Helping patients through the minefield of complementary medicines
Published on 01 April 2009
Is there any evidence that complementary medicines actually work for people with arthritis? Arthritis Research UK's new guide takes a hard look at available scientific proof.
Forty-six per cent of the UK population use complementary medicines at some point in their lives, spending more than £450 million a year on non-conventional treatment.
Among people with arthritis the figure is even higher – 60 per cent of patients try such treatments as green-lipped mussels, homeopathy and rosehip – in a desperate bid to relieve their pain.
But despite the vast numbers of products available in health food shops and via the internet, it can be very difficult for people to know if what they are taking actually works – or whether they are simply wasting their money.
It was in response to this that Arthritis Research UK decided to produce the first evidence-based report dedicated to complementary medicines in arthritis. The aim was to inform the public whether there is scientific evidence to support the clinical effectiveness and safety of a range of products for which claims have been made, but in many cases are unsubstantiated by hard evidence.
The report, Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia reveals considerable variation in the levels of scientific information available.
And despite the vast number of complementary and alternative medicines on the market, the report found that evidence from randomised controlled trials was available for only 40 of them.
Professor Alan Silman, Arthritis Research UK medical director, explained: “Complementary medicines are widely used by people with arthritis as they seek to avoid taking potentially harmful drugs, preferring natural products. However, natural does not mean they are either safe – or effective. Many people spend hundreds of pounds on these products and they need to know that there is a strong chance of benefit.”
Guidance is important
The report covers medicines taken by mouth or applied to the skin, rather than therapies such as acupuncture and chiropractic. It scores medicines according to their effectiveness with 1 indicating that the available evidence suggests that the compound is not effective and 5 indicating that the compound is effective. It also grades the medicines according to safety, providing traffic light classifications for each.
Professor Gary Macfarlane, who led the research, said it was important that people with arthritis had some guidance on the complementary medicines available. “While over 60 per cent of people with arthritis or other aches and pains use some form of complementary and alternative medicine - and find different things work for them - it is useful to also have the scientific evidence available and just as important to know how safe we think they are to use,” said Professor Macfarlane. “All of the evidence can now be accessed in this definitive report.”
Fish body oil scores highly for rheumatoid arthritis
The report throws up several surprises. For nearly two thirds of compounds used for rheumatoid arthritis, for example, the data in the report suggests they don’t work, while the effectiveness of glucosamine sulphate, a supplement popular with people with osteoarthritis, is again called into question, scoring only three.
The two highest-scoring products in terms of reducing pain, movement or general well-being were fish body oil for rheumatoid arthritis and capsaicin cream for osteoarthritis.
Products for osteoarthritis scoring four were herbal extract phytodolor and nutritional supplement SAMe (although these products are not available in the UK), while fish liver oil only registered a one.
What does the report say?
For rheumatoid arthritis (RA):
Nearly two thirds (13 out of 21 complementary medicines [62 per cent]) were shown to have no or little effect based on the available evidence (scoring 1 out of 5 on the effectiveness scale)
The 13 are: antler velvet; blackcurrant seed oil; collagen; eazmov herbal preparation; feverfew; flaxseed oil; green-lipped mussels; homeopathy; reumalex herbal mixture; selenium; Chinese herb tong luo kai bi; vitamins A,C and E anti-oxidant vitamins; and willow bark.
By contrast fish body oil scored 5 out of 5 for people with RA, reducing joint pain and stiffness.
For osteoarthritis (OA):
Nearly one fifth (6 out of 27 medicines [22 per cent]) were shown to have little or no effect based on the available evidence
Glucosamine one of the most widely taken products showed mixed results with glucosamine sulphate scoring 3 and glucosamine hydrochloride scoring 1
Capsaicin gel (available on prescription), made from chilli peppers, proved most effective in relieving pain and joint tenderness, scoring the full 5.
Only four products were assessed
None of them highly effective with three medicines scoring 2 out of 5, and the fourth an ineffective 1.
One quarter of the compounds were given an “amber” safety classification indicating there were important side-effects which had been reported, although there is much less safety information available for complementary medicines in comparison to conventional medicines.
Only one “red” safety classification was issued against thunder god vine for RA.
Note from the editor: The Complementary and alternative medicines report was updated in 2013. Visit our Complementary and alternative medicines section for more information.