I have read about a new complementary medicine in my magazine, do you think it will be of help in trying to improve my RA?

Taken from NRAS magazine, Spring 2010

The helpline team often receives calls asking for information about the efficacy and safety of complementary and alternative therapies that callers have seen on the news or read about in the newspapers.  We always advise caution when considering taking a complementary or alternative therapy as products which may be deemed to be more ‘natural’ are not necessarily harmless and can have side effects and interact in a harmful way with your prescribed medications.  They can also of course be very expensive.  Before embarking on any new therapy it is important to talk to your rheumatology team and discuss this with them and look at the possible impact this may have on your current medication.  Your team will look for evidence to suggest both the safety and efficacy of these products, unfortunately in many cases there will not be sufficient evidence available.  

Evidence from the Arthritis Research UK (ARUK) report

ARUK recently published a report on this topic entitled ‘The complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia’, this report was written and produced by ARUK and is an evidence-based report on the use of complementary and alternative medicines for arthritis and musculoskeletal conditions. It uses evidence from randomised controlled trials and aims to help people with arthritis or fibromyalgia select which complementary medicines may be beneficial for them.  Copies can be downloaded from the ARUK website or by calling 0870 850 5000.

Despite the number of complementary medicines available and used, this report found only 40 with evidence available from randomised controlled trials (the type of studies that give the best evidence on whether a treatment is effective or not). Even for those which had been studied, many had been tested in only a single or just a few studies. This makes it difficult to be sure whether they work or not.

Evidence of efficacy and safety in Rheumatoid Arthritis

For people with rheumatoid arthritis (RA) the medicines researched score poorly, with 13 out of 21 complementary medicines (62 per cent) scoring just 1 point i.e. the available evidence suggests that the compound is not effective.

At the other end of the scale, fish body oil scores a maximum 5 for effectiveness among people with RA, offering real benefits. It also receives a green light for safety.  Other products which were given a green light and scored at least 3/5 for efficacy included borage seed oil, evening primrose oil, green lipped mussel, Indian Frankincense, SKI 306X (a mixture of 3 herbal medications prepared from Clematis mandshurica).

Recommendations from NICE and BSR Guidelines

In 2009 NICE published their RA guidelines and part of this document looked at the role of diet and complementary therapies in the treatment of RA.  The guideline group looked at the evidence available for the use of complementary therapies in the treatment of people with RA and felt that it was important to inform people with RA who wished to try complementary therapies that, although some may provide short-term symptomatic benefit, there is little or no evidence for their long-term efficacy. They also advised that these approaches should not replace conventional treatment nor prejudice the attitudes of members of the multidisciplinary team, or affect the care offered.

The British Society for Rheumatology (BSR) also published guidelines for the treatment of RA in the 1st two years and they also reported that the evidence for the effectiveness of complementary therapy was conflicting and no firm recommendations could be made.   Although the evidence supporting the benefits of complementary therapies in arthritis is limited, for some, these treatments can help alleviate symptoms such as pain and stiffness as well as dealing with some of the unwanted effects of taking drugs. Complementary therapies can play an important role in encouraging positive changes in lifestyle and outlook. However, it is particularly important that complementary therapies do not replace prescribed treatment.