAM intervention that you are using or interested in trying with your doctor. However, you should always let your doctor know about ALL the treatments you are considering, including supplements, vitamins, herbal products, body work, and alternative medicine approaches. It is important for your care team to have a complete picture of the treatments you are using. This is especially true with substances that may react inside your body with the drugs that you are taking. So, keep your doctor in the loop about any and all treatments you are trying.

Why is there so much disagreement about the benefits of certain CAMs?

The gold standard in testing the effectiveness and safety of any medication used to treat a disease, including treatments for RA, is the randomized, controlled clinical trial (RCT). Typically, an RCT compares a medicine or treatment with a placebo, which is often an inert pill containing no medicine or, in the case of an injection or infusion, a liquid such as a saline solution. In a clinical trial, the comparison between a treatment and placebo is made in groups of patients who are randomly assigned to receive either the drug or placebo. Ideally, the groups are large enough and the effects of the test medication are strong enough to demonstrate a statistically significant difference in the effectiveness of the medication versus the placebo.

This statistical difference demonstrates that a medication works. Just to make sure that the results of one study are not a fluke, multiple RCTs that replicate or repeat the results are typically needed. For many CAMs, there have not been sufficient well-designed studies including enough people to determine with any confidence that the CAM being studied works. (This is not true for all CAMs, so check individual treatments to see what the study results show.)

RCTs are needed to provide evidence that there is a real difference in effectiveness between a medication or placebo to avoid the placebo effect. Placebo effect is something that is seen in studies, where a certain percentage of patients who get placebo instead of active treatment will experience an improvement. It may be their belief that they are receiving real treatment, or their confidence in their doctor, or just the power of positive thinking, but results from studies show that in some patients, placebo treatment results in a real, measurable health improvement.

Because of placebo effect and because of the rising popularity of CAMs, the U.S. National Institutes of Health established the National Center for Complementary and Alternative Medicine (NCCAM) to promote the systematic study and dissemination of study results of various CAM approaches.