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Complementary and Alternative Medicine Use in Rheumatoid Arthritis

  • Complementary and Alternative Medicine (S Kolasinski, Section Editor)
  • Published:
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Abstract

Purpose of Review

Despite advances in pharmacologic management of rheumatoid arthritis (RA), complementary and alternative medicine (CAM) remains popular adjuncts to therapy among patients for ongoing symptomatology.

Recent Findings

Mind-body interventions are becoming increasingly popular, including yoga and meditation. Randomized controlled trials have found these interventions to be helpful regarding pain, mood, and energy in RA patients. Other CAM modalities, such as natural products, special diets, acupuncture, and body-based therapies, also continue to be used by RA patients with limited evidence for efficacy and safety.

Summary

While there are numerous CAM interventions available, the data is very limited at this time with only low-quality evidence supporting various therapies. Medical providers are more open to the addition of CAM in their patients and require increased education on the topic. Additional research needs to be conducted in order to provide evidence-based recommendations to our patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68:1–26.

    PubMed  Google Scholar 

  2. Lahiri M, Santosa A, Teoh LK, Clayton JA, Lim SY, Teng GG, et al. Use of complementary and alternative medicines is associated with delay to initiation of disease-modifying anti-rheumatic drug therapy in early inflammatory arthritis. Int J Rheum Dis. 2017;20:567–75.

    CAS  PubMed  Google Scholar 

  3. • Phang JK, Kwan YH, Goh H, Tan VIC, Thumboo J, Østbye T, et al. Complementary and alternative medicine for rheumatic diseases: a systematic review of randomized controlled trials. Complement Ther Med. 2018;37:143–57 This systematic review provided a thorough evaluation of 60 RCTs of CAM therapy usage in rheumatic disease including RA.

    PubMed  Google Scholar 

  4. • (2006) Rheumatoid Arthritis: In Depth. In: NCCIH. https://nccih.nih.gov/health/RA/getthefacts.htm. Accessed 23 Mar 2020. This is an important summary of what the NIH feels to be common and important CAM therapies in RA.

  5. Herman CJ, Allen P, Prasad A, Hunt WC, Brady TJ. Use of complementary therapies among primary care clinic patients with arthritis. Prev Chronic Dis. 2004;1.

  6. Nahin RL, Barnes PM, Stussman BJ. Expenditures on complementary health approaches: United States, 2012. Natl Health Stat Rep. 2016:1–11.

  7. Clarke TC, Stussman BJ. Use of yoga, meditation, and chiropractors among U.S. adults aged 18 and over. 2018;8.

  8. Tamhane A, McGwin G, Redden DT, et al. Complementary and alternative medicine use in African Americans with rheumatoid arthritis. Arthritis Care Res. 2014;66:180–9.

    Google Scholar 

  9. Quandt SA, Chen H, Grzywacz JG, Bell RA, Lang W, Arcury TA. Use of complementary and alternative medicine by persons with arthritis: results of the National Health Interview Survey. Arthritis Care Res. 2005;53:748–55.

    Google Scholar 

  10. Yang L, Sibbritt D, Adams J. A critical review of complementary and alternative medicine use among people with arthritis: a focus upon prevalence, cost, user profiles, motivation, decision-making, perceived benefits and communication. Rheumatol Int. 2017;37:337–51.

    CAS  PubMed  Google Scholar 

  11. Efthimiou P, Kukar M, Mackenzie CR. Complementary and alternative medicine in rheumatoid arthritis: no longer the last resort! HSS J Musculoskelet J Hosp Spec Surg. 2010;6:108–11.

    Google Scholar 

  12. • Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Sci Rep. 2019;9:1–17 This study provides important insight into patient perceptions of provider attitudes toward CAM therapies and barriers to open discussions.

    CAS  Google Scholar 

  13. Manek NJ, Crowson CS, Ottenberg AL, Curlin FA, Kaptchuk TJ, Tilburt JC. What rheumatologists in the United States think of complementary and alternative medicine: results of a national survey. BMC Complement Altern Med. 2010;10:5.

    PubMed  PubMed Central  Google Scholar 

  14. Sleath B, Callahan LF, Devellis RF, Beard A. Arthritis patients’ perceptions of rheumatologists’ participatory decision-making style and communication about complementary and alternative medicine. Arthritis Care Res. 2008;59:416–21.

    Google Scholar 

  15. Ernst E. Acupuncture--a critical analysis. J Intern Med. 2006;259:125–37.

    CAS  PubMed  Google Scholar 

  16. David J, Townsend S, Sathanathan R, Kriss S, Doré CJ. The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-controlled cross-over study. Rheumatol Oxf Engl. 1999;38:864–9.

