Complementary And Alternative Therapies For Osteoarthritis
Facts About Osteoarthritis
There are more than 100 types of arthritis, the most common of which is osteoarthritis.
This "wear and tear" arthritis is seen most frequently in older people. Research suggests that genetic effects, weight, diet and injuries are also risk factors for this disease.
At present, there is no cure, but this does not mean there is no relief for the usual symptoms of pain and joint stiffness. Physical therapy, weight loss and exercise are helpful for many patients.
Conventional drug treatment with analgesics (such as acetaminophen) and nonsteroidal anti-inflammatory drugs (such as ibuprofen) is often effective in controlling pain and inflammation, but these agents do not always work well. In addition, side effects may limit their usefulness.
In severe cases, joint injections or joint surgery may be appropriate.
People with the most common form of arthritis, osteoarthritis, frequently turn to complementary or alternative therapies. In a study published in 2007, more than 80% of people with osteoarthritis reported using a complementary or alternative therapy for their arthritis in the prior month. The most common complementary and alternative remedies are discussed below.
Used for many years in Germany and other parts of Europe, glucosamine has rapidly gained popularity in the United States. Recent research supports its effectiveness, at least as a pain reliever. A study of more than 200 patients with osteoarthritis published in the British journal Lancet in January 2001 reported that people treated with glucosamine had fewer symptoms and exhibited less progressive damage on X-rays than did people treated with placebo. Some experts believe, however, that the improved X-ray findings resulted from flawed radiology techniques. In 2006, a trial published in the New England Journal of Medicine concluded that glucosamine may reduce moderate to severe knee pain due to osteoarthritis.
Although glucosamine's effect on joint damage is still debated, many medical experts believe this supplement reduces pain and is safe. The usual dose is 500 milligrams three times a day. Twice this amount may be recommended for the first few weeks. It may take four to eight weeks to get significant benefit, and like most remedies, glucosamine does not work for everyone. Consider stopping after eight to 10 weeks if you do not experience any improvement.
Chondroitin And Sam-e
Two other supplements on the market, chondroitin and S-adenosylmethionine (SAM-e), are not as well studied or accepted in the United States as glucosamine. Most studies of these agents are of insufficient quality to draw firm conclusions. One study of SAM-e found the agent to have similar benefits as naproxen (Naprosyn, Aleve), used to relieve pain and inflammation.
Some herbs, including evening primrose, ginger, stinging nettle and curcumin, are sold as remedies for arthritis pain, but there is not enough evidence to support their use.
Always discuss the use of herbs or other supplements with your doctor to check for interactions and side effects.
Before seeking an herbal therapy practitioner, first consult with your doctor. Another source of information is the National Center for Complementary and Alternative Medicine. Search their Web site to find research centers at universities and medical schools throughout the United States that are conducting studies on complementary and alternative therapies. Try to find the name of a researcher near you who is conducting an herbal study; find out if that person provides guidance to patients as well.
Homeopathy is based on administering tiny (often undetectable) amounts of a substance that in higher doses might cause symptoms or disease in healthy persons. Scientific evidence of benefit is lacking. A recent review in a British homeopathic journal identified only four methodologically sound studies and concluded that the available studies "do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis."
Vitamins And Fish Oil
Evidence that antioxidant vitamins can prevent arthritis is lacking. Fish oil capsules (containing omega-3 fatty acids) may decrease pain and swelling in some people with rheumatoid arthritis. Fish oil for osteoarthritis cannot be recommended. Omega-3 fatty acids may have other health benefits, most notably related to heart disease. Fish that are especially rich in omega-3 fatty acids include salmon, mackerel, herring and sardines.
Acupuncture And Acupressure
Acupuncture is an ancient Chinese practice. By inserting hair-fine needles into the skin along defined tracts called meridians, practitioners believe they can stimulate the flow of "qi," or vital life energy.
Acupressure and shiatsu, a Japanese form of acupressure, use no needles. Instead intense local pressure is applied to certain points on the body.
Although medical experts do not understand how acupuncture and acupressure work, some people experience less joint pain with these techniques. Recent, well-controlled trials of acupuncture for osteoarthritis of the knee suggest a benefit not only for pain relief but also with respect to function.
Magnet therapy has gained popularity, but again the scientific evidence of its benefit is lacking. Magnets are sold in various strengths, but there is no proof that one strength is better than another or that any magnet really helps. A word of caution, keep them away from your computer!
