New review of complementary medicines and arthritis

Given that 1 in 8 people over 65 suffer from osteoarthritis and, according to Arthritis Care, as many as 1 in 5 of the adult population live with some form or other of arthritis, this review is important for a massive number of people. The researchers looked at the evidence for forty herbal and other alternative medicines that are taken by mouth or applied to the skin. They did not examine acupuncture or manipulative therapies such as chiropractic and massage.

Osteoarthritis

Capsaicin gel, (a therapy based on chilli peppers) scored 5 out of a possible 5 points for effectiveness. It has been shown to reduce pain and joint tenderness among osteoarthritis patients. A herbal mixture called phytodolor and the nutritional supplement S-adenosyl-L-methionine (SAMe), both received 4 points for effectiveness. The jury is still out for the popular glucosamine sulphate and chondroitin, which both scored 3 out 5. That means there is some promising evidence that they may work, but some studies suggest they do not. So their effectiveness is uncertain. A further eight remedies also scored 3 out of 5. But they found little evidence for sixteen other treatments, including glucosamine hydrocholoride which scored only 1 out of 5.

Rheumatoid arthritis

Fish body oils were the only treatment to score 5 out 5. The evidence confirms they are successful in reducing pain and joint stiffness.

No treatments scored 4 out of 5, while for thirteen of the twenty one medicines assessed, the score was just 1 out of 5.

Fibromyalgia

The researchers found clinical trials for only four medicines intended to treat fibromyalgia. None scored high for effectiveness, with three scoring 2 out 5 and one scoring 1 out of 5.

Safety

The researchers have used a red, green and amber rating. Patients are also advised to check the patient information leaflet before taking any medicine. Nine medicines were given an amber rating, meaning that adverse effects were reported to be common, there might serious adverse effects, or that no information on safety was available.

One Chinese herbal extract, called Thunder God Vine, was identified as having significant safety concerns. There are well documented adverse effects including stomach pain, diarrhoea, nausea and headache. It can cause male infertility and amenorrhea (failure to menstruate) in women. It interacts with certain immuno-suppressant drugs and patients who are prescribed these drugs should not also take Thunder God Vine. Life threatening adverse effects have been reported associated with high dosage. This was the only medicine to be given a red safety rating.

Our view

This is a useful review of the current evidence. We would recommend anyone taking or considering complementary medicines to treat their arthritis to read the report, which is easily available on the Arthritis Research Campaign (ARC) website. Acupuncture and manipulative therapies, where good evidence exists, were not included.  The charity says that these will be the subject of a future report. A superficial reading of the report – and of the press headlines – could lead to the assumption that no complementary therapies are effective for arthritis. That is not what the report said.

There are two important limitations to this review, as the researchers themselves acknowledge. In herbal medicine, emphasis is on an individualised approach, with patients receiving a tailored prescription. However, a recent review concluded that there was a scarcity of evidence regarding individualised herbal medicine and no convincing evidence to support its use.  The authors did not search for reports of such an approach. No evidence is not the same as evidence that individualised treatment does not work.

Our view is that more research is needed. The report’s authors relied heavily on the results of randomised trials and gave preference to this type of evidence when estimating an effectiveness score. However important though this sort of evidence is, eminent scientists such as Professor Sir Michael Rawlings, Chairman of NICE, have been calling for more outcomes-based research.

Read the arthritis and complementary medicines report here

or contact ARC at: Arthritis Research Campaign Copeman House St Mary's Court St Mary's Gate Chesterfield Derbyshire S41 7TD Tel: 0870 850 5000 Email: Info@arc.org.uk