Alternative remedies for arthritis are nothing new. Folklore is full of potions and poultices that supposedly relieve joint pain, and the advent of modern medicine hasn't dampened the public's interest. If anything, arthritis patients are more adventuresome than ever before.
It's no surprise that so many arthritis sufferers are willing to venture beyond the bounds of mainstream medicine, says John H. Klippel, MD, president of the Arthritis Foundation. With few exceptions, patients with arthritis are never completely cured by standard medicine. "Traditional treatments can relieve pain, but people still suffer," he says. In addition, today's patients aren't always willing to just sit back and take doctor's orders. "Many patients will try anything to take charge of their health,"
Heading for the mainstream?
When this proactive attitude is backed up with caution and common sense, good things can sometimes happen, Klippel says. In some cases, he says, today's alternative medicine may someday be tomorrow's mainstream. Many rheumatologists (doctors who specialize in arthritis and other joint diseases) are very open to the idea of complementary medicine, he says. If any remedy can prove its worth in controlled clinical trials, doctors will quickly embrace it.
Unfortunately, most alternative treatments have rarely, if ever, been put to the scientific test. A few studies have shown some benefit from these treatments, but the results aren't consistent. While some patients swear by the results, doctors are still waiting for the hard data. There are, however, a number of studies on at least three complementary treatments that show great promise: acupuncture, exercise and glucosamine/chondroitin.
A landmark study funded by the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, found that acupuncture provides pain relief and improves function in patients with osteoarthritis of the knee. Other studies have also found it helpful in relieving pain. As a result, it is increasingly being used as part of arthritis treatment and may even be covered by health insurance.
Exercise -- though considered more self-care than alternative remedy -- is also widely recognized as reducing arthritis pain and improving flexibility, range of motion and mobility. One study published in Arthritis Care and Research found that two hours of strength building exercises a week showed that after eight weeks, participants had less pain and fatigue, and improved leg and arm functioning; those that continued the program beyond eight weeks also saw an improvement in stiffness. The U.S. Centers for Disease Control and Prevention recommends that -- with the approval of your physician -- you exercise 30 minutes a day at least five days a week.This could include a combination of strength-building exercises and walking , biking, dancing, swimming or water exercise.
Glucosamin and chondroitin have also begun to enter the mainstream. According to Klippel, preliminary studies have suggested that the supplements can relieve osteoarthritis, presumably by restoring cartilage. The supplements may even be able to slow down the advance of the disease, a claim that no current medication can make. (There's no reason to think that the supplements would be effective against any other form of arthritis, including rheumatoid arthritis, he says.)
Interest in glucosamine and chondroitin has been so great that the National Institutes of Health conducted a large-scale study of the supplements for treating osteoarthritis of the knee. More than 1,500 osteoarthritis sufferers at 16 rheumatology centers across the United States participated in the study over a 24-week period. Scientists gave research subjects five different treatment options including glucosamine only, chondroitin only, and a combination of both. Although there were no significant differences between treatments overall, researchers found that for those with moderate to severe pain, glucosamine combined with chondroitin reduced patient suffering by at least 20 percent. However, a follow-up study published in 2008 found that the supplement did no better than a placebo in slowing the loss of cartilage. Since the placebo group did better than expected, however, researchers cautioned that the results are difficult to interpret and further research is needed.
In 2010, however, a new analysis of large-scale studies on the issue found that there is no evidence that supplements containing glucosamine and chondroitin relieve the pain of osteoarthritis in the hips and knees. However, the study found no evidence that the pills cause harm, and the study authors said that in general, there was little reason to stop taking them if people feel they are helpful.
Still, patients should talk to their doctors before trying glucosamine, chondroitin, or any other alternative remedies, Klippel says. For one thing, doctors can offer valuable advice. More importantly, they need to know about anything and everything that might affect a patient's condition. If a patient suddenly gets better after trying a new treatment, the doctor should know where the credit belongs. Likewise, if something goes wrong, physicians should know about any potential causes.
Many people assume that "natural" products like glucosamine and chondroitin must be safe, but that assumption could backfire. According to the Arthritis Foundation, glucosamine and chondroitin carry some potential risks. For example, chondroitin may interfere with blood-thinning medications, and glucosamine could potentially raise blood sugar in people with diabetes or cause allergies in people allergic to shellfish. The Arthritis Foundation says that children, pregnant women, or women who might become pregnant shouldn't take the supplements because there are no long-term studies of the effects on those populations.
Patients shopping for glucosamine or chondroitin need to be aware of another potential pitfall. Since nutritional supplements are not as stringently monitored as drugs, the pills in the bottle may not have all of the ingredients listed on the label. For this reason, the Arthritis Foundation recommends buying supplements only from large, reputable companies. Be aware, however, that the federal government doesn't regulate any supplements for safety and effectiveness before they are put on the market.
The Arthritis Foundation also warns against taking certain supplements at all for safety reasons. These include adrenal, spleen or thymus extracts (they can be contaminated); autumn crocus (a potential poison); 5-HTP (associated with a serious illness); GBL (has been linked to coma, death and seizures); L-tryptophan (associated with a serious illness); chapparal (may cause hepatitis or kidney and liver damage); and kombucha tea (it has a high risk of being contaminated with anthrax or other bacteria).
Alternative therapies should never take the place of standard medical care, Klippel says. People with joint pain need to know exactly what kind of arthritis they have and what their future holds. Working together with their doctors and complementary care providers, they may find alternative treatments that really work.
Interview with John H. Klippel, M.D., medical director of the Arthritis Foundation.
Interview with Charlie Jannings, M.D., specialist in geriatrics and sports medicine.
Wandel, Simon et al. "Effects of glucosamine, chondroitin or placebo in patients with osteoarthritis of hip or knee: network analysis." BMJ online, Sept. 17, 2010.
Nine Supplements to Avoid. Arthritis Foundation.
National Center for Complementary and Alternative Medicine. Questions and answers: NIH glucosamine/chondroitin arthritis intervention trial.
Arthritis Foundation. Glucosamine.
Arthritis Foundation. About Us. http://www.arthritis.org/resources/aboutus/Klippel.asp
Food and Drug Administration. Dietary Supplements: Overview. http://www.cfsan.fda.gov/~dms/supplmnt.html
National Center for Complementary and Alternative Medicine. Questions and Answers: NIH Glucosamine/Chrondroitin Arthritis Intervention Trial (GAIT). February 2006. http://nccam.nih.gov/research/results/gait/qa.htm
Berman BM, Lao L, Langenberg P, et al. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial. Annals of Internal Medicine. Vol. 141(12): 901-910.
Sawitzke AD, Shi H, Finco MF, et al. The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatology, Vol. 58(10): 3183-91.