Arthritis and complementary and alternative treatment

Complementary and alternative medicine or CAM became a formal and recognized body of treatment for many diseases, including the arthritides. CAM joined mainstream medicine and has been offered as part of the medical curriculum by the mid 80's.

CAM include such diverse modes  of treatment- from balneotherapy, massage, acupuncture and other physical applications to plant products as herbal concoction either applied or taken in. CAMs was reviewed in the Philippine Rheumatology Association(PRA) Recommendations for the Medical Treatment of knee osteoarthritis (OA).

Natural is not necessarily safe, so it is important for prospective users to look for seal of approval by reputable organizations (ex. Arthritis Foundation) or certifications for specific standards of manufacturing (ex. ISO). Like other treatment forms, CAMs can have side effects. We still warn against CAMs markated as a panacea. There have been reports of sideeffects to the heart, liver, kidneys and infections that arise with indiscrimate use of some of these agents.

Among the CAMs reviewed by the PRA were those with scientifically conducted trials and research for its effects on knee OA pain and function.  The following is part of the 25 recommendations published in the Philippine Compendium of Medicine, 2010.

Recommendation for Complementary and Alternative Medicine (CAM)

A. Recommended
1. Herbal preparations
The use of concentrated standardized ginger preparation is recommended for its moderate effect in the control of pain and improvement of function in knee OA. Patients should be warned of gastrointestinal adverse reactions that can occur with this preparation.
Level of evidence: Moderate

2. Acupuncture
Manual or electroacupuncture is recommended as additional therapy to achieve pain relief lasting a few weeks in patients with moderate knee pain due to OA.
The procedure must be adequate and performed by a trained and experienced acupuncturist.
Level of evidence: High

B. Insufficient Data to recommend
1. Spa or balneotherapy
There is insufficient evidence to recommend spa treatment for the control of pain and improvement of function in knee OA.
Level of evidence: Low
2. Tai Ch’i
There is insufficient evidence to recommend Tai ch’i for the control of pain and improvement of function in knee OA.
Level of evidence: Low
3. Yoga
There is insufficient data to recommend yoga to control pain and improve function in knee OA.
Level of evidence: Low
4. Herbals
There is insufficient data on comfrey, Chinese herbal recipe, Chinese pills, rose hip, devil’s claw, to recommend their use in knee OA.
5. Massage
There is insufficient evidence to recommend massage (standard Swedish) for the treatment of knee OA.
Level of evidence: Low