Alternative medicine and complementary medicine are terms that are often used interchangeably. We will follow this practice in this text.
Alternative medicine comprises a mixed group of practices that target hygiene, diagnosis, and treatment of many diseases. The theoretical bases of alternative medicine diverge from those of modern scientific medicine and are not generally accepted by modern physicians. Alternative medicine has failed to gain widespread acceptance because these practices currently lack a plausible scientific basis. Furthermore, few studies have demonstrated their safety and efficacy.
Alternative medicine may emerge from any of the following sources:
- Religious sources
- Cultural beliefs
- Supernatural, magical, or cultist practices
- Naive, illogical, or false understandings of anatomy, physiology, pathology, or pharmacology
- Fraud and exploitation of the sick and hopeless
Any treatment that is outside the traditional medicine or practice of your primary health system can be considered alternative medicine. Of course, a treatment that is considered to be “alternative” in one culture may be deemed “traditional” in another culture. For example, acupuncture is a system of treatment that has been practiced in China for more than 5000 years, yet is considered an alternative medicine in the United States.
Practitioners of Western (allopathic) medicine are closely monitored and regulated in the United States, and must undergo rigorous training and testing as well as licensing by state and federal authorities. The facilities of modern practitioners, such as hospitals, surgical centers, and dialysis units, are subject to similar scrutiny and licensing requirements. By contrast, complementary medicine practitioners and their therapies are rarely—if ever—subject to this level of testing and regulatory oversight in the United States. Therefore, patients who seek out these therapies cannot be confident in the abilities of the practitioners to safely practice their remedies.
The greatest risk involved with using complementary medicine is the risk of missing a necessary or possibly life-saving diagnosis or treatment from a practitioner of conventional medicine. In RA, early treatment with one of the newer medications can significantly inhibit joint destruction. Using an alternative medicine that lacks the same properties could lead to irreversible joint damage and disability.
In RA, early treatment with one of the newer medications can significantly inhibit joint destruction. Using an alternative medicine that lacks the same properties could lead to irreversible joint damage and disability.
Other problems associated with complementary therapies include the potential for dangerous interactions with conventional therapies. Many complementary therapies also lack evidence of effectiveness (most have not been subjected to rigorous clinical trials). Also, many complementary therapies may not be covered by health insurance.
The growing consumer interest in alternative medicine has expanded the market for a wide range of products, from acupuncture to the flood of dietary supplements that are now on the market. Supplements are popular, but questions remain about the safety of some of these products. In 1994, the U.S. Congress decided that dietary supplements should be regulated as if they were foods. In other words, these products are assumed to be safe unless the Food and Drug Administration (FDA) can demonstrate that they pose a significant risk to consumers. Manufacturers are not legally required to provide specific information about supplements' safety and effectiveness before marketing their products. Furthermore, some supplements may interfere with the effectiveness of your other RA medications. For all these reasons, you should use caution when taking supplements and do so only after discussing these products with your treating physician.
The following are some alternative medicine treatments you may want to discuss with your physician.
Acupuncture
Acupuncture is commonly used by patients with chronic painful musculoskeletal disorders. There are, however, few welldesigned studies that demonstrate its efficacy.
Glucosamine and Chondroitin Sulfate
Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue. Chondroitin sulfate is a complex carbohydrate that helps cartilage retain water. In the United States, glucosamine and chondroitin sulfate are sold as dietary supplements; hence, they are regulated as foods rather than drugs. Recent medical trials have shown that glucosamine and chondroitin sulfate are more effective than placebo in relieving pain from osteoarthritis of the knee. As yet, however, similar studies demonstrating these supplements' effectiveness in relieving pain in patients with RA have not been performed. Before trying glucosamine or chondroitin sulfate, discuss this choice with your doctor and ask how it would fit in with your current treatment program.
Glucosamine
An amino sugar produced by the body that is found in cartilage. Glucosamine is a popular dietary supplement and is thought to improve the joints symptoms of osteoarthritis.
Chondroitin sulfate
A sugar-based material that is present in cartilage. Chondroitin is a popular dietary supplement that is thought to improve the joint symptoms of osteoarthritis.