Efforts to find food allergies that cause arthritis have not yielded definitive results. The most common approach is to eliminate vegetables from the nightshade family: white potatoes, tomatoes, peppers and eggplant. Tobacco also belongs to this family. (Of course, there are more compelling reasons to avoid tobacco than its effect on arthritis.) Some people with arthritis also feel that dairy products aggravate their symptoms.
If you suspect food allergies may be affecting your arthritis (for example, if your symptoms become worse after you eat certain foods), keep a record of what you eat for several weeks, along with notes about your arthritis symptoms. Eliminate from your diet foods that seem to cause trouble; after a period of time, gradually reintroduce these foods one at a time, noting any change in symptoms. Research-based evidence on the value of this approach is lacking, but diet therapy still may be worth a try.
Exercise And Weight Control
Exercise and weight control are among the most effective self-help measures for alleviating the symptoms of osteoarthritis (and perhaps other types of arthritis). The objective is to avoid obesity and improve or maintain cardiovascular fitness, range of motion and muscle tone while avoiding excessive stress or injury to joints. Walking, biking, cross-country skiing and swimming are the best choices. Water offers support and gentle resistance; if possible, water temperature should be 83 to 88 degrees Fahrenheit or warmer.
In one study, 33 adults with arthritis reported being better able to manage their disease symptoms and enjoyed better health after a three-month tai chi program; another study found improved balance and abdominal muscle strength. A 2011 review of several studies of tai chi for osteoarthritis concluded that although results are encouraging, the evidence of benefit is not yet conclusive. Other studies of moderate, low-impact exercise have suggested a benefit in arthritis symptoms. Guidelines for appropriate exercise may be obtained from the Arthritis Foundation (800-283-7800). If you have arthritis, consider setting up an exercise program with the advice of a physician or physical therapist. He or she can also suggest effective weight control measures if needed.
Many arthritis sufferers find that warm showers and baths -- particularly whirlpool baths -- are often helpful in reducing pain and stiffness, especially first thing in the morning. For arthritis in the hands, the simple act of squeezing a sponge in a basin or sink full of warm water provides gentle exercise and relief of stiffness. Warm, wet compresses, especially castor oil compresses (available where specialty health products are sold), may provide comfort for sore joints.
Helpful suggestions abound in books and magazines and on the Internet about joint-sparing techniques for ordinary activities. For example:
- Pick up a coffee cup with both hands instead of thumb and finger.
- Open doors with the side of your arm and body.
- Open a car door with both hands.
Occupational therapists are trained professionals who can teach these and many more helpful techniques.
Massage by an expert in therapeutic massage can contribute to an overall feeling of relaxation and well-being. There are many types of massage, including Western, Swedish, deep-tissue and neuromuscular. A massage therapist can teach you some do-it-yourself techniques.
Massage therapists are required to be licensed in at least 28 states and the District of Columbia. You can find a qualified practitioner by asking your physician or by contacting a professional massage therapy association.
A Positive Outlook
Like any person with a chronic disease, a person with osteoarthritis may be more prone to depression. You may worry about becoming increasingly unable to perform activities of daily living or doing things you enjoy. The capacity to adapt, cope and continue full function varies greatly among patients. Some patients feel disabled by their symptoms, but only a very small percentage will ever become severely disabled. A positive outlook, focusing on what you are able to do rather than what you are unable to do, can be immensely helpful. Some people find that meditation and other stress-reduction techniques help them to relax and better adjust the pace of their lives to the limitations imposed by their arthritis.
The Bottom Line
Recognize that for many unproven approaches, uncertainty about benefit and risk must be accepted before pursuing treatment. For example, small studies may find benefit for a particular approach, but if the patients in the study were highly selected (for example, taking no other medications and having no other major health problems besides their arthritis), that same approach may not work for others. A particular source of concern is that the treatment may interact with another medication, something the small studies cannot predict. Finally, keep in mind that herbs and supplements such as glucosamine are not regulated by the Food and Drug Administration; active ingredients, purity and quality may vary greatly.
Studies now underway should shed light on which treatments are helpful and which are a waste of time, money and faith. In addition, the reasons a treatment may work -- including the possibility of a placebo effect -- may also be sorted out in the next few years when the results of carefully performed studies are published. Even if it turns out that patients are better because of a placebo effect (in which the expectation of benefit from an inactive treatment somehow induces improvement), learning how to harness that effect may prove highly useful and safe.
For more information on complementary and alternative medicine, visit the InteliHealth Complementary And Alternative Medicine Area.