If you are suffering from what medicine calls 'arthritis', you
could have any one of a hundred different kinds of illness, including
everything from the most common - osteoarthritis and the crippling
rheumatoid arthritis - to gout and fibromyalgia. While organisations
such as the Arthritis Foundation pooh-pooh all but the most widely used
conventional treatments, the sheer pandemic proportions of arthritis -
one in three in America and one in five in Britain - and the wide
variety of different kinds of arthritis make it clear that considering
other solutions is necessary and desirable.
therapy, which includes the use of aspirin and NSAIDs, used to reduce
inflammation in the joints, can produce side-effects such as bleeding
in the stomach. Likewise, second-line treatment in the form of
slow-acting antirheumatic drugs (SAARDs) such as gold, methotrexate and
sulphasalazine, traditionally prescribed to advanced rheumatoid
arthritis sufferers to slow the progress of the disease, bring with
them a host of side-effects, including ulcers and life-threatening
The official line is that there are
no other 'cures' for arthritis, that anything other than the accepted
pathway is just quackery. The Arthritis Foundation believes that nine
out of 120 arthritis sufferers have tried at least one form of
alternative therapy and that most of these have failed to find relief.
Their attitude assumes two things: 1) that copper bracelets, motor oil
and bee venom can happily be lumped in with acupuncture, yoga and
herbs; and 2) that conventional medicine is some sort of haven for
sufferers to return to. These views fail to acknowledge that perhaps 90
per cent of sufferers feel in some way let down by the conventional
approach and its myriad unpleasant side-effects. Of course, it also
ignores those studies which show that arthritis sufferers can find
relief from pain, stiffness and inflammation through a variety of
alternative methods, either singly or in combination.
present, the numbers of patients enrolled in studies of alternative
arthritis treatments are small. Since these small studies show many
positive outcomes, it is worth asking why they have not been followed
up with larger studies. Are our doctors as hopeless about arthritis as
Several studies show that
acupuncture can help reduce pain. In one study, a group of 42 patients
with osteoarthritic knees were randomised into two groups: either
acupuncture (group A) or no treatment (group B). After nine weeks,
those receiving no treatment were treated with acupuncture as well.
Investigators who were 'blind' as to which individuals belonged to
which group concluded that, in the treatment group, there was a
significant reduction in pain, analgesic consumption and most other
objective measures. When groups A and B were combined, there was an 80
per cent subjective improvement, including a significantly increased
knee-range movement, even in the most immobile knees. Those who had not
been ill for a long time showed the greatest improvement - emphasising
the need for early treatment - and improvements were maintained over
time (Acta Anaesthesiol Scand, 1992; 36: 519-25). Another study showed
that acupuncture is at least as effective as diazepam for relieving the
pain of osteoarthritis (Am J Chin Med, 1991; 19(2): 95-100).
results were found in one study of patients with fibromyalgia (G Ital
Riflessot Agopunt, 1995; 7(2): 33-7), although results have been mixed.
In one study, 40 patients with osteoarthritis were randomly assigned to
two groups. One received acupuncture at genuine points, the other at
placebo points. Both groups showed improvement in tenderness and the
subjective assessment of pain (N Engl J Med, 1975; 293: 375-8). This
finding has been repeated elsewhere (Z Physiother, 1990; 42: 375-8),
although some analysts remain sceptical (J Clin Epidemiol, 1990;
the Codetron machine has also been shown to be highly beneficial
(Acupunct Electrother Res, 1992; 17: 95-105) and as equally effective
as other forms of acupuncture (Pain Clin, 1991; 4: 155-61), though less
effective than Transcutaneous Electronic Nerve Stimulation (TENS)
(Altern Ther Clin Pract, 1996; 3: 33-5).
A group of 70 patients
with fibromyalgia was randomised to receive either electroacupuncture
treatment or a sham procedure. Outcome parameters were pain threshold,
analgesic use, regional pain scores, pain recorded on a visual analogue
scale, sleep quality and morning stiffness, and also by the assessment
of the patients themselves and evaluating physicians. In the treatment
group, seven of the eight outcome parameters showed a significant
improvement, whereas none of the patients in the sham group showed any
improvement (BMJ, 1992; 305: 1249-52).
