Introduction
Rheumatoid arthritis is an autoimmune disease in the general family of lupus. For reasons that are not understood, in rheumatoid arthritis the immune system goes awry and begins attacking tissues, especially cartilage in the joints. Various joints become red, hot, and swollen under the onslaught. The pattern of inflammation is usually symmetrical, occurring on both sides of the body. Other symptoms include inflammation of the eyes, nodules (or lumps) under the skin, and a general feeling of malaise.
Rheumatoid arthritis is more common in women than in men and typically begins between the ages of thirty-five and sixty. The diagnosis is made by matching the pattern of symptoms with certain characteristic laboratory results.
Medical treatment consists mainly of two categories of drugs: anti-inflammatory drugs in the ibuprofen family (nonsteroidal anti-inflammatory drugs, or NSAIDs) and drugs that may be able to put rheumatoid arthritis into full or partial remission (the disease-modifying antirheumatic drugs, or DMARDs).
Anti-inflammatory drugs relieve symptoms of rheumatoid arthritis but do not change the overall progression of the disease, whereas DMARDs seem to affect the disease itself. In rheumatoid arthritis, the drugs believed to alter the course of the disease (to slow it down or stop it) include antimalarials (hydroxychloroquine and chloroquine), sulfasalazine, TNF inhibitors (etanercept, infliximab, and adalimumab), interleukin-1 receptor antagonists, leflunomide methotrexate, goldcompounds, D-penicillamine, and cytotoxic agents (azathioprine, cyclophosphamide, and cyclosporine). These drugs are unrelated to one another but work somewhat similarly in practice.
Most of the drugs in this category can cause severe side effects. Because of this toxicity, for years a so-called pyramid approach was taken with people with rheumatoid arthritis. Physicians started with NSAIDs to help with the pain and inflammation and progressed to successively stronger and more toxic medications only when the basic treatments failed. Natural treatments such as those described here might also be useful in early stages.
However, more recent research has found that severe joint damage occurs early in rheumatoid arthritis. This evidence has caused many authorities to suggest early, aggressive treatment with disease-modifying drugs to prevent joint damage. Nonetheless, this approach has not been universally adopted, and some physicians still prescribe NSAIDs for early stages of rheumatoid arthritis. The treatments described here may be reasonable alternative options.
Principal Proposed Natural Treatments
Rheumatoid arthritis is a difficult disease, and no alternative approach solves it easily. Even if one chooses to use alternative methods, regular visits to a rheumatologist should be maintained to watch for serious complications. Medical treatment may be able to slow the progression of rheumatoid arthritis. It is not likely that any of the alternative options have the same ability.
Fish oil
. Fish oil is the only natural treatment for rheumatoid arthritis with significant documentation. According to the results of about thirteen double-blind, placebo-controlled studies involving more than five hundred participants, supplementation with omega-3 fatty acids can significantly reduce the symptoms of rheumatoid arthritis. Also, at least one small study suggests that omega-3 fatty acids may help persons with rheumatoid arthritis lower their dose of nonsteroidal anti-inflammatory medication (such as ibuprofen).
However, unlike some of the standard treatments, fish oil has not been shown to slow the progression of rheumatoid arthritis. It has been suggested that omega-3 supplementation is more effective when omega-6 intake (particularly arachidonic acid) is kept low, as occurs with a vegetarian diet. The benefits of fish oil may also be enhanced by simultaneous use of olive oil. One badly designed human study hints that a relative of fish oil, krill oil, might be helpful as well. Flaxseed oil has been offered as a more palatable substitute for fish oil, but it does not seem to work.
Other Proposed Treatments
Boswellia serrata is a shrublike tree that grows in the dry hills of the Indian subcontinent. It is the source of a resin called salai guggal, which has been used for thousands of years in Ayurvedic medicine, the traditional medicine of the region. It is very similar to a resin from a related tree, B. carteri, which is also known as frankincense. Both substances have been used historically for arthritis.
Research has identified boswellic acids as the likely active ingredients in boswellia. In animal studies, boswellic acids have shown anti-inflammatory effects, but their mechanism of action seems to be quite different from that of standard anti-inflammatory medications.
An issue of the journal Phytomedicine that was devoted to boswellia briefly reviewed previously unpublished studies on the herb. A pair of placebo-controlled trials involving eighty-one people with rheumatoid arthritis found significant reductions in swelling and pain over the course of three months. Furthermore, a comparative study of sixty people over six months found the boswellia extract relieved symptoms about as well as oral gold therapy. However, while gold shots can induce remission in rheumatoid arthritis, there is no evidence that boswellia can do the same.
