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Rheumatoid arthritis (RA) is a chronic disease that affects the joints, often those in a person's wrists, fingers, and feet. The common symptoms of RA are pain, stiffness, fatigue, sleep disturbances, and fever. There are treatments for RA in conventional medicineMedicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses., but some people also try complementary and alternative medicine (CAM)A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine..a This report answers some frequently asked questions on this topic and suggests sources for more information.
aCAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians. Some practitioners of conventional medicine are also practitioners of CAM.
Rheumatoid arthritis (RA) is what is called an autoimmune disease. In this type of disease, a person's immune system (the system in the body responsible for fighting disease) mistakenly attacks the person's own body. In RA, the parts attacked are the linings of the joints (places in the body where two bones connect). The reasons that this happens are complex and not fully understood. RA causes pain, swelling, and stiffness in a person's joints and problems with functioning. However, RA affects different people in different ways, in terms of the symptoms they have, how serious the symptoms are, and how long the symptoms last. RA is different from other types of arthritis (such as osteoarthritis). For example:
To find out more about RA, contact the National Institute of Arthritis and Musculoskeletal and Skin Diseases (see "For More Information").
There are many proven treatments in conventional medicine for RA. They are used to relieve pain, reduce swelling, slow down or stop the damage to joints, help the person function better, and improve the person's sense of well-being. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biological response modifiers, and corticosteroids. Non-drug treatments include physical therapy; modified exercise programs; devices such as canes, special shoes, and splints (rigid supports that keep a part of the body from moving while it heals); and lifestyle changes--such as balancing activity with rest, eating a healthy diet, and reducing stress. Scientific research is advancing in understanding the many complexities of RA and in uncovering new and promising treatments.
It is important for people with RA to have their condition followed by a rheumatologist (a physician who specializes in diseases of the bones, muscles, and joints). This helps prevent or minimize damage to the joints and disability, which can occur if RA is left untreated over time.
Among the many reasons that some people use CAM for RA are:
Many types of CAM are tried for RA, such asb:
It is beyond the scope of this report to discuss the scientific evidence about all CAM therapies used for RA. The therapies listed below were selected because they are among those most frequently discussed in the scientific literature and inquired about at the NCCAM Clearinghouse.c In reading about them, you will also see some general points to consider about similar therapies (for example, other botanicals). You can seek science-based information on any CAM therapy that interests you through some of the resources listed in "For More Information."
b Information on these or any other CAM therapies can be obtained from the NCCAM Clearinghouse (see "For More Information").
cReferences for the discussions on therapies are listed at the end of this report. They consist of recent peer-reviewed literature in English in the National Library of Medicine's PubMed database; two evidence-based databases on natural products; and other Federal Government publications.
Therapies Discussed in This Report
About Dietary Supplements
Dietary supplements were defined in a law passed by Congress in 1994. A dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements. must meet all of the following conditions:
Other important information about dietary supplements:
1. Botanical Supplements and Other Dietary Supplements
Overall, there is not much rigorous research available on the effectiveness and safety of botanical and other supplements that people try for RA. It is also important to know that while supplements are regulated by the U.S. Food and Drug Administration (FDA) as a category of foods, supplements made from plants and used for medicinal purposes (sometimes referred to as herbal medicines) can have effects as powerful as those of drugs. In fact, many conventional drugs first came from plants, such as digitalis (from the foxglove plant), used to treat heart failure and heart rhythm, and paclitaxel (from the yew tree), a cancer chemotherapy drug.
It is important to be as informed as possible about the safety of any supplement you are considering or using. Some information already exists from a long history of botanical use outside conventional medicine. This knowledge is being strengthened as NCCAM supports rigorous studies on botanicals and other supplements that have shown promise in early studies to find out more about their molecular structure, their safety, how they may work, and for what diseases or conditions.
Thunder God Vine
Thunder god vine (TGV for short; botanical name Tripterygium wilfordii Hook F) is a perennial vine native to China, Japan, and Korea. Preparations made from the skinned root of TGV have been used in traditional Chinese medicine to treat inflammatory and autoimmune diseases. Interestingly, TGV also has a history of use to kill insects in farm fields.
Gamma-Linolenic Acid (GLA)
GLA is an omega-6 fatty acid that is found in the oils of some plant seeds, including evening primrose (Oenothera biennis L.), borage (Borago officinalis L.), and black currant (Ribes nigrum L.). GLA can be used by the body to make substances that reduce inflammation.