In another double-blind
placebo-controlled trial, patients suffering from pain due to
osteoarthritis of the hip and knee received either genuine Codetron
treatment or a sham treatment. Of the Codetron group, 74 per cent
showed improvement in pain levels (as measured by a visual analogue
scale), while only 28 per cent of the sham treatment group showed
improvement (Clin J Pain, 1989; 5: 137-41).
compared mock electroacupuncture with local heat from an infrared gun.
In the treatment group, 75 per cent of patients received significant
pain relief, compared to 31 per cent in the mock treatment group (Acup
Electrother Res, 1981; 6: 277-84).
Mind and body
It is now
recognised that patients' emotional or psychological state may affect
the course and perception of their disease, and that intervention, in
the form of group therapy, may help perceptions of pain (Arthr Rheum,
1986; 29: 1203-9).
The effectiveness of short, intensive
programmes of patient education has been evaluated in several studies.
In one, individuals with ankylosing spondylitis showed improvement in
rates of depression and self-esteem, and severity of the disorder at
three weeks, and this improvement continued until the end of the trial
at six months. The researchers noted, however, that motivating the
patients to continue their home exercise programme past the six-month
mark remained one of the biggest prob-lems (Patient Educ Couns, 1996;
Another study looked at the effect of group
treatment on chronic pain and the emotions linked with it - anger,
anxiety and depression - on a group which included sufferers of
low-back pain, tension headache, rheumatoid arthritis and ankylosing
spondylitis. A cognitive behavioural programme that included components
of relaxation, cognitive restructuring and the promotion of wellbeing
was used, and the effect on the different groups assessed. Subjects
with inflammatory rheumatoid diseases showed improvement on all fronts
(Patient Educ Couns, 1993; 20: 167-75).
Patients with rheumatoid
arthritis may also benefit from a cognitive behavioural programme. In
one 12-month trial, subjects showed greater confidence in using coping
strategies to deal with pain as well as improvements in their emotional
state (Arthr Rheum, 1988; 31: 593-601).
A further randomised
clinical trial to evaluate a psychological treatment and a
social-support programme compared with a control programme of no
treatment showed that psychological intervention produced significant
reductions in pain, anxiety and disease activity post-treatment. The
effect was still detectable at the six-month follow-up. The
social-support programme also showed a reduction in anxiety (Arthr
Rheum, 1987; 30: 1105-14).
One study looked at the efficacy of
several treatments: pain-management education, relaxation training and
visualisation compared with no treatment. Those participating in the
pain management and visualisation groups showed improvements, while
relaxation on its own proved to be little better than no treatment at
The authors noted that patient attitude was important and
that simply attending the groups was not enough. Those who were able to
take on board the methods used and practise them fully showed the
greatest improvement (Zeitschr Klin Psychol Psychopathol Psychother,
1994; 42: 319-38).
Of course what one person finds relaxing,
another might not. One small study supports the idea that we must
choose methods of relaxation carefully. Thirty women with rheumatoid
arthritis were told to relax while listening to music of their choice,
and researchers studied the effect which this had on their perceptions
of pain. The results of the study, based on questionnaires completed
before, during and after listening to music, showed that this kind of
relaxation can be a valid way to help chronic pain (Adv Nurs Sci, 1993;
Hypnotherapy may also be useful. In a controlled
study of patients with fibromyalgia, 40 patients were randomised either
into hypnotherapy or physical therapy groups for 12 weeks. Follow-up
was at 24 weeks. In the hypnotherapy group, the subjective scores of
pain, morning fatigue and sleep patterns all showed improvement, though
objective assessment of the disease progression showed no change (J
Rheumatol, 1991; 18: 72-5).