Another double-blind study found no difference between boswellia and placebo. More research is needed to know whether boswellia is an effective treatment for rheumatoid arthritis.
Devil’s claw
. The herb devil’s claw may be beneficial in rheumatoid arthritis. One double-blind study followed eighty-nine people with rheumatoid arthritis for two months. The group given devil’s claw showed a significant decrease in pain intensity and an improvement in mobility. Another double-blind study of fifty people with various types of arthritis showed that ten days of treatment with devil’s claw provided significant pain relief.
Other herbs and supplements. Glucosamine is best known as a proposed treatment for osteoarthritis, but it might also be helpful for rheumatoid arthritis. A double-blind, placebo-controlled study of fifty-one people with rheumatoid arthritis found that glucosamine at a dose of 1,500 milligrams (mg) daily significantly improved symptoms. Glucosamine did not, however, alter measures of inflammation as determined through blood tests.
Some evidence, including small double-blind trials, supports the use of the following herbs and supplements for the treatment of rheumatoid arthritis: gamma-linolenic acid (found in evening primrose oil and borage oil), cat’s claw (Uncaria tomentosa), rose hip powder, and the Chinese herb Tripterygium wilfordii (applied topically or taken orally). T. wilfordii is believed to be unsafe for pregnant or nursing women and may present risks in other groups too.
Preliminary evidence suggests potential benefits with the following herbs and supplements: methyl sulfonyl methane, yucca, and a mixture of poplar, ash, and goldenrod.
Vitamin E may reduce pain in rheumatoid arthritis, but it does not seem to reduce inflammation. Some evidence suggests that adding vitamin E, or vitamin E plus other antioxidants, to standard rheumatoid arthritis therapy might improve results. However, an extremely large randomized trial involving more than 39,000 women found that taking 600 international units of vitamin E every other day did not reduce the risk of rheumatoid arthritis.
Persons taking the drug methotrexate for treatment of rheumatoid arthritis may benefit by taking folate supplements. Folate appears to reduce methotrexate side effects, including mouth sores, nausea, and liver inflammation. In addition, folate supplements may help reverse a more subtle methotrexate side effect: a rise in blood levels of homocysteine. Elevated levels of homocysteine are thought to increase risk of heart disease.
The following treatments are also sometimes proposed as effective for rheumatoid arthritis, but there is little to no scientific evidence for or against their use: adrenal extract, beta-carotene, betaine hydrochloride, boron, burdock, cayenne, chamomile, copper, feverfew, folate, ginger, L-histidine, horsetail, magnesium, manganese, molybdenum, pantothenic acid, D-phenylalanine, perilla frutescens, pregnenolone, proteolytic enzymes, sea cucumber, and vitamin C. Evidence regarding green-lipped mussel for rheumatoid arthritis is more negative than positive.
One study failed to find vitamin B6 at a dose of 50 mg daily helpful for rheumatoid arthritis, despite a general vitamin B6 deficiency seen in people with this condition. Zinc supplements have been evaluated as a treatment for rheumatoid arthritis, but overall, the study results have not been encouraging. Other treatments that have generally failed to prove effective in small double-blind trials include selenium, collagen, probiotics, white willow, and an Ayurvedic herbal mixture containing extracts of ashwagandha, boswellia, ginger, and turmeric. Two studies commonly cited as evidence that turmeric alone is useful for rheumatoid arthritis actually fail to provide any meaningful supporting evidence. A six-month, double-blind, placebo-controlled study of 168 people with rheumatoid arthritis failed to find that elk velvet antler enhanced the effectiveness of conventional treatment for rheumatoid arthritis.
Other alternative therapies. Adopting a vegan (pure vegetarian) diet might help mild rheumatoid arthritis, although the supporting evidence for this claim is weak. Identifying and avoiding food allergens has also been tried, but one controlled trial found no clear evidence of benefit with a low-saturated-fat, hypoallergenic diet.
Balneotherapy (hot baths), relaxation therapy, and magnet therapy have shown some promise for rheumatoid arthritis. Two separate groups of researchers conducting detailed reviews of eight randomized, controlled trials found some beneficial effects of acupuncture for rheumatoid arthritis, but they were not convinced that it was more beneficial than sham acupuncture or other standard treatments.
Herbs and Supplements to Use with Caution
Various herbs and supplements may interact adversely with drugs used to treat rheumatoid arthritis, so one should be cautious when considering the use of herbs and supplements.
Bibliography
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