New and alternative
therapies for rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory condition.
The condition can affect many tissues throughout the
body, but the joints are usually most severely affected.
Drug therapy and other conventional therapies, such
as physical therapy, are the mainstays of treatment
for rheumatoid arthritis. However, these therapies
may have limited effectiveness and drug therapies
may cause considerable side effects. Some new and
alternative (complementary) therapies show promise
for expanding the current treatment options although,
at this time, the effectiveness and safety of many
of these therapies are still being defined.
It is important to discuss the likely benefits and
risks of new and alternative therapies with your doctor.
Your doctor can help you evaluate these therapies
and determine if they are appropriate for you.
NEW THERAPIES — Several medical therapies
for rheumatoid arthritis have recently been developed
and tested. At this time, most of these therapies
are reserved for people who have rheumatoid arthritis
that does not respond to other therapies.
Immunoadsorption — During immunoadsorption,
a person's blood is filtered through a column that
presumably traps immune substances and removes them
from the blood. The Food and Drug Administration has
recently approved this therapy for the treatment of
rheumatoid arthritis.
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Immunoadsorption improves symptoms in people with
chronic and severe rheumatoid arthritis. However,
this therapy is expensive and is not appropriate for
people who take certain drugs, called angiotensin-converting
enzyme inhibitors, and for people who have certain
medical conditions, such as heart failure.
The side effects of immunoadsorption may include
a brief flare of joint pain and joint swelling during
or after the procedure.
Oral type II collagen — One study suggested
that oral collagen improves symptoms in people with
rheumatoid arthritis, while another study suggested
that the effects of oral collagen are no greater than
those of a placebo. Therefore, the benefits of oral
collagen remain uncertain. These experiments used
a form of collagen which is found primarily in joint
cartilage. Use of any other type of collagen is unsupported
by evidence from clinical trials in people with rheumatoid
arthritis.
Stem cell transplantation and/or high-dose cyclophosphamide
treatment — During stem cell transplantation,
existing stem cells (cells that give rise to other
cells, including immune cells) are replaced with treated
stem cells in the hopes of restoring normal immune
function. Cyclophosphamide is a drug that kills immune
cells when given in high doses. These therapies may
be used individually or in combination. Both therapies
carry substantial risks, especially a risk of serious
or life-threatening infection.
One study found that people with severe rheumatoid
arthritis who underwent stem cell transplantation
plus cyclophosphamide treatment had substantial improvements
in their symptoms after three months, but that this
improvement lessened over time.
A second study in people with severe rheumatoid arthritis
found that very high doses of cyclophosphamide were
needed to achieve long-term improvements in symptoms
after stem cell transplantation. Furthermore, this
treatment did not completely eliminate symptoms.
A third study found that people with severe rheumatoid
arthritis had a marked improvement in symptoms when
treated with high-dose cyclophosphamide and then granulocyte
colony-stimulating factor (a substance that promotes
the growth of certain types of new immune cells).
However, this treatment required two to three weeks
of hospitalization in intensive care, and joint inflammation
returned in about half of the people within one year.
Overall, the risks of stem cell transplantation and
cyclophosphamide treatment and their lack of a lasting
benefit suggest that they are not a practical treatment
option for rheumatoid arthritis.
Antibiotics — Studies of the usefulness
of antibiotics in the treatment of rheumatoid arthritis
to date have produced conflicting results. Antibiotics
kill or halt the growth of infectious organisms, and
infection is suspected of playing a role in rheumatoid
arthritis. Some antibiotics have added effects that
may lessen arthritis—they reduce the activity
of enzymes that damage connective tissue, they slow
bone loss, and they alter the function of immune cells.
People with mild to moderate rheumatoid arthritis
who took the antibiotic minocycline were more likely
to have experienced an improvement in their symptoms
and in markers of inflammation than people who took
a placebo; furthermore, these benefits persisted for
up to four years. However, in some people, minocycline
may actually cause symptoms that resemble those of
rheumatoid arthritis.
Similarly, the antibiotics rifamycin and ampicillin
have been suggested to have benefits in some people
with rheumatoid arthritis, and the antiviral drug
amantadine has been shown to have benefits in some
people with juvenile rheumatoid arthritis.
Thalidomide — Thalidomide is a sedative
drug that may also reduce levels of an inflammatory
substance called tumor necrosis factor.
In one study, treatment with thalidomide plus another
drug with similar actions improved symptoms in some
people with rheumatoid arthritis.