In another trial, hypnotherapy with
guided images was compared with two control groups - a relaxation group
and a waiting-list group receiving no treatment. Self-assessment during
therapy and at three and six months was used, as were blood tests to
measure erythrocyte sedimentation rates (ESR), C-reactive protein,
haemoglobin and leukocyte levels. The hypnosis group showed a decrease
in joint pain both during and after the therapy period. The relaxation
group also showed a decline in joint pain during therapy, but this
state stabilised at follow-up. The hypnosis group also showed
improvements in ESR (Psychol Beitr, 1994; 36: 205-12).
meta-analysis of trials on massage for relief of symptoms of arthritis
provided some support for the idea that manipulation may help improve
pain and flexibility (Spine, 1985; 10: 833-7), though the results were
Several herbs have proven
anti-inflammatory effects. In an experimental, double-blind, crossover
study, 42 patients with osteoarthritis randomly received a combination
formula, Articulin-F (comprising the stem of Boswellia serrata, Curcuma
longa rhizome, Withania somnifera root and zinc), or a matching placebo
for three months and then, after a 15-day 'wash-out period', the
patients changed places with the other treatment group for a further
period of three months. After three months, those taking the
combination treatment had a significant reduction in pain and
disability. The authors emphasise that this was a subjective assessment
since radiological assessment failed to show any signs of improvement
(J Ethnopharmacol, 1991; 33: 91-5).
An over-the-counter remedy,
Reumalex, has been shown in a double-blind study to have a mild
analgesic effect and thus improve pain for those with chronic symptoms
(Br J Rheumatol, 1996; 35: 874-8).
Devil's claw (Harpagophytum
procumbens) is a herb native to Africa that has a long history in the
treatment of arthritis, and there is some evidence that it may be
useful as an anti-inflammatory (Schweiz Apothek-Zeitung, 1976; 114:
337-42). In one experimental study over 60 days, 86 per cent of
patients noted decreased morning stiffness. Improvement was reported
just eight days on the treatment and gradually improved (J Med
Actuelle, 1985; 12: 65-7). Another study also showed positive results
(J Pharm Belg, 1980; 35: 143-9).
Feverfew (Tanacetum parthenium)
has a long history as a remedy for rheumatoid arthritis. It has been
shown to inhibit the release of blood vessel-dilating substances and to
inhibit the production of inflammatory substances. Most of the
research, however, has been confined to in-vitro (Lancet, October
25,1980) and animal studies (Planta Med, 1992; 58: 117-23; Planta Med,
1993; 59: 20-5). Select the best quality feverfew that you can since
many commercial preparations vary in the amount of parthenolide, the
active component of feverfew, contained within them (J Pharm Pharmacol,
1992; 44: 319-5). In about 10 per cent of individuals, chewing the
leaves can result in small ulcerations of the mouth, and swelling of
the lips and tongue (Can Pharm J, 1989; 122: 266-70).
of Tripterygium wilfordii may also be helpful, but should be used with
caution in children and women of childbearing age since it can lead to
amenorrhoea and impaired spermatogenesis (both of these side-effects
eventually disappear once treatment has stopped). It has been shown
useful in rheumatoid arthritis and ankylosing spondylitis (Chin Med J,
1989; 102: 327-32; J Trad Chin Med, 1983; 3: 125-9).
have been several studies which show a positive effect of homoeopathic
preparations on arthritic conditions. In one trial, patients with
fibromyalgia showed improvement (BMJ, 1989; 299: 365-6).
randomised, controlled trial to evaluate the effectiveness of
homoeopathy in rheumatoid arthritis, 44 patients were assigned either
homoeopathic remedies or placebo. At six months, the treatments were
generally equally effective in most assessments, with those taking
homoeopathic remedies reporting slightly better results (Scand J
Rheumatol, 1991; 20: 204-8).
In another double-blind trial, 23
patients with rheumatoid arthritis took first-line anti-inflammatory
treatment plus homoeopathy, while a similar group of 23 took first-line
anti-inflammatory treatment plus placebo. There was a significant
improvement in subjective pain, stiffness and grip strength in the
homoeopathy group, and perhaps most important, there were no
side-effects observed (Br Homeop J, 1986; 75: 148-57).
homoeopathic preparation Rheumaselect was tested on patients with
rheumatoid arthritis against a placebo over a 12-week period in a
randomised double-blind, controlled trial. Although both groups
improved, the improvement was more marked in the Rheumaselect group
(Erzt Akt Rheumatol, 1991; 16: 1-9).
