NOTE: For the body and manipulative therapies, such as the Alexander Technique, Bowen Technique, osteopathy, Reiki, reflexology, and T'ai chi, see the Body & Mind section.
Given the persistent problems with conventional treatments, it's small wonder that many arthritis sufferers have looked to alternative medicine for help. One study has found that as many as 80 per cent of patients have consulted an alternative practitioner or used alternative treatments for their arthritis.
Because of its analgesic effects, acupuncture is widely used for arthritis. Although clinical trials are thin on the ground, most research studies are generally positive.
Dramatic results were reported by Scandinavian doctors in osteoarthritis cases that were so severe as to be scheduled for surgery. Despite such advanced cases, monthly acupuncture was found to relieve as much as 80 per cent of the pain.
Doctors at the Princess Margaret Hospital in Swindon, who studied patients with advanced osteoarthritis of the hip, found similar benefits. Six half-hour acupuncture sessions eased the pain and improved mobility for up to eight weeks after treatment.
Electroacupuncture via the Codetron machine has also been shown to be highly beneficial and just as effective as other forms of acupuncture, though less effective than Transcutaneous Electronic Nerve Stimulation (TENS).
A group of 70 patients with fibromyalgia was randomised either to receive electroacupuncture treatment or a sham procedure.
Outcome parameters were: pain threshold, analgesic use, regional pain scores, pain recorded on a visual analogue scale, sleep quality, morning stiffness, and the assessment of patients and evaluating physicians. In the treatment group, seven of the eight outcome parameters showed a significant improvement, whereas none of the patients in the sham group showed any improvement.
A herbal remedy made from the Yucca plant has been shown to be helpful in easing the symptoms of RA. In an American study involving Desert Pride Herbal Food Tablets (containing Yucca plant saponin extract), 149 RA patients were given either the Yucca saponin extract or placebo for one week to 15 months. At the end of the trial, 61 per cent had less pain, swelling and stiffness compared with 22 per cent of those taking the placebo. Some improved within days or weeks whereas some took several months or more.
Three herbs particularly useful in arthritis are Boswellia, Devil's claw and white willow bark. A herbal based on Boswellia was tested on over 40 osteoarthritis patients in a double-blind trial, with highly significant effects on pain and joint mobility.
Devil's claw (Harpagophytum procumbens) is a herb native to Africa that has a long history in the treatment of arthritis, and there is some evidence that it may be a useful treatment as an anti-inflammatory. In a separate study, 250 men and women with pain in the lower back, knee or hip took two tablets of a standardized Devil's claw extract three times a day for eight weeks, which provided 60 mg of harpagoside a day. Improvements were noted in up to 70 per cent of participants, although it was more effective for hip and knee pains, than for back pain. However, side effects were relatively common in the trial, with 11.6 per cent reporting effects such as gastrointestinal upset, nausea, vomiting, and allergic rash. In all, 10 patients had to discontinue treatment. In one experimental study over 60 days, 86 per cent of patients noted decreased morning stiffness. Improvement was reported after just eight days on the treatment and continued gradually. Another study also showed positive results. Devil's claw is thought to work by inhibiting the release of molecules that promote inflammation. It has been found to be more effective than placebo and as effective as the discredited drug rofecoxib (Vioxx).
Willow bark (Salix) is a recognized pain reliever. It was tested on 210 patients with chronic back pain, who were given either a placebo or 120 mg or 240 mg of oral willow bark. After four weeks, 39 per cent of those receiving the higher dose were still reporting no pain, compared with 21 per cent of those taking the lower dose and six per cent of those taking placebo. More of the placebo group also needed to supplement with a painkiller.
Feverfew (Tanacetum parthenium) has a long history as a remedy for rheumatoid arthritis. It has been shown to inhibit the release of blood vessel-dilating substances and inhibit the production of inflammatory substances. Most of the research, however, has been confined to in vitro and animal studies. Select the best quality that you can, since many commercial preparations vary in the amount of feverfew's active component, parthenolide, contained within them. In about 10 per cent of individuals, chewing the leaves can result in ulcerations of the mouth and swelling of the lips and tongue.
