Are alternative therapies helpful in arthritis?

Because you have a persistent illness you will inevitably become frustrated from time to time with the progress of your treatment and the ongoing symptoms. You may wonder if the treatment is the best - so often it seems to be a matter of trial and error until the most effective regimen is found.

With arthritis, controlling the pain is a major part of the illness, with the associated problems of tiredness and loss of mobility which often leads to depression. You may wish to seek alternatives and try just about anything, to rid yourself of the problem and be "normal" again.

Well-meaning friends offer a wealth of advice. Books and advertisements depict new or old remedies that are just the answer. The issue is as old as humankind. There have always been beliefs about the curative properties of foods, plants, practices and healers.

Alternative or complementary therapies are generic terms for all the different types of non-traditional therapies not normally dispensed by a general practitioner or specialist. They include therapies which often date back many centuries, practices from many cultures, physical applications, dietary and oral medications, psychological and spiritual assistance.

So what can you do when tempted to try out some of these out-of-the-mainstream therapies? Educate yourself! Some important points to keep in mind:

Your doctor still knows best.

Of necessity, doctors are becoming more knowledgeable about the variety of treatments available and are often receptive to the benefits gained. Some may even suggest alternatives that can be safely used in conjunction with your treatment.

If you are going to try an alternative, make sure your doctor knows - some alternatives may be harmful (like a neck manipulation if you have arthritis in your neck) or cause a reaction and possibly an overdose with your prescription medicine.

Discuss both the risks and benefits of therapies and their interaction with your current regimen. Don't stop any part of your current treatment regimen - consider them as additional and not an alternative.

What about "natural" products?

Natural isn't necessarily safer.

There are a multitude of remedies that claim to be natural, but just because a product is labelled "natural" or is from a plant source, it is not guaranteed to be safe. Any substance you are going to swallow or put on your skin should be regarded with the same amount of respect as pharmaceuticals.

The natural products will all have active chemicals in them, and though many of them are safe most of the time, they may also cause serious side effects, especially when taken in conjunction with the prescribed medication.

Herbal supplements are virtually unregulated.

Unlike prescription and over-the-counter drugs which must pass rigorous multiphase testing to be approved, herbal supplements can land on the shelves with little scrutiny. As long as their product labels or advertising do not make direct health claims (such as "cures arthritis"), they are not required to provide on-label warnings about possible side effects, interaction with other medicines or advice on when not to use them. Nor do they give guidelines for appropriate usage and dose, or other directions for safe, effective use. They may not even list all the ingredients in the product.

What about alternative practitioners?

Some alternative practitioners are licenced, others are not.

Some professional organisations certify and licence their members. Chiropractors, acupuncturists, naturopaths and osteopaths mostly have their own associations which require certain levels of training and proficiency.

Check out their credentials - they should be willing to discuss their training and should provide contact information for any organisation they are affiliated to. Details such as experience with your particular diagnosis, where they learned their technique, how long they have been practising and any continuing education or additional course work should be discussed.

It may seem a bit over the top, but doctors must undergo years of rigorous training to qualify, while practitioners of alternative therapies can just "hang out a shingle" and start taking clients.

The "placebo effect" works - at least for a while.

What is the placebo effect?

You take an unproven herbal supplement for your osteoarthritis, and suddenly your joints don't hurt any more. A miracle treatment? More likely, your relief is due to the so-called "placebo effect", the term used to describe the circumstance that causes 20-40 % of people unknowingly taking a "sugar pill" (placebo) or a substance with no medicinal content, to report they feel better.

Although this result cannot be fully explained, experts think it is linked to the hope that what the person is doing will somehow help and is more likely in people experiencing chronic pain. It can also be linked to people feeling better because they are taking extra control over their own health.

Also, alternatives are often taken at the peak of a disease's effect. As the normal cycle of symptoms reduces, this coincides with the introduction of the alternative. But the person would have started to feel better regardless of what they had been taking.

