Complementary and Alternative Medicine

The evidence for Complementary and Alternative Medicine (CAM) in the treatment for:

1. Rheumatoid arthritis
2. Osteoarthritis and
3. Fibromyalgia can be accessed via the link below.

Some 46% of people in the UK use complementary medicine at some point in their lives for a wide range of conditions, spending over £450 million a year on acupuncture, chiropractic, homeopathy, hypnotherapy,medical herbalism and osteopathy.1

People with arthritis and musculoskeletal conditions,whose symptoms are often chronic, are particularly attracted to try such medicines, with 60 per cent of people trying a variety of products.2

The complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia report, written and produced by the Arthritis Research Campaign 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.

The report scores medicines according to their effectiveness with 1 indicating that the available evidence suggests that the compound is not effective and 5 indicating that there is consistent evidence that the compound is effective. Effectiveness is measured by improvements in pain, movement, or general wellbeing.

The report also grades the medicines according to safety, providing traffic light classifications for each. The authors of the report focused on compounds taken by mouth or applied to the skin. They did not look at therapies such as acupuncture and chiropractic massage which have been commonly used for arthritis and musculoskeletal conditions. The role of these will be considered in a subsequent report.

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.

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.

Alternative medicines appear to be more promising for people with osteoarthritis (OA) with only 6 out of 27 approaches (22 per cent) scoring 1 point. Found to be safe to use and scoring well, are the herbal preparation phytodolor and nutritional supplement SAMe, both receiving a 4 for effectiveness. Capsaicin gel, made from chilli peppers, proved the most effective for OA, scoring the full 5 points.

Glucosamine is one of the most widely taken products and there have been many trials conducted. The evidence however is mixed; many trials show benefit while some do not. The evidence is stronger for glucosamine sulphate (which scored 3) compared to glucosamine hydrochloride (which scored 1).

Only four products were assessed for fibromyalgia but none of them were highly effective with three medicines scoring just 2 out of 5, and the fourth an ineffective 1.

In terms of safety, there is much less information available for complementary medicines in comparison to conventional medicines. However for approximately one quarter of the compounds considered, the ARC  gave them an “amber” safety classification indicating there were important side effects which had been reported. A “red” safety classification was issued against thunder god vine. The research studies used in the report are referenced so that you can find out more information on individual medicines should you wish to.

1 Thomas KJ, Coleman P. Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus Survey. J Public Health 2004;26:152-7

2 Bishop FL, Yardley L, Lewith GT. A systematic review of beliefs involved in the use of complementary and alternative medicine. J Health Psychol 2007;12:851-67