Complementary and alternative therapies for arthritis: What may and may not work

The controversy over the arthritis medications called COX-2 inhibitors has raised concern among the many patients who rely on these and other anti-inflammatory medications for pain relief. But even before the withdrawal of Vioxx last year, many patients were already looking into other options for pain management, including complementary and alternative medicine (CAM). For example, according to a survey by the US National Center for Complementary and Alternative Medicine (NCCAM), joint pain and arthritis tied for fourth and fifth place among the top 10 reasons Americans turn to CAM.

One of the biggest problems when dealing with CAM is that people equate the words "natural" with "safe," stresses Steven Magid, MD, of the Hospital for Special Surgery in New York. Dr. Magid says when his patients protest that a remedy is "natural," he counters: "So is asbestos!" This is not to say that natural remedies can’t and don’t help arthritis. As Patience White, MD, chief public health officer of the Arthritis Foundation (AF), points out, "Aspirin is made from a tree bark." Here’s a look at what may work – and what may not.

Acupuncture

Acupuncture can help the pain of arthritis in the knee and can improve freedom of movement, US researchers reported recently. The study adds to the evidence that the 2,000-year-old Chinese treatment, which uses needles placed at specific points on the body, can help a range of health problems. "For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of the knee," says Dr. Stephen Straus, director of NCCAM, which helped fund the study. "These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers."

Writing in the Annals of Internal Medicine, Dr. Bryan Berman of the University of Maryland School of Medicine and colleagues across the US studied 570 patients aged 50 or older with osteoarthritis of the knee. They all had significant pain but had never tried acupuncture, had not had knee surgery in the previous six months, and had not used steroids or similar injections. They got either regular acupuncture treatments, sham acupuncture, or a self-help course for managing pain. Everyone also continued to receive standard medical care, including anti-inflammatory drugs and pain relievers.

By the end of the second month, patients who got acupuncture had a significant increase in function and by the 14th week, had a significant reduction of pain, compared to the other two groups, the researchers reported. The volunteers given true acupuncture had 40 percent less pain and a nearly 40 percent improvement in function over the course of the study. Dr. Lixing Lao, one of the chief investigators, thinks that ultimately, "we might consider using acupuncture first instead of medications, at least for less severe cases of osteoarthritis. Or this therapy might enable the patient to benefit from lower doses of pharmaceutical treatment."

"This disease is one of the most frequent causes of physical disabilities among adults. This study will benefit the millions of people suffering from osteoarthritis," adds Dr. Stephen Katz, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which also funded the study.

Glucosamine And Chondroitin

Glucosamine is a natural substance the body uses to build and repair cartilage. It also has anti-inflammatory properties. Chondroitin exists naturally in cartilage, where it acts to draw fluid into the tissue and also has anti-inflammatory properties. Glucosamine supplements are made from crab, lobster, or shrimp shells; chondroitin is made from animal cartilage. Each seems to have a positive effect on human cartilage. Laboratory studies show glucosamine and chondroitin provide added elasticity and even repair damaged cartilage.

There have been dozens of clinical studies of glucosamine and chondroitin over the years, but many of these were funded by the supplements’ makers. So in 2000, the US federal government started enrolling 1,588 participants at 13 sites around the country for the GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) study. GAIT had just recently been completed and the results are now being analyzed. While one recent study reported in the American Journal of Medicine found glucosamine was no better than placebo for knee osteoarthritis, Dr. Magid is a believer in glucosamine. "I’m 100 percent sure that glucosamine works," he says.

Dr. Magid recommends 1,500 mg of glucosamine daily to patients. For chondroitin, the suggested dosage is 1,200 mg, and it’s recommended that this be broken into three doses throughout the day. The Arthrtis Foundation offers these caveats: Because glucosamine is an amino sugar, check your sugar levels more frequently if you have diabetes. Check with your doctor about chondroitin if you’re on blood-thinning drugs, and do not use glucosamine if you’re allergic to shellfish.

Magnet Therapy

Magnet therapy has been highly touted over the years by arthritis patients, but until recently, it has not been clinically tested. Worldwide sales of magnet bracelets and other products were estimated at $5 billion in 1999. Magnets are believed to interfere with pain transmission by nerve fibers, but study results so far have been mixed.

A recent study in England involving 194 men and women with knee or hip osteoarthritis found a significant reduction (27 percent) in pain scores of patients who wore a standard-strength bipolar magnet bracelet for 12 weeks, compared to those wearing a nonmagnetic bracelet. However, the researchers reported in the British Medical Journal in December 2004 that they could not determine how much of the reported effectiveness was also due to the subjects’ use of painkillers.

By contrast, a US study of 49 patients found magnets did not change the "pain information" transmitted by neurons and so concluded they weren’t really a viable therapy. Both studies hypothesized that any "relief" came from the placebo effect; subjects simply believed it would work.

Herbal And Dietary Supplements

Among the many herbal and dietary supplements touted for arthritis, few have much credibility.

Avocado-soybean unsaponifiables (ASU) has had limited testing. One six-month study of 114 people with knee and 50 people with hip osteoarthritis found a "statistically significant" increase in pain relief and mobility, but it took a while for the effects to kick in. Once they did, the study said, benefits persisted for up to eight months. (ASU is available commercially as Avosoy.)

Devil’s Claw is made from the root of an African herbal plant. The Clinical Journal of Pain and Rheumatology recently pooled data from several small trials, and found only limited support for its use. People who took six 435 mg capsules daily for one to two months had modest relief of osteoarthritic pain in the knee and hip. Possible side effects include lowered blood pressure and interference with blood-thinning, cardiac, or diabetes medications.

MSM (methylsulfonylmethane) is sometimes combined with chondroitin and glucosamine, but so far its effectiveness has not been proven. "I tell my patients it’s bad enough to take poisons that we know are poisons," says Dr. Magid, who adds that even FDA-approved medications can and do have side effects. So he cautions against taking any herbal or nutritional supplement that hasn’t been clinically proven.

The problem with MSM is that there is little published research to back up the claims – and nothing even close to a large clinical trial. An MSM manufacturer has sponsored two very small trials, but they haven’t been published. So it is the same story with MSM as it is with many alternative medicines these days – that while so far there doesn’t seem to be any reason that it would cause harm, there isn’t much credible, published evidence that it works either!