Fish oil contains high amounts of two omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). As with GLA, the body can use omega-3s to make substances that reduce inflammation.
dTwo Federal publications are "Mercury Levels in Commercial Fish and Shellfish" and "What You Need to Know About Mercury in Fish and Shellfish: Advice for Women Who Might Become Pregnant, Women Who Are Pregnant, Nursing Mothers, and Young Children" are available online. They are copublished by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency.
The herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. valerian has a history of use for sleep problems and anxiety disorders. Disrupted sleep has been called a common and often neglected symptom of arthritis. A large, nationally representative survey of people over 65 with arthritis in 2000 found that disruption of sleep, among all the disruptions of arthritis, was the main reason that people sought a variety of CAM, self-care, and conventional medical treatments. Valerian has also been taken for other reasons, such as the intent to relieve muscle and joint pain. The species of valerian most used in American supplements is Valeriana officinalis.
Four Other Botanicals
Three of the other botanicals marketed with claims to benefit arthritis pain are:
These three botanicals have a history of use in Ayurveda to treat inflammatory conditions. Based on some early findings that may indicate promise, NCCAM is supporting studies at the University of Arizona on these three botanicals, to increase scientific knowledge about them and determine whether they are helpful for chronic inflammatory conditions such as arthritis and asthma.
A fourth botanical, feverfew, has been used in folk medicine with an intent to treat arthritis, migraine, and other conditions. One small published clinical trial was located for this report. It found no more benefit from feverfew than from the placebo. Overall, feverfew has not been proven to help RA symptoms.Safety
Glucosamine and Chondroitin
Glucosamine sulfate (glucosamineA substance found in the fluid around joints and used by the body to make and repair cartilage. Glucosamine in dietary supplements is made in the laboratory or from the shells of shrimp, lobster, and crabs. for short) and chondroitinA substance found in the cartilage around joints. Chondroitin in dietary supplements is made in the laboratory or from the cartilage of sharks and cattle. sulfate (chondroitin) are popular dietary supplements for arthritis. They are sold separately, in combination with each other, and in other combinations.
Glucosamine is a substance found in the fluid around the joints. It can also be obtained from the shells of shrimp, lobster, and crabs, or made in the laboratory. The body uses glucosamine to make and repair cartilage, a firm but flexible tissue that covers the ends of bones, keeps them from rubbing against each other, and absorbs the force of impact.
Chondroitin is a substance found in the cartilage around joints. As a supplement, it is obtained from sources such as sharks and cattle.Effectiveness and safety
2. Special Diets
Many people with RA are interested in whether certain foods can affect their symptoms. Examples of foods that are believed to possibly worsen the symptoms of arthritis (including RA) are the nightshade family of plants (white potatoes, tomatoes, eggplant, and peppers), dairy, citrus fruits, acidic foods, sweets, coffee, and animal protein. There are various theories about how foods may affect RA, including:
Acupuncture is a practice that developed as a part of traditional Chinese medicine. Some people try acupuncture to treat RA pain or to treat the RA itself. For more about acupuncture, see NCCAM's fact sheet "Acupuncture."Effectiveness and Safety
Magnets are objects that produce a type of energy called magnetic fields. The term "magnets" is also used to refer to consumer products that contain magnets. Examples include shoe insoles, clothing, wraps for parts of the body, and mattress pads. These are of a type called static magnets, because their magnetic fields are unchanging.Effectiveness and Safety: Static Magnets
The second type of magnets used for health purposes are called electromagnets (EMs), because they produce magnetic fields only when electric current flows through them. EMs are used in conventional medicine to treat bone fractures that have not healed well, and they are being studied in research settings for a number of other conditions (including cancer, epilepsy, RA, and mental disorders). Some consumer products using EMs are available.Effectiveness and Safety: Electromagnets
For more about magnets, see the NCCAM fact sheet "The Use of Magnets for Pain."
Hydrotherapy is the use of water for therapeutic purposes. A few examples of hydrotherapy include bathing in heated water, as from hot springs or the sea; mineral baths; and water-jet massages. Another term used for hydrotherapy baths is balneotherapy.
