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Despite new and more effective treatments, many arthritis patients live with chronic pain and disability. Some people turn to herbal medicines and other "natural" remedies in the belief that they are effective and safer than conventional medications. Unfortunately, most information available to the public about these remedies in the media and on the internet is misleading. It is not based on the quality of scientific evidence required by the Food and Drug Administration (FDA) for approval of conventional medications. The purpose of this patient fact sheet is to provide you with objective, sound information so that you can make informed decisions, and to enable you to discuss with your physician the benefits and risks of natural remedies.
What is a “natural” medicine and how does it differ from prescription and over-the counter (OTC) medications? Medicines are chemicals that alter body functions, such as lowering blood pressure or blood sugar. These chemicals may produce beneficial or harmful effects. Prescription and OTC drugs are purified chemicals whose ingredients, benefits and potential side effects have been studied extensively.
Herbal medicines are plant extracts that contain dozens of chemicals whose actions are unknown. It is no more “natural” to swallow a mixture of plant chemicals than to swallow a single chemical: a drug is a drug. In fact, there is no scientific basis for advertising claims that natural remedies are gentler and safer than conventional medications.
During the last 50 years all new medications approved by the Food and Drug Administration (FDA) have been tested to establish whether they provide any benefit beyond a placebo effect. A placebo is a substance or a procedure that has no specific activity. For example, when a new medication for arthritis is tested for its ability to relieve pain, half of the people in the trial receive a pill or capsule that is identical in appearance to the medication but contains no active ingredients. Approximately 30-40 percent of people who receive a placebo report a marked improvement in their symptoms. The benefit results from trust in the physician who administers the medication and in the expectation of relief. Many medications that were thought to be effective before placebo-controlled trials were found subsequently to have no specific benefit.
Although natural and conventional medicines may work in similar ways, there are important differences between them.
Herbal remedies promoted for the treatment of arthritis include, ginger, Chinese Thunder God Vine, willow bark extract, feverfew, cat’s claw and stinging nettle.
While there is some evidence that ginger and willow bark extract may relieve pain, these remedies contain chemicals that are similar to FDA-approved nonsteroidal anti-inflammatory compounds (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil). NSAIDs, whether purified or in herbal mixtures, may cause inflammation of the stomach and intestines. Further, they can interfere with blood clotting and lead to fluid retention, causing problems for people with high blood pressure or heart failure.
Chinese Thunder God Vine also relieves pain and inflammation, but chronic use may cause weakening of the immune system and bones (osteoporosis).
Supplements are also marketed over the counter for treatment of rheumatologic symptoms. Patients should consider the best information available before taking these products.
S-adenosylmethionine (SAMe), a naturally occurring chemical in the body, has been used in Europe for some time as a prescription drug for depression as well as for relief of arthritis pain and inflammation. Not only is the role of its anti-depressant action in providing subjective relief from arthritis unclear, there are other deterrents. When taken by mouth, SAMe is not efficiently absorbed into the body, nor are there any large, well-controlled studies of its effectiveness. Further, this very expensive supplement can cause gastrointestinal distress as well as reported incidents of extreme agitation. Like other unregulated products, many commercial preparations of SAMe do not contain the quantity of drug indicated on the label.
Chondroitin sulfate and glucosamine sulfate supplements are promoted separately, or in combination, for patients with degenerative arthritis (osteoarthritis). Studies paid for by manufacturers suggest that these products can relieve arthritis pain. Independent trials, including a large study paid for by the National Institutes of Health, have found no benefit beyond that provided by a placebo. A recent review by a government agency, the Agency for Healthcare Research and Quality, also concluded that there was no evidence that glucosamine, chondroitin, or injections of hyaluronic acid were beneficial for osteoarthritis.
Fish oils that contain omega-3 fatty acids have been reported to relieve pain and joint tenderness in patients with rheumatoid arthritis. The benefits are modest and may take several months to appear. Side effects may include gastrointestinal distress and a fishy odor to the breath. Those who consider fish oil supplements should be aware that some fish oil supplements may contain high levels of mercury or vitamin A, which could be toxic.
As developed in Asian countries over 2000 years ago, acupuncture needles are inserted into the skin at specific points along meridians or channels. Selected groups of points are used to treat different diseases. In traditional Chinese medicine acupuncture is part of a comprehensive treatment plan that may also include herbal therapy, diet and exercise, but it is increasingly used as a stand-alone treatment by Western health care providers.
There have been many studies of the use of acupuncture for relief of pain caused by osteoarthritis (degenerative arthritis) of the knee. Early trials found that patients treated with acupuncture experienced less pain than patients who received only conventional treatment. However, in recent years traditional acupuncture has been compared to a variety of “sham” or unconventional acupuncture controls, including insertion of needles at non-acupuncture points, non-insertion of needles, and use of telescoping needles that appeared to be inserted into the skin. Sham and conventional acupuncture provided significant relief of pain compared to no treatment. However, there was little or no difference between the benefit produced by conventional or sham acupuncture.
The interpretation of these studies is that the relief of pain resulted from placebo effects that can be elicited by contact of the skin with needles, or their insertion at random points. The pain caused by osteoarthritis of the knee can be severe and may be incompletely relieved by conventional treatments. Although the best current evidence suggests that acupuncture relieves pain because it is an unusually potent placebo, it is safe and can be considered as an adjunct to conventional treatment.
Many books, magazines and web sites provide advice about using herbal medicines and other dietary supplements. These sources promote the use of these remedies in an unscientific manner and do not provide adequate information about potential dangers. Three recent books that provide more sound advice are listed below. The most reliable and accessible information is provided though health newsletters published by nonprofit consumer organizations and medical schools. Sources of more technical information are listed below.
The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.
Updated April 2015. Written by Donald M. Marcus, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.
© 2015 American College of Rheumatology
Herbal Remedies, Supplements, & Acupuncture for Arthritis in Spanish