The more pain you are in, the more you want to believe.

People with chronic disease frequently go to alternative therapies because the therapies they get from their doctors don't always work or don't always adequately relieve pain. Doctors recognise this is one of the main reasons people consider alternatives.

Unfortunately, chronic pain can cloud judgement, putting people desperate for relief at higher risk of trying questionable, even dangerous alternatives. For people in this situation it is even more important that they choose alternatives carefully and in consultation with their medical team.

What are the main types of alternatives?

Acupuncture
Acupuncture is sometimes useful in assisting the management of arthritis. It may relieve pain temporarily but does not restore permanently damaged tissues, nor does it normally prove helpful in active rheumatoid arthritis.

Acupuncture helps most in the milder, transient conditions in people who cannot tolerate drugs. It does not cure or reverse the underlying disease process, but may help through a particularly painful episode.

Osteopathy and chiropractic
Osteopathy and chiropractic manipulation may be helpful in cases of neck and back pain due to wear and tear on spinal joints and discs. Manipulation is no longer considered "unorthodox" treatment. Given to the right person in the right way, it is often very helpful in the short term, but there is no evidence that it reverses the changes caused by osteoarthritis.

Homoeopathy
Homoeopathy aims to improve health by giving special treatments that are tailor-made to the person. It has been applied to a whole range of medical and psychological conditions in children and adults, as well as for improved general health. Homoeopathic treatments involve remedies that come mainly from plants, minerals and metals, and there are more than 3000 remedies throughout the world.

Herbal remedies and dietary supplements
Research shows no evidence that vitamins and minerals alter the course of arthritis. However, initial studies on Omega-3-fatty acids (present in cold-water fish such as salmon, tuna, halibut) have found they could delay or even reverse joint cartilage destruction, as well as easing pain and inflammation. (Cod liver oil is generally not recommended because of its high levels of vitamins A and D, which could lead to toxicity.)

GLA (Gamma-linolenic acid) is a type of Omega-6 fatty acid found in evening primrose oil, black currant oil and borage oil. These oils have shown promise in relieving symptoms of arthritis.

Diets low in saturated fats also seem to have a mild anti-inflammatory effect.

Supplements can cause side effects and in some cases may interact with traditional medicines. It is a good idea to discuss your intentions to take any supplements with your doctor first.

Glucosamine and chondroitin sulphate
Glucosamine is a major component of joint cartilage. Supplements are derived from shrimp, lobster and crab shells.

Chondroitin sulphate is a component of human cartilage, bone and tendon. Supplements usually come from bovine trachea (cows' windpipes) or pork byproducts.

The Cochrane Collaboration is an international non-profit and independent organisation, producing evidence-based reviews on health interventions. According to Cochrane reviews, both glucosamine and chondroitin sulphate are useful in arthritis and seem to be safe. They appear to protect cartilage from damage and help with pain relief and mobility. However, more information is needed about the long term effects.

Large, independent clinical trials are currently under way and will hopefully provide more definitive evidence about the use of these agents in arthritis.

Other common remedies

Other commonly considered remedies include royal jelly, ginseng, cider vinegar, herbs, garlic, honey and deer velvet. Often these products are promoted on anecdotal evidence that is not backed by sound research.

It should be noted that the New Zealand Ministry of Health issued a warning about health risks associated with royal jelly in 1997 because its use can produce allergic and other reactions. Although products are encouraged to have a health warning, not all do so.

Dietary changes are also commonly considered to assist in the management of arthritis. These issues are considered in the article on diet and arthritis.

In conclusion, alternative and complementary therapies can play an important role in the management of arthritis, especially to assist with the management of pain, depression and general well-being. There is no cure within these practices. However, by alleviating the symptoms, they can provide you with better coping skills for the day-to-day traumas of living with a chronic illness.

Original material provided by Arthritis New Zealand. Edited by everybody, July 2005.