Hydrotherapy
Hydrotherapy is the use of water in the treatment of disease. Hydrothermal therapy also exploits temperature-related effects, as in hot baths, saunas, and wraps. Hydrotherapy may make patients feel better by taking the weight off of painful joints, allowing them to participate in exercise classes and helping them to relax afterward. It has not been shown to affect the course of RA or to be able to replace drug therapy.
Herbs
Ginseng is a root that has been used to treat patients with a variety of illnesses for the last 2000 years, particularly in Asian cultures. To date, research results on Asian ginseng are not conclusive enough to prove the many health claims associated with the herb. Only a handful of large clinical trials on Asian ginseng have been conducted to date. Most studies have been small or have had flaws in design and reporting. Some claims for health benefits have been based only on studies conducted in animals.
Antioxidants, such as vitamin C and E, may help reduce the oxidative damage that occurs during flare ups of RA. As yet, no studies have demonstrated that the use of antioxidants results in an improvement in RA symptoms.
Fatty acids are the building materials of fats. Although most fatty acids can be produced in your body, the essential fatty acids need to be part of your diet, because your body cannot manufacture them. There are two essential fatty acids, called alpha linolenic acid and linoleic acid. Alpha linolenic acid (also known as omega-3 fatty acid) is found in flax seed, walnuts, and canola oil. Linoleic acid (also known as omega-6 fatty acid) is found in soy, sunflower seeds, corn oil, and most nuts. Some medical studies suggest that gamma-linolenic acid, which is found in evening primrose oil, can produce a subjective improvement in symptoms and allow some patients to reduce or stop treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). There is, however, no evidence that they act as disease-modifying agents.
Aromatherapy is a treatment wherein the body and especially the face are massaged with preparations of fragrant essential oils. These oils are extracted from herbs, flowers, and fruits. Aromatherapy may be of some benefit in patients with RA, but more convincing research is needed to prove their efficacy.
Biofeedback
Biofeedback has been used to reduce stress and relieve anxiety in many studies. Research regarding its use in RA is lacking.
Yoga
For thousands of years, people have used yoga to build flexibility, strength, improve concentration, relieve stress, and increase energy. Medical studies have demonstrated that yoga can improve strength and flexibility in patients with RA, and yoga exercises have been created especially for these patients. A guide to these exercises, called The Remain Active with RA Yoga Guide, is offered for free at www.RAacademy.com and can be accessed after you register as a visitor to the site.
Exercise
Many people with RA may benefit from low-impact exercises. These exercises help improve overall health and fitness without further damaging or hurting the joints. Exercise has repeatedly been shown to improve quality of life, endurance, and lung function in patients with RA.
Massage
Patients with RA may complain of muscle pain as well as joint pain. Muscle pain can be the result of either muscle tension associated with joint pain or an abnormal gait produced by a swollen knee or ankle. Massaging sore muscles can help them to relax; indeed, many people feel better after a massage. Massage therapy has not been shown to alter the course of RA or to reduce inflammation in the joints.
Therapeutic Bracelets
The marketers of several brands of therapeutic bracelets have made unsubstantiated claims regarding their use in the treatment of arthritis. These manufacturers have claimed that the unique properties of the bracelet—for example, its composition, ionization, and electrical or magnetic charge—have curative effects for arthritis sufferers. This treatment rationale is complete nonsense. Not surprisingly, little or no clinical testing has been performed in an attempt to substantiate these claims. The FDA and the Federal Trade Commission (FTC) have sued several of these manufacturers for making false claims and for failing to honor advertised “money back” guarantees.
Homeopathic Remedies
Homeopaths use remedies that come from many different sources. Most are derived from plants, but minerals and metals may also be used in these therapies. After the initial preparation of the raw materials, these components are put into solutions of water or alcohol and turned into “remedies.” The liquid is then used as a treatment or soaked into tablets or granules for convenience. No controlled clinical studies have shown that these remedies are any more effective than taking sugar pills.
With any treatment, it is always best to get as much information as possible; this is especially true regarding unregulated complementary therapies. After you've gathered all the necessary information regarding the benefits and risks of a treatment, you can then make an informed decision in consultation with your doctor.