    CAS  Google Scholar 

  17. Lee MS, Shin B-C, Ernst E. Acupuncture for rheumatoid arthritis: a systematic review. Rheumatology. 2008;47:1747–53.

    CAS  PubMed  Google Scholar 

  18. Mishra L, Singh BB, Dagenais S. Ayurveda: a historical perspective and principles of the traditional healthcare system in India. Altern Ther Health Med. 2001;7:36–42.

    CAS  PubMed  Google Scholar 

  19. Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, et al. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol. 2011;17:185–92.

    PubMed  Google Scholar 

  20. Basnyat S, Kolasinski SL. Ayurvedic medicine for rheumatoid arthritis. Curr Rheumatol Rep. 2014;16:435.

    PubMed  Google Scholar 

  21. Chopra A, Lavin P, Patwardhan B, Chitre D. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol. 2000;27:1365–72.

    CAS  PubMed  Google Scholar 

  22. Chopra A, Saluja M, Tillu G, Venugopalan A, Narsimulu G, Handa R, et al. Comparable efficacy of standardized Ayurveda formulation and hydroxychloroquine sulfate (HCQS) in the treatment of rheumatoid arthritis (RA): a randomized investigator-blind controlled study. Clin Rheumatol. 2012;31:259–69.

    PubMed  Google Scholar 

  23. Shahidi F, Miraliakbari H. Omega-3 (n-3) fatty acids in health and disease: part 1--cardiovascular disease and cancer. J Med Food. 2004;7:387–401.

    CAS  PubMed  Google Scholar 

  24. Peterson LD, Jeffery NM, Thies F, Sanderson P, Newsholme EA, Calder PC. Eicosapentaenoic and docosahexaenoic acids alter rat spleen leukocyte fatty acid composition and prostaglandin E2 production but have different effects on lymphocyte functions and cell-mediated immunity. Lipids. 1998;33:171–80.

    CAS  PubMed  Google Scholar 

  25. Yaqoob P, Calder P. Effects of dietary lipid manipulation upon inflammatory mediator production by murine macrophages. Cell Immunol. 1995;163:120–8.

    CAS  PubMed  Google Scholar 

  26. Tortosa-Caparrós E, Navas-Carrillo D, Marín F, Orenes-Piñero E. Anti-inflammatory effects of omega 3 and omega 6 polyunsaturated fatty acids in cardiovascular disease and metabolic syndrome. Crit Rev Food Sci Nutr. 2017;57:3421–9.

    PubMed  Google Scholar 

  27. Akbar U, Yang M, Kurian D, Mohan C. Omega-3 fatty acids in rheumatic diseases: a critical review. JCR J Clin Rheumatol. 2017;23:330–9.

    PubMed  Google Scholar 

  28. Barden AE, Moghaddami M, Mas E, Phillips M, Cleland LG, Mori TA. Specialised pro-resolving mediators of inflammation in inflammatory arthritis. Prostaglandins Leukot Essent Fatty Acids. 2016;107:24–9.

    CAS  PubMed  Google Scholar 

  29. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with blackcurrant seed oil. Br J Rheumatol. 1994;33:847–52.

    CAS  PubMed  Google Scholar 

  30. Watson J, Byars ML, McGill P, Kelman AW. Cytokine and prostaglandin production by monocytes of volunteers and rheumatoid arthritis patients treated with dietary supplements of blackcurrant seed oil. Br J Rheumatol. 1993;32:1055–8.

    CAS  PubMed  Google Scholar 

  31. Leventhal LJ. Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med. 1993;119:867–73.

    CAS  PubMed  Google Scholar 

  32. Zurier RB, Rossetti RG, Jacobson EW, Demarco DM, Liu NY, Temming JE, et al. Gamma-linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum. 1996;39:1808–17.

    CAS  PubMed  Google Scholar 

  33. Brzeski M, Madhok R, Capell HA. Evening primrose oil in patients with rheumatoid arthritis and side-effects of non-steroidal anti-inflammatory drugs. Br J Rheumatol. 1991;30:370–2.

    CAS  PubMed  Google Scholar 

  34. Belch JJ, Ansell D, Madhok R, O’Dowd A, Sturrock RD. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis. 1988;47:96–104.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Homayouni Rad A, Torab R, Ghalibaf M, Norouzi S, Mehrabany EV. Might patients with immune-related diseases benefit from probiotics? Nutrition. 2013;29:583–6.