In another study, treatment with thalidomide alone
improved symptoms in a large proportion of people
with rheumatoid arthritis, but many people stopped
taking the drug because of side effects.
Thalidomide is well known to cause birth defects.
Overall, the limited effectiveness of thalidomide
and its potential side effects suggest that this drug
is not a practical treatment for rheumatoid arthritis.
Other investigational therapies — Several other
therapies for rheumatoid arthritis are currently in
the investigational stage. These therapies include
new drugs, antibodies targeted at substances that
participate in inflammation, gene therapy, and radiation
synovectomy (a therapy that targets radiation to the
inflamed tissue lining the joint).
ALTERNATIVE (COMPLEMENTARY) THERAPIES —
Several alternative (complementary) therapies may
play a useful role in the treatment of rheumatoid
arthritis, but the safety and effectiveness of most
of these therapies are still uncertain.
Alternative therapies are attractive because they
are perceived to be safe and natural and because conventional
therapies may have limited effectiveness and substantial
side effects. However, many alternative therapies
are marketed with unproven claims, and certain alternative
therapies have even been shown to be harmful.
People with rheumatoid arthritis who are considering
alternative therapies should discuss these therapies
with their doctors first. Furthermore, alternative
therapies that have proven benefits should only be
used to complement, not replace, conventional medical
treatment.
Exercise — Recent studies suggest that
exercise is both safe and beneficial in people with
rheumatoid arthritis. Regular exercise can build endurance
and strength, preserve muscle and normal joint motion,
minimize bone loss, and improve pain control. Exercise
may also have psychological and social benefits.
Several different kinds of exercises are beneficial,
including range of motion exercises to preserve and
restore joint motion; exercises to increase strength,
such as weight lifting and isometrics; and exercises
to increase endurance, such as walking, dancing, swimming,
and cycling.
Recent studies have also found that aerobic exercise
(the type of exercise that increases heart rate and
breathing rate for sustained periods of time) also
has substantial benefits and does not worsen arthritis.
Exercise programs for people with rheumatoid arthritis
should be designed by a physical therapist and should
be tailored to the severity of the condition, a person's
body build, and a person's former activity level.
Exercise should never cause increased pain and should
never push the joints past their normal range of motion.
Foods and diets — There is no evidence
that food allergies or sensitivities cause or worsen
rheumatoid arthritis in most people. However, some
people may notice that their symptoms improve when
they fast or eliminate certain foods from their diet,
suggesting that an allergy or sensitivity is contributing
to arthritis. For most people with rheumatoid arthritis,
a healthy, balanced diet is a sensible component of
the treatment plan.
Fish oils and plant oils — Substances
found in fish oils and plant oils (such as primrose
oil and flaxseed oil) can suppress immune and inflammatory
responses. These oils have been shown to modestly
reduce symptoms of rheumatoid arthritis in some people.
Diets that include plant oils, particularly olive
and rape-seed oil, instead of animal fat may be of
some benefit and may also reduce the risk of coronary
heart disease. (See "Primary prevention of cardiovascular
disease and stroke").
Vitamins, minerals, and other supplements
— Some people with rheumatoid arthritis have
a slight improvement in symptoms when they take copper,
zinc, vitamin B, or the amino acid L-histidine. In
contrast, studies suggest that vitamin C does not
relieve symptoms in people with rheumatoid arthritis.
Hydrotherapy — Hydrotherapy has been
shown to improve symptoms in people with rheumatoid
arthritis.
Venom — Although venom from stinging
insects reduces inflammatory and immune responses
in the laboratory setting, there is currently no evidence
that venom is of benefit in treating rheumatoid arthritis.
Hyperbaric oxygen and topical dimethyl sulfoxide
(DMSO) — Studies have found that neither
hyperbaric oxygen nor topical DMSO has any benefits
in people with rheumatoid arthritis.
Laser therapy, homeopathy, and biofeedback
— Preliminary studies suggest that laser therapy,
homeopathy, and biofeedback may improve the symptoms
of rheumatoid arthritis in some people.
Acupuncture — Studies have found that
acupuncture does not reduce symptoms of rheumatoid
arthritis. Furthermore, acupuncture has been associated
with injuries.
Magnets — Studies have found that magnets
are not effective for relieving joint pain.
S-Adenosylmethionine (SAM-E) — Preliminary
studies suggest that SAM-E may reduce the symptoms
of rheumatoid arthritis. However, this supplement
may be inappropriate for people with rheumatoid arthritis
who take methotrexate.
