When I was growing up I had a friend who became a doctor. I remember going to his home one day and asking for his advice about a medical dilemma with which I was grappling. In my 20′s I struggled with depression. It had become severe enough for my doctor to suggest that I begin using a prescription antidepressant. But I had reservations. I was concerned about the impressive list of reported side effects and a whole host of adverse reactions that might occur during the course of long term use. It literally felt like a lose-lose situation. If I was lucky, I might experience an improvement in mood. However, I was almost assured of one or more unintended consequences of treatment such as constipation, dry mouth, insomnia, nausea, restlessness and sexual dysfunction. The feelings that I experienced during that decision making process are shared by many people. And it’s not exclusive to those with depression. Anyone who is prescribed a powerful medication for a chronic condition may very well share similar thoughts.

If you have rheumatoid arthritis (RA) you’ll almost certainly be asked to take a combination of drugs that are intended to improve mobility, lessen joint damage and reduce pain. However the real possibility of side effects often influences the decision about the right course of treatment. Anti-inflammatory medications can promote abnormal bleeding (bruising and ulcers) and can occasionally cause kidney and liver damage. Antirheumatic drugs, immunosuppressants and steroids have been associated with a greater risk for bone loss, cataracts, infections and weight gain. Perhaps this is why some research shows that up to 90% of patients with RA incorporate some form of alternative or complementary medicine into their treatment programs. (1,2)

A recent review in the December edition of the journal Phytotherapy Research attempts to summarize the current state of herbal medicine in the management of RA. In this research, scientists from Victoria University in Melbourne, Australia conclude that two natural remedies show the greatest promise as “mediators of inflammation” in those with rheumatism. Oils containing a rare fatty acid known as GLA (gamma linolenic acid) have the largest amount of evidence to support their use. Blackcurrant, borage and evening primrose oil, the best sources of GLA, were deemed promising when given at a dosage of 1,400 mg of GLA/day. Lower amounts of 500 mg or less were found to be ineffective. The second noteworthy herbal medicine is one that I’ve previously highlighted on this site: Thunder God Vine (Tripterygium wilfordii). (3)

After reading the meta-analysis, I couldn’t shake this thought from my head: Two remedies?! That’s it? Do you mean to tell me that RA patients only have these two options from which to choose? I had a hard time accepting that. It’s a good thing too because it led me to investigate the issue further. The result of my curiosity yielded five additional alternatives that may be worth considering.