Hydrotherapy dates back to ancient Greece and Rome. In recent centuries, it has been a popular treatment in Europe and Israel. Some forms of hydrotherapy are used in conventional medicine in the United States, such as whirlpool baths for athletic injuries and ice for sprains. As CAM, hydrotherapy is often combined with other treatments, such as exercises, massagePressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area., diets, herbs, and/or mud packs. It is used with the intent to benefit arthritis, circulation, and various other health issues, and to enhance feelings of relaxation and well-being. Some also claim that hydrotherapy "detoxifies" the body. In this report, the term hydrotherapy refers to external water treatments and not to internal treatments using water, such as colon irrigation or drinking specially treated water.Effectiveness and Safety
Homeopathy is a whole medical systemA complete system of theory and practice that has evolved over time in different cultures and apart from conventional medicine. Examples of whole medical systems include traditional Chinese medicine, Ayurvedic medicine, homeopathy, and naturopathy. that was developed in Germany and brought to the United States in the 19th century. Homeopathy involves giving very small doses of substances called remedies that would produce the same or similar symptoms of illness in healthy people when given in larger doses. This approach is called "like cures like." The remedies are diluted very highly, often to a point where not one molecule of the original substance remains. For more about homeopathy, see NCCAM's fact sheet "Questions and Answers About Homeopathy."Effectiveness and Safety
7. Selected Mind-Body Techniques
Mind-body techniques draw upon the interactions that exist in health and disease between the mind, the emotions, the body as a whole, and various body systems (such as the immune, nervous, and endocrine systems). Some mind-body techniques are part of ancient healing traditions, others have emerged in recent times. Examples of mind-body techniques include meditation, tai chi, relaxation techniques, and spiritualityAn individual's sense of purpose and meaning of life beyond material values. Spirituality may be practiced in many ways, such as through religion. for health purposes.Effectiveness and Safety
e In this study, spirituality was described as something "often viewed as an intrinsic quality of the individual, a desire for personal connectedness with a transcendence reality." This was different from religiousness, "an outward practice of a particular spiritual understanding and/or the framework of beliefs, values, and rituals," although the authors noted that this distinction is difficult. Spirituality was measured using a scale designed to evaluate "the capacity of an individual to stand outside of his/her immediate sense of time and place and to view life from a larger, more detached perspective."
Yes. Examples of recent studies include:
Recently published NCCAM-supported research on RA has included:
These and many other reports on NCCAM-supported research may be located in the CAM on PubMed database (See "For More Information").
Agency for Healthcare Research and Quality. Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis. Evidence Report/Technology Assessment no. 89. Rockville, MD: Agency for Healthcare Research and Quality; 2004. 04-E012-1.
Ariza-Ariza R, Mestanza-Peralta M, Cardiel MH. Omega-3 fatty acids in rheumatoid arthritis: an overview.* Seminars in Arthritis and Rheumatism. 1998;27(6):366-370.
Astin JA, Beckner W, Soeken K, et al. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials.* Arthritis and Rheumatism. 2002;47(3):291-302.
Balick MJ, Lee R. Digging in the herb garden: responding to a patient's query about thunder god vine.* Alternative Therapies in Health and Medicine. 2001;7(6):100-103.
Berbert AA, Kondon CR, Almendra AL, et al. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis.* Nutrition. 2005;2:131-136.
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. 2004;141(12):901-910.
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Brinker AM, Raskin I. Determination of triptolide in root extracts of Tripterygium wilfordii by solid-phase extraction and reverse-phase high-performance liquid chromatography.* Journal of Chromatography. 2005;1070:65-70
Capriotti T. Any science behind the hype of "natural" dietary supplements?* Medsurg Nursing. 2004;13(5):339-350.Casimiro L, Brosseau L, Milne S, et al. Acupuncture and electroacupuncture for the treatment of RA. Cochrane Database of Systematic Reviews. 2004;(3):CD003788. Accessed on January 26, 2004.
Cleland LG, James MJ, Proudman SM. The role of fish oils in the treatment of rheumatoid arthritis.* Drugs. 2003;63(9):845-853.
Curtis CL, Harwood JL, Dent CM, et al. Biological basis for the benefit of nutraceutical supplementation in arthritis.* Drug Discovery Today. 2004;9(4):165-172.
Danao-Camara TC, Shintani TT. The dietary treatment of inflammatory arthritis: case reports and review of the literature.* Hawaii Medical Journal. 1999;58(5):126-131.
Ernst E. Usage of complementary therapies in rheumatology: a systematic review.* Clinical Rheumatology. 1998;17(4):301-305.
Fisher P, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis.* Rheumatology (Oxford). 2001;40(9):1052-1055.
Fortin PR, Lew RA, Liang MH, et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis.* Journal of Clinical Epidemiology. 1995;48(11):1379-1390.
Hafstrom I, Ringertz B, Spangberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens.* Rheumatology (Oxford). 2001;40(10):1175-1179.Han A, Robinson V, Judd M, et al. Tai chi for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2004;(3):CD004849. Accessed on July 21, 2004.