    PubMed  Google Scholar 

  36. Kato I, Endo-Tanaka K, Yokokura T. Suppressive effects of the oral administration of Lactobacillus casei on type II collagen-induced arthritis in DBA/1 mice. Life Sci. 1998;63:635–44.

    CAS  PubMed  Google Scholar 

  37. So J-S, Lee C-G, Kwon H-K, Yi H-J, Chae C-S, Park J-A, et al. Lactobacillus casei potentiates induction of oral tolerance in experimental arthritis. Mol Immunol. 2008;46:172–80.

    CAS  PubMed  Google Scholar 

  38. Mohammed AT, Khattab M, Ahmed AM, Turk T, Sakr N, Khalil AM, et al. The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol. 2017;36:2697–707.

    PubMed  Google Scholar 

  39. Marcason W. Probiotics: where do we stand? J Acad Nutr Diet. 2013;113:1424.

    PubMed  Google Scholar 

  40. Zhao S, Otieno F, Akpan A, Moots RJ. Complementary and alternative medicine use in rheumatoid arthritis: considerations for the pharmacological management of elderly patients. Drugs Aging. 2017;34:255–64.

    PubMed  Google Scholar 

  41. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2011. https://doi.org/10.1002/14651858.CD002948.pub2.

  42. Wang J, Chen N, Fang L, Feng Z, Li G, Mucelli A, et al. A systematic review about the efficacy and safety of Tripterygium wilfordii Hook.f. preparations used for the management of rheumatoid arthritis. Evid-Based Complement Altern Med ECAM. 2018. https://doi.org/10.1155/2018/1567463.

  43. Zhou Y, Zhao L, Chen H, et al. Comparison of the impact of Tripterygium wilfordii Hook F and methotrexate treatment on radiological progression in active rheumatoid arthritis: 2-year follow up of a randomized, non-blinded, controlled study. Arthritis Res Ther. 2018;20:1–12.

    Google Scholar 

  44. Research C for DE and (2020) Tainted arthritis/pain products. FDA

  45. Dreyer NE, Cutshall SM, Huebner M, Foss DM, Lovely JK, Bauer BA, et al. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: a randomized study. Complement Ther Clin Pract. 2015;21:154–9.

    PubMed  Google Scholar 

  46. Diego MA, Field T. Moderate pressure massage elicits a parasympathetic nervous system response. Int J Neurosci. 2009;119:630–8.

    PubMed  Google Scholar 

  47. Tozzi P. Selected fascial aspects of osteopathic practice. J Bodyw Mov Ther. 2012;16:503–19.

    PubMed  Google Scholar 

  48. Field T, Diego M, Delgado J, Garcia D, Funk CG. Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy. Complement Ther Clin Pract. 2013;19:101–3.

    PubMed  Google Scholar 

  49. Nelson NL, Churilla JR. Massage therapy for pain and function in patients with arthritis: a systematic review of randomized controlled trials. Am J Phys Med Rehabil. 2017;96:665–72.

    PubMed  Google Scholar 

  50. Santos I, Cantista P, Vasconcelos C. Balneotherapy in rheumatoid arthritis—a systematic review. Int J Biometeorol. 2016;60:1287–301.

    PubMed  Google Scholar 

  51. Verhagen AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie R, et al. Balneotherapy (or spa therapy) for rheumatoid arthritis. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD000518.pub2.

  52. Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317:1451–60.

    PubMed  PubMed Central  Google Scholar 

  53. Weltgesundheitsorganisation, editor. WHO guidelines on basic training and safety in chiropractic. Geneva; 2005.

  54. Bonic EE, Stockwell CA, Kettner NW. Brain stem compression and atlantoaxial instability secondary to chronic rheumatoid arthritis in a 67-year-old female. J Manip Physiol Ther. 2010;33:315–20.

    Google Scholar 

  55. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for rheumatic diseases: a systematic review. Rheumatology. 2013;52:2025–30.

    PubMed  Google Scholar 

  56. Ward L, Stebbings S, Cherkin D, Baxter GD. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013;11:203–17.

    PubMed  Google Scholar 

  57. Moonaz SH, Bingham CO, Wissow L, Bartlett SJ. Yoga in sedentary adults with arthritis: effects of a randomized controlled pragmatic trial. J Rheumatol. 2015;42:1194–202.

    PubMed  PubMed Central  Google Scholar 

  58. • Ganesan S, Gaur GS, Negi VS, Sharma VK, Pal GK. Effect of yoga therapy on disease activity, inflammatory markers, and heart rate variability in patients with rheumatoid arthritis. J Altern Complement Med. 2020. https://doi.org/10.1089/acm.2019.0228This is a very recent RCT evaluating a 12-week yoga intervention in RA patients along with standard therapy leading to significant reduction in disease activity.