• Probiotics May Tame the Flame - A new study in the journal BMC Complementary and Alternative Medicine examined the effects of a specific probiotic strain (Bacillus coagulans GBI-30, 6086) in a group of 45 men and women with RA. Half of the study participants were given a capsule of the probiotic and the remainder received a placebo. All of the participants were instructed to continue using their standard medication during the 60 day trial period. Those receiving the GBI-30 bacteria reported significant improvements in their Pain Scale, Patient Global and Pain Assessment scores and “self-assessed disability”. Before and after blood tests also revealed a decline in C-reactive protein concentrations, a measure of inflammation. Strides were also made in the patients’ “ability to walk 2 miles” and with regard to participation in daily activities. No adverse reactions were associated with the addition of GBI-30. These current findings are supported by recent studies conducted in Korea using other healthy bacteria including Lactobacillus casei. (4,5,6)
• Aquatic Exercise for RA Muscle Preservation - A newly published systematic review in the Journal of Epidemiology determined that aquatic exercise yields “small but statistically significant effects on pain relief and related outcome measures of locomotor diseases (eg, arthritis, rheumatoid diseases, and back pain)”. Reducing inflammation and pain is certainly of critical importance in the successful management of RA. But it’s also very important for those with rheumatoid arthritis to actively work to prevent the loss of muscle mass and strength that often accompanies this disease. Specific underwater exercises such as “water treadmill walking” and underwater bicycle riding can help those with rheumatism to increase their aerobic capacity, burn extra calories and help maintain lean body function and mass. (7,8,9)
• Fish Oil for Pain, Prevention and Protection - Adding 1 gram of fish oil to a conventional treatment protocol results in significant reductions in key inflammatory markers associated with RA. This is according to a new trial published in the December edition of the journal Clinical Biochemistry. 83 women with RA were asked to take a fish oil soft gel or a similar looking placebo for 3 months. Blood tests were used to assess any serum changes due to this complementary treatment. The results indicate that fish oil “could decrease the inflammatory response by lowering serum TNFalpha levels and sRANKL/osteoprotegerin ratio”. A November 2009 experiment also revealed that EPA (eicosapentaenoic acid), one of the two major omega-3 fatty acids in fish oil, may affect gene expression that protects against “arthritis-induced muscle wasting”. Finally, a large population study from Sweden recently determined that “intake of oily fish was associated with a modestly decreased risk of developing rheumatoid arthritis”. (10,11,12)
• Freeze the RA Away - Cryotherapy is a type of physical therapy that employs the use of cold chambers, cold packs or cold air sprays that lower “skin and tissue temperature and subsequently decrease neuronal activity and tissue blood flow”. These physiological effects often result in analgesia (pain relief). But questions remain about its safety and tolerability. Several new studies attempt to clarify the promise and risks involved with this unconventional treatment. A three month trial published in the journal Inflammatory Research discovered that 2-3 minutes of “whole body cryotherapy at -140 to -160 degrees C” daily for 4 weeks resulted in “beneficial clinical effects” due to a reduction in histamine levels in RA patients. It’s interesting to note that histamine degradation, production and release were not affected by conventional physiotherapy. A comparison group of patients with osteoarthritis was also unresponsive to cryotherapy. Other cryotherapy studies have documented improvements in RA severity, as measured by reductions in inflammation (TNF-alpha and IL-1), Disease Activity Score and Visual Analog Scale indexes. However some research has found that a considerable percentage of patients discontinue treatment due to side effects (up to 21.7%). (13,14,15,16)

• Rose Hips to the Rescue - A standardized extract of rosehip (Rosa canina) was recently evaluated in a double-blind placebo controlled study involving 89 patients with RA. 5 grams of encapsulated rosehip powder or a “matching placebo” was provided to study participants recruited from “two outpatient clinics in Berlin and Copenhagen”. Most of the volunteers were middle-aged women who had suffered from rheumatism for an average of 11.3 years. Several indicators of RA symptom severity improved in the women treated with rosehips vs. placebo. Specifically, benefits were noted when analyzing before and after Health Assessment Questionnaires (HAQ) and an index known as DAS-28 – a “physician’s global evaluation of disease activity”. While the results suggest some positive activity, no reduction in pain medication use was found in either the experimental or placebo groups. Still, there may be reason for optimism with regard to rosehips and arthritis in general. A recent meta-analysis concluded that rosehip powder can effectively reduce pain in osteoarthritic patients. In addition, a one-year survey of patients with chronic low back pain and osteoarthritic knee pain revealed that those with “greater degrees of pain and disability” may respond in a more pronounced way to this form of phytotherapy. Overall, most of the scientists involved in the rosehip research urge for additional studies on this seemingly promising supplement. (17,18,19)

If I had rheumatoid arthritis, I’d certainly explore every available natural therapy that I could find. Today’s column isn’t a comprehensive review of all of the alternative and complementary options for RA. I simply wanted to point out some of the most recent findings that may be worth considering and that you may not have already heard or read about. Please remember that much of this research utilizes a holistic approach in concert with standard care. An integrative program may very well be the best way to go for many patients. It sometimes allows for greater efficacy and a lower overall toxicity profile. However, it’s vital to consult with well informed health professionals prior to applying a “kitchen sink” approach to RA treatment. One important reason is that certain supplements may interact with medications. The best way to avoid this issue and other common pitfalls is to work with an integrative health team. If you do so, please make sure that they’re aware of the research presented here today.

Be well!

JP

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