The root of Tripterygium wilfordi may also be helpful, but should be used with caution in children and women of childbearing age since it can lead to amenorrhoea and impaired spermatogenesis (both of these side effects eventually disappear once treatment has stopped). It has been shown useful with rheumatoid arthritis and ankylosing spondylitis.
A century ago, electromagnetic fields were used extensively in medicine, but this died out when the drug-based approach to disease took over. In the last 20 years, however, their use has begun a tentative comeback. To date, their major medical application has been in orthopedic bone fractures. For unknown reasons, magnetic fields can speed up the natural bone-healing process.
This discovery has sparked off a limited amount of research, with spin-offs for arthritis. In the laboratory, electromagnetic fields have been shown to stimulate the growth of both bone and cartilage.
The copper bracelet
Probably the best-known self-help treatment for arthritis is the copper bracelet. According to one American survey, the copper bracelet was shown to be useless. However, Patrick Holford of the Institute of Optimum Nutrition says its efficacy depends on the level of copper in the wearer's body.
Wearing copper bracelets for arthritis sounds like ancient folklore, but it appears to have begun in the 1970s. At the time, doctors tended to dismiss it out of hand, claiming that any benefits were due to the natural ebb and flow of the disease.
However, one study showed "some therapeutic value" after 300 people with arthritis wore either real copper bracelets or look-alike fakes. This fit in with the finding that arthritis patients are copper-deficient because they excrete abnormally high amounts of copper in the urine. So, does the bracelet work because it's a source of copper? Yes, says Australian rheumatologist Dr Ray Walker: "Copper, when in contact with the skin, chelates with human sweat (sometimes seen as a green deposit under the bracelet) and is thus absorbed through the skin."
There have been several studies that show a positive effect of homeopathic preparations on arthritic conditions. In one trial, patients with fibromyalgia showed improvement.
In a randomised controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis, 44 patients were assigned either homeopathic remedies or placebo. At six months, the treatments were generally equally effective in most assessments, with those taking homoeopathic remedies reporting slightly better results.
In another double-blind trial, 23 patients with rheumatoid arthritis took first-line anti-inflammatory treatment plus homeopathy, while a similar group of 23 took first-line anti-inflammatory treatment plus placebo. There was a significant improvement in subjective pain, stiffness and grip strength in the homoeopathy group and, perhaps most importantly, there were no side effects observed.
A proprietary homeopathic preparation, Rheumaselect, was tested on patients with rheumatoid arthritis against a placebo, over a 12-week period in a randomised double-blind, controlled trial. Although both groups improved, the improvement was more marked in the Rheumaselect group.
This Indian system of medicine has long used the yellow pigment, called curcumin, derived from the turmeric plant (Curcuma longa) to treat joint inflammation.
In one double-blind study, RA patients were given either curcumin or phenylbutazone, a non-steroidal anti-inflammatory drug (NSAID). Those taking the turmeric showed similar improvements in duration of morning stiffness, walking and joint swelling compared with those taking the NSAID, but without the substantial side-effects usually seen with the drug.
Ayurvedic medicine also uses plants to combat arthritis. In particular, the herb guggul, combined with changes in diet and life-style, has been shown to be beneficial.
Traditional Chinese Medicine (TCM)
Two experimental studies have shown that the root of the Chinese medicinal herb Lei gong teng (Tripterygium wilfordii) is usually effective to some degree for both RA and ankylosing spondylitis. Traditional Chinese medicine has specific herbs for arthritis, and claims startling success with them. In a randomised clinical study, two formulas-shu guan wen jing and shu guan qing luo-were reported to 'cure' over 50 per cent of rheumatoid arthritis patients, and with no side-effects.
The difference between hydrotherapy in a mineral bath and hydrotherapy in a normal hospital exercise bath was evaluated in one study. The researchers concluded that morning stiffness was significantly improved in both groups, though objective measures such as ESR rate showed no improvement.
Sulphur baths and mud pack treatments, singly or in combination, have been shown to improve symptoms of rheumatoid arthritis in a controlled randomized trial over two weeks. Patients had daily treatment and the improvements lasted for up to three months.