Movement and exercise
has been shown to be effective in a randomised trial to improve pain,
strength, motion, joint circumference, tenderness and hand function in
patients with osteoarthritis (J Rheum, 1994; 21: 2341-3).
another controlled study of the effect of Tai Chi as opposed to a
traditional exercise programme, the Tai Chi group showed a greater
range of motion, better rest and greater enjoyment of daily activities
than those in the traditional exercise group. These results were
maintained at the four-month, post-trial follow-up (Am J Occup Ther,
1987; 41: 90-5). These results are interesting because analysis showed
that, although the traditional exercise group exercised more
frequently, they seemed to gain less benefit from it.
study, aerobic exercise was compared with stress management and
treatment-as-usual for those with fibromyalgia (Scand J Rheumatol,
1996; 25: 77-86). Those who engaged in aerobic exercise showed the
greatest improvement in pain levels, sleep patterns and feelings of
depression as well as increased energy. The authors expressed surprise
at this conclusion since the subjects in the aerobic exercise group
were the most sceptical about exercise as a form of treatment. Yet, at
the four-year follow-up, the aerobic group was the one most likely to
have carried on using exercise as a form of treatment.
difference between hydrotherapy in a mineral bath and hydrotherapy in a
normal hospital exercise bath was evaluated in one study. The
researchers concluded that morning stiffness was significantly improved
in both groups, though objective measures such as ESR rate showed no
improvement (Ned Tijdschr Geneesk, 1992; 136: 173-6).
baths and mud pack treatments singly or in combination have been shown
to improve symptoms of rheumatoid arthritis in a controlled randomised
trial over two weeks. Patients had daily treatment and the improvements
lasted for up to three months (Ann Rheum Dis, 1990; 49: 99-102).
another trial, the efficacy of Dead Sea bath salts used in a warm bath
were assessed in a double-blind study. One group received genuine Dead
Sea bath salts, the other simple table salt. Each group had a daily
bath for two weeks. The Dead Sea salt bath group showed a significant
improvement over the table salt group, and the effects lasted for up to
one month after the end of the treatment period (Clin Exp Rheumatol,
1990; 8(4): 353-7).
There is, as yet, no 'cure' for arthritis.
What the evidence shows us is that many alternative methods for
relieving the symptoms, both physical and emotional, of arthritis can
be at least as effective as conventional therapy and that these methods
carry with them the promise of fewer debilitating side-effects.
Perhaps, as with any chronic disease, the individual's belief that one
system or another is right for them is the most potent factor in
Conventional medicine has yet to answer this question
convincingly, which is why controlling symptoms is the best it has to
offer most patients. Dr John Mansfield takes a different line from some
other practitioners and does not believe that arthritis is caused by a
virus nor, he says, is it an autoimmune disease. Instead, he believes
that the body is reacting against allergens and not against itself.
is still controversial to some to suggest that arthritis may be linked
to food allergy, the environment or even nutrition. And yet it is in
these areas where alternative practitioners are having the greatest
successes in effecting cures.
Arthritis is a multifactorial
disease, and its causes can vary a great deal from one patient to
another. A programme which involves dietary and environmental changes
along with one or more of the alternative therapies outlined in the
main article may show the greatest positive effect.
In his book
Arthritis: Allergy, Environment and Nutrition (Thorsons, £6.99), Dr
Mansfield outlines case studies from his own practice at the Burghwood
Clinic in Banstead, Surrey, where he specialises in allergy and
nutrition, as well as from the growing body of evidence showing
nutritional and environmental links with arthritis.
some arthritis sufferers with simple food allergies are helped by
simple dietary manipulation. Those who do not respond to minor changes
may have more complex food allergies, which are further complicated by
inhaled allergens of ingested chemicals. Dr Mansfield cites the
evidence, from both the UK and the US, of arthritis patients who
entered environmental control clinics (totally allergy-free
environments) and who, after a few days of fasting and despite the
absence of medication, lost most and sometimes all of their arthritis
symptoms. Those who do not respond are long-term sufferers whose joints
have been irreversibly damaged. Were our physicians to work in such
clinics, he concludes, they 'could hardly fail to conclude that
arthritis is a condition in which food and environmental factors play a
What's more, Mansfield is confident that 'the vast
majority of people do not need the attention of an environmental
control unit and its attendant expense. They can normally be helped by
attending an outpatient clinic specialising in this approach. In-depth
history taking will often yield clues as to whether the problems are
related to food, chemicals, inhaled allergens or nutrients.'
time to consider nutritional and environmental causes is early on in
the disease, and before your body has become battered and compromised
by years of taking