A systematic review of complementary therapies for Rheumatoid arthritis has concluded that there is little evidence to support their use in relieving the pain of this autoimmune condition. Millions of patients make use of alternative treatments for neck pain and back pain but this latest research may make them think twice before shelling out money for unproven remedies for Rheumatoid arthritis.
Reducing Pain and Inflammation in Chronic Disease
The research, published in the journal Rheumatology, looked at randomized, controlled trials of alternative medicine for Rheumatoid arthritis and assessed the treatments’ efficacy in reducing inflammation and chronic pain for patients. The analysis was done on behalf of the Arthritis Research UK Working Group on Complementary and Alternative Therapies for the Management of the Rheumatic Diseases. The key finding from the study is a lack of good evidence supporting the use of any complementary therapy for Rheumatoid arthritis.
Complementary Therapies Used for RA
Eleven RCTs met the group’s criteria for assessment, and these studies encompassed seven alternative therapies for Rheumatoid arthritis, including acupuncture, meditation, autogenic training, healing therapy, progressive muscle relaxation, static magnets, and tai chi. No complementary treatments for Rheumatoid arthritis involving oral or topical medications were included and all trials analyzed in the study were compared with a placebo or sham control, or usual care for RA. The main endpoints reviewed in the study were pain relief and patient global assessment.
Acupuncture for Rheumatoid Arthritis
Three trials of acupuncture, compared to sham acupuncture, revealed no significant differences in pain reduction. One trial did see patient global assessment improved after acupuncture for Rheumatoid arthritis, and one had a reduction in Physicians’ assessment of disease activity. Unfortunately, the trials for complementary Rheumatoid arthritis treatments were usually small and failed to include calculations as to their power to detect the size of effect.
Another problem with these studies was the measurement of multiple outcomes over several time periods, thus increasing the likelihood of some positive effects beings seen even where no real difference occurred between groups. Specifying a primary endpoint would have allowed many of the studies to better contextualize their findings but most failed to do this and so it is hard for researchers to determine the perceived benefits of the complementary treatments for Rheumatoid arthritis being studied.
Better Clinical Trial Standards
The working group determined that to truly assess the merits of complementary therapies for Rheumatoid arthritis researchers should adhere to standards such as CONSORT (Consolidated Standards of Reporting Trials). Many of the studies into alternative treatments for chronic illnesses like RA are underfunded and have problems attracting sufficient patients to make the results of significant power. Whilst a cursory look at the review gives the impression that acupuncture, mindfulness training, and other complementary therapies are of no benefit to patients with chronic neck pain, back pain, or other symptoms of Rheumatoid arthritis, the real take-home message is that there is little evidence proving a strong benefit.
Benefits of Alternative Therapies for Pain
Many of the studies have hard endpoints, such as significant decreases in inflammatory markers, and this could lead patients and their physicians to the conclusion that the therapy is of no benefit at all. Instead, it is important to remember that many patients view CAM for Rheumatoid arthritis as part of an overall treatment profile, alongside conservative treatments for neck pain and other symptoms. Recent studies have reported benefits for mindfulness training in RA, for example, and other mind/body therapies are often noted to be helpful for patients coping with insomnia, depression, and pain management issues rather than specific joint swelling in RA.
Although this review casts doubt on the usefulness of alternative therapies for Rheumatoid arthritis, patients are, as always, advised to review the review with caution. Complementary treatments for Rheumatoid arthritis and neck pain remain popular for a reason, namely that they can target symptoms that many neck pain medications fail to treat.
Macfarlane, G.J., Paudyal, P., A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis, Rheumatology (2012), doi:10.1093/rheumatology/kes133, First published online: June 1, 2012