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Joint Institute Non-Surgical Treatments

Complementary Medicine

The terms Complementary Medicine and Alternative Medicine (abbreviated CAM) are often used interchangeably.

The difference:

  • Complementary medicines are used together with a doctor-prescribed treatment program.
  • Alternative treatments are used instead of doctor-prescribed treatments, though many hospitals, including AtlantiCare, provide CAM programs.

If you are considering using CAM:

  • Check with your doctor or local chapter of the Arthritis Foundation to find out what is known about the effects and safety of the therapy before trying it or recommeding it to others.
  • Talk to your doctor and let him or her know what you thinking about trying.
  • Continue regular medical care for arthritis.

Examples of common CAM for Arthritis:

  • Mind-body therapies, such as
    • meditation
    • relaxation
    • tai chi 
  • Dietary supplements, such as
    • Fish oil
    • Gamma-linolenic acid (GLA)
    • Thunder god vine
  • Other
    • acupuncture
    • special diets

Source: National Institutes of Health (NIH), National Center for Complementary and Alternative Medicine (NCCAM)

Mind-Body Therapies

Mind-body therapies—such as meditation, relaxation, and tai chi—are among the most commonly used types of CAM in the United States. They have been used and studied for a variety of pain conditions, including RA. Results from clinical trials suggest that mind-body therapies may be beneficial additions to RA treatment regimens. They may have particular value in helping people cope with their disease.

  • Psychological therapies incorporating mind-body techniques such as relaxation, imagery, and biofeedback may help improve physical and psychological symptoms associated with RA. Findings from a 2002 review of the research suggest that these therapies—when added to conventional medical treatments—could have beneficial effects on pain, physical function, psychological state, and ability to cope. The review also found that people who have had RA for a shorter duration experience greater benefits.
  • A recent preliminary study funded by NCCAM found that a type of meditation called mindfulness-based stress reduction had positive effects on the psychological aspects of RA (such as depression and coping ability) but did not relieve symptoms.
  • A few small studies have been conducted on tai chi for RA. In general, tai chi has not been shown to be effective for joint pain, swelling, and tenderness, although improvements in mood, quality of life, and overall physical function have been reported. A 2007 review of the research concluded that the value of tai chi as a treatment for RA is still unproven. Some people have reported soreness when first learning tai chi, but most studies have found that it is relatively safe for people with RA.

Dietary Supplements

Surveys suggest that people who use CAM for RA are likely to try dietary and herbal supplements. Although no supplement has shown clear treatment benefits, there is preliminary evidence for a few—particularly fish oil, gamma-linolenic acid, and the herb thunder god vine. Dose, safety, and potential interactions with conventional medicines need to be more thoroughly evaluated.

Fish oil contains high amounts of omega-3 fatty acids—substances the body needs in order to perform a number of important functions. The body can also use omega-3s to make substances that reduce inflammation. Interest in the use of fish oil for RA stems from observations that groups of people who consumed large amounts of foods rich in omega-3s had lower rates of inflammatory diseases. Types of fish high in omega-3s include herring, mackerel, salmon, and tuna. Fish oil supplements are available as capsules or oils. 

  • Evidence from clinical trials on RA is encouraging. Fish oil supplements may be useful in relieving tender joints and morning stiffness. Studies have also found that fish oil may reduce the need for NSAIDs and other conventional RA medicines. Additional research is needed and under way to establish more firmly fish oil’s potential role in treatment regimens for RA.
  • Some have questioned the safety of fish oil supplements because some species of fish can contain high levels of mercury, pesticides, or polychlorinated biphenyls (PCBs). However, fish oil supplements do not appear to contain these substances. In high doses, fish oil may interact with certain medicines, including blood thinners and drugs used for high blood pressure. Products made from fish liver oil (for example, cod liver oil) can contain dangerously high amounts of vitamins A and D.

Gamma-linolenic acid (GLA) is an omega-6 fatty acid found in the oils of some plant seeds, including evening primrose (Oenothera biennis), borage (Borago officinalis), and black currant (Ribes nigrum). In the body, GLA can be converted into substances that reduce inflammation.

  • There is some preliminary evidence that GLA may be beneficial for RA; however, some studies of GLA’s effects have had quality issues. The more rigorous studies suggest that GLA may relieve symptoms such as joint pain, stiffness, and tenderness; in some cases,
  • GLA led to a decreased need for NSAIDs medication. More high-quality research—looking particularly at dose and duration of treatment—is needed before making recommendations on the use of GLA for RA.
  • GLA appears to be safe for most adults. However, some borage oil preparations contain chemicals called pyrrolizidine alkaloids that can harm the liver.

Thunder god vine (Tripterygium wilfordii) has been used for centuries in traditional Chinese medicine. Extracts are prepared from the skinned root of the herb, as other parts of the plant are highly poisonous. Thunder god vine can cause severe side effects. Although widely used in China, commercial thunder god vine products are not readily available in the United States.

Other Types of CAM

Other CAM therapies are used for RA:

  • Acupuncture has been used and studied for a variety of pain conditions, but very little acupuncture research has focused on RA. Currently, there is not enough evidence to determine whether acupuncture has any value in RA treatment. Larger and more rigorous studies are needed.
  • Balneotherapy is the technique of bathing in heated tap or mineral water for health purposes. Preliminary research on balneotherapy for RA has been conducted in areas where it is most popular, such as Europe and Israel’s Dead Sea region. Although some benefits have been reported, there is not enough reliable evidence to draw conclusions.