Henderson CJ, Panush RS. Diets, dietary supplements, and nutritional therapies in rheumatic diseases.* Rheumatic Disease Clinics of North America. 1999;25(4):937-968.
Herman CJ, Allen P, Hunt WC, et al. Use of complementary therapies among primary care clinic patients with arthritis. Preventing Chronic Disease: Public Health Research, Practice, and Policy. 2004;1(4).
James MF, Proudman SM, Cleland LG. Dietary n-3 fats as adjunctive therapy in a prototypic inflammatory disease: issues and obstacles for use in rheumatoid arthritis.* Prostaglandins, Leukotrienes and Essential Fatty Acids. 2003;68(6):399-405.
Johnson, MT, Waite LR, Nindl G. Noninvasive treatment of inflammation using electromagnetic fields: current and emerging therapeutic potential.* Biomedical Sciences Instrumentation. 2004;40:469-474.
Jordan JM, Benard SL, Callahan LF, et al. Self-reported arthritis-related disruptions in sleep and daily life and the use of medical, complementary, and self-care strategies for arthritis: the National Survey of Self-care and Aging.* Archives of Family Medicine. 2000;9(2):143-149.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.* Journal of the American Medical Association. 2004;292(12):1433-1439.Lewis C. Arthritis: timely treatments for an ageless disease. FDA Consumer. 2000;34(3):27-29, 31-33.
Little C, Parsons T. Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2004;(1):CD002948. Accessed on January 26, 2004.
Martin RH. The role of nutrition and diet in rheumatoid arthritis.* Proceedings of the Nutrition Society. 1998;57(2):231-234.
National Center for Complementary and Alternative Medicine. Acupuncture. National Center for Complementary and Alternative Medicine Web site. Accessed on November 23, 2004.
National Center for Complementary and Alternative Medicine. Mind-Body Medicine: An Overview. National Center for Complementary and Alternative Medicine Web site. Accessed on July 28, 2005.
National Center for Complementary and Alternative Medicine. Questions and Answers About Homeopathy. National Center for Complementary and Alternative Medicine Web site. Accessed on November 23, 2004.
National Center for Complementary and Alternative Medicine. Questions and Answers About Using Magnets To Treat Pain. National Center for Complementary and Alternative Medicine Web site. Accessed on July 28, 2005.
National Center for Complementary and Alternative Medicine. Questions and Answers: NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). National Center for Complementary and Alternative Medicine Web site. Accessed on July 28, 2005.
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Natural Medicines Comprehensive Database. Black Currant. Natural Medicines Comprehensive Database Web site. Accessed on September 29, 2004.
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Natural Medicines Comprehensive Database. Evening Primrose Oil. Natural Medicines Comprehensive Database Web site. Accessed on September 29, 2004.
Natural Medicines Comprehensive Database. Feverfew. Natural Medicines Comprehensive Database Web site. Accessed on July 7, 2005.
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Natural Medicines Comprehensive Database. Gamma-Linolenic Acid. Natural Medicines Comprehensive Database Web site. Accessed on August 18, 2004.
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*Links to a PubMed abstract.
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The NCCAM Clearinghouse provides information on CAM and on NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. Examples of publications available include "What's in the Bottle? An Introduction to Dietary Supplements," "Herbal Supplements: Consider Safety, Too," "Questions and Answers About Homeopathy," and "Acupuncture."
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
NIAMS supports research on these diseases, training of scientists, and information (including publications on RA) based on scientific evidence.
Toll-free in the U.S.: 1-877-22-NIAMS
Web site: www.niams.nih.gov
A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) abstracts of articles from biomedical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of NLM's PubMed system and focuses on the topic of CAM.
National Institute of Allergy and Infectious Diseases
A brochure, "Food Allergies: An Overview," is available.
In the U.S.: 301-496-5717
Web site: www3.niaid.nih.gov
NCCAM thanks the following people for their technical expertise and review of this publication: Carol Pontzer, Ph.D., and Richard L. Nahin, Ph.D., M.P.H., NCCAM; Barbara Mittleman, M.D., and Peter E. Lipsky, M.D., National Institute of Arthritis and Musculoskeletal and Skin Diseases; Diana M. Taibi, M.S.N, R.N., and Cheryl Bourguignon, Ph.D., R.N., University of Virginia School of Nursing; Donald M. Marcus, M.D., Baylor College of Medicine; Barbara N. Timmermann, Ph.D., University of Arizona College of Pharmacy; and Robert Zurier, M.D., University of Massachusetts Medical School.
NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.
National Institutes of Health
U.S. Department of Health and Human Services
NCCAM Publication No. D282
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