  59. Akyuz G, Kenis-Coskun O. The efficacy of tai chi and yoga in rheumatoid arthritis and spondyloarthropathies: a narrative biomedical review. Rheumatol Int. 2018;38:321–30.

    PubMed  Google Scholar 

  60. Koh TC. Tai chi chuan. Am J Chin Med. 1981;9:15–22.

    CAS  PubMed  Google Scholar 

  61. Jin P. Efficacy of tai chi, brisk walking, meditation, and reading in reducing mental and emotional stress. J Psychosom Res. 1992;36:361–70.

    CAS  PubMed  Google Scholar 

  62. Tse S-K, Bailey DM. T’ai chi and postural control in the well elderly. Am J Occup Ther. 1992;46:295–300.

    CAS  PubMed  Google Scholar 

  63. Wolf SL, Barnhart HX, Ellison GL, Coogler CE. The effect of tai chi quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and injuries: cooperative studies on intervention techniques. Phys Ther. 1997;77:371–81 discussion 382-384.

    CAS  PubMed  Google Scholar 

  64. Li F, Harmer P, McAuley E, Duncan TE, Duncan SC, Chaumeton N, et al. An evaluation of the effects of tai chi exercise on physical function among older persons: a randomized controlled trial. Ann Behav Med Publ Soc Behav Med. 2001;23:139–46.

    CAS  Google Scholar 

  65. • Mudano AS, Tugwell P, Wells GA, Singh JA. Tai chi for rheumatoid arthritis. Cochrane Database Syst Rev. 2019. https://doi.org/10.1002/14651858.CD004849.pub2This updated review evaluated tai chi in RA patients and found that conclusions could not be made due to the low-quality evidence.

  66. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–48.

    PubMed  Google Scholar 

  67. Keng S-L, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev. 2011;31:1041–56.

    PubMed  PubMed Central  Google Scholar 

  68. DiRenzo D, Crespo-Bosque M, Gould N, Finan P, Nanavati J, Bingham CO. Systematic review and meta-analysis: mindfulness-based interventions for rheumatoid arthritis. Curr Rheumatol Rep. 2018;20:75.

    PubMed  PubMed Central  Google Scholar 

  69. Athanas AJ, McCorrison JM, Smalley S, Price J, Grady J, Campistron J, et al. Association between improvement in baseline mood and long-term use of a mindfulness and meditation app: observational study. JMIR Ment Health. 2019;6:e12617.

    PubMed  PubMed Central  Google Scholar 

  70. Zautra AJ, Davis MC, Reich JW, Nicassario P, Tennen H, Finan P, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76:408–21.

    PubMed  Google Scholar 

  71. Wallace R, Benson H, Wilson A. A wakeful hypometabolic physiologic state. Am J Physiol-Leg Content. 1971;221:795–9.

    CAS  Google Scholar 

  72. Barsky AJ, Ahern DK, Orav EJ, Nestoriuc Y, Liang MH, Berman IT, et al. A randomized trial of three psychosocial treatments for the symptoms of rheumatoid arthritis. Semin Arthritis Rheum. 2010;40:222–32.

    PubMed  PubMed Central  Google Scholar 

  73. Trichopoulou A, Vasilopoulou E. Mediterranean diet and longevity. Br J Nutr. 2000;84(Suppl 2):S205–9.

    CAS  PubMed  Google Scholar 

  74. Sköldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62:208–14.

    PubMed  PubMed Central  Google Scholar 

  75. de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med. 2019;381:2541–51. https://doi.org/10.1056/NEJMra1905136.

    Article  PubMed  Google Scholar 

  76. Müller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001;30:1–10.

    PubMed  Google Scholar 

  77. Badsha H. Role of diet in influencing rheumatoid arthritis disease activity. Open Rheumatol J. 2018;12:19–28.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. • Lv Q, Zhang W, Shi Q, et al. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Ann Rheum Dis. 2015;74:1078–86 This is one of the most recent RCTs evaluating a CAM therapy in RA. This study compared thunder god vine to methotrexate and found it be non-inferior.

    CAS  PubMed  Google Scholar 

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Funding

Dr. DiRenzo is supported by the Jerome L. Greene Foundation.

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Correspondence to Dana D. DiRenzo.

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Baig, S., DiRenzo, D.D. Complementary and Alternative Medicine Use in Rheumatoid Arthritis. Curr Rheumatol Rep 22, 61 (2020). https://doi.org/10.1007/s11926-020-00938-z

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