Patients with arthritis commonly use such treatments, possibly partly as a reflection of the perceived inadequacies of orthodox medical treatments for the condition, but also because it enables them to regain a greater level of control over their treatment choices. Commonly used therapies include homeopathy, manipulation, including chiropractic and osteopathy, acupuncture and herbal medicines; some patients also use less 'medical' treatments such as aromatherapy or massage.
There is little evidence for any of these in inflammatory arthritis. A recent systematic review of herbal medicines in RA suggested moderate support for gamma linolenic acid (found in some herbal medicines) in terms of reducing pain, stiffness and joint tenderness. The review also identified controlled trials of other agents, including capsaicin, curcumin, feverfew, flaxseed oil, Boswellia serrata and other traditional ayurvedic medicines, reumalex and Tripterygium wilfodii. However, because these were only single studies no definite conclusions could be drawn.
Acupuncture has been shown to reduce pain in a variety of circumstances. There are no controlled trials of manipulative therapies such as chiropractic or osteopathy in rheumatoid arthritis; however, patients considering such treatment should be warned of the potential for serious damage from neck manipulation since neck stability is reduced by RA. Previous studies of homeopathy in arthritis have been complicated by the difficulty in separating the effect of the treatment from the effect of the consultation; further studies are in progress.
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