Some people with RA may try following special diets—such as vegetarian and vegan diets, the Mediterranean diet, and periods of fasting—to control symptoms. Research on these diet approaches has been inconclusive. While a few studies suggest that decreasing or eliminating consumption of meat, dairy, or foods likely to cause allergies may be helpful in some cases, others do not. One drawback is that special diets may be difficult for people to follow over time. In addition, some diets could put people at risk for nutritional deficiencies.

If You Have RA and Are Thinking About Using CAM

Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see the National Center for Complementary and Alternative Medicine’s (NCCAM) Time to Talk campaign at nccam.nih.gov/timetotalk/.

  • Do not replace proven conventional treatments for RA with CAM treatments that are unproven.
  • Be aware that some CAM therapies—particularly dietary supplements—may interact with conventional medical treatments. Also consider the possibility that what’s on the label of a dietary supplement may not be what’s in the bottle; for example, some tests of dietary supplements have found that the contents did not match the dose on the label, and some herbal supplements have been found to be contaminated.
  • Women who are pregnant or nursing, or people who are thinking of using CAM to treat a child, should consult their health care provider before using any CAM therapy.

 

CAM begins with regular supervised exercise:  strongly  recommended for all arthritis patients to

  • reduce pain
  • improve physical function
  • improve muscle strength
  • improve quality of life for arthritis sufferers

Exercise is essential for treatment of arthritis, yet more than 33 percent of arthritis patients say they do not exercise!

 

Natural Treatments

If you are suffering from arthritis pain, you can try pain management with natural treatments first. They’re effective for some people, but not for others. 

  • Acupuncture or acupressure performed by a certified acupuncturist
  • Biofeedback
  • Chiropractic
  • Magnets
  • Massage
  • Meditation
  • Tai-Chi
  • Yoga
  • Supplements (fish oil, glucosamine, chondroitin, MSM)

Your best course of action is to work with your family doctor so he or she can monitor the effectiveness of what you’re doing, and how long relief lasts. 

 

Nonsurgical Treatments

If you have early-stage arthritis, non-surgical treatments are probably the first options your doctor will pursue in treating joint pain.

If you have osteoarthritis, your doctor can help you choose from of a wide range of treatment options. The effectiveness of these non-surgical treatments varies from person-to-person.

Rheumatoid arthritis is usually treated with medication. A wide variety of non-steroidal, anti-inflammatory, cortisone-like prescriptions are usually used.

In either case, the goal of treatment is to reduce pain, increase function and help you return to normal activities.

Nonsurgical treatments fall into four major groups:

  • medication (including complementary and/or prescription medications)
  • natural treatments and lifestyle modifications
  • exercise
  • supportive devices

Medication

There is no known cure for arthritis but many medications can help to reduce pain and maintain joint movement. More information about medications for arthritis. 

Natural Treatments and Lifestyle Modification

Lifestyle modifications can include losing weight, switching from high-impact exercises like running or jumping to low-impact workouts like swimming or cycling, and minimizing activities that aggravate the condition, such as climbing stairs. Simple weight loss can reduce stress on weight bearing joints, like the knee, resulting in reduced pain and increased function.

Exercise

Research has shown that exercise is an essential tool in managing your arthritis. The benefits of an appropriate exercise program inclued: 

  • reduced joint pain and stiffness
  • increased strong muscle around the joints, and
  • increased flexibility and endurance

Excercise also helps promote overall health and wellness by giving you more energy, helping you sleep better, controlling your weight, decreasing depression, and giving you more self-esteem.

The Arthritis Foundation offers an excellent guide to exercise for people with arthritis.

Supportive Devices

Using supportive devices, such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. Some research studies have focused on the use of knee braces for treatment of osteoarthritis of the knee. They may be especially helpful if the arthritis is centered on one side of the knee. A brace can assist with stability and function. There are two types of braces that are often used. An "unloader" brace shifts load away from the affected portion of the knee. A "support" brace helps support the entire knee load. In most studies, the knee symptoms improved, with a decrease in pain on weightbearing and a general ability to walk longer distances.

Medications

While there is no known cure for arthritis, medications and treatments can help to reduce pain and maintain joint movement.

The medications most commonly prescribed by doctors include:

  • NSAIDS (non-steroidal anti-inflammatory drugs)
  • COX-2 Inhibitors
  • Analgesics that lessen pain and work to reduce swelling
  • Corticosteroids
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologics

Prior to prescribing for you, your doctor’s first question will be, “Are you allergic to any drugs?” 

Before accepting his prescription(s), ask your doctor about results you can expect and how soon the drug should start to work.  Ask him or her about any known potentially harmful side effects of the drug so you’re alert to them.

Be sure to ask how your progress will be monitored. Will you require routine blood tests? 

Your doctor may suggest that you relieve pain with local steroid injections for a specific painful joint.  Most doctors will not allow more than three injections per year as they may weaken bones.  If you participate in sports professionally, steroids are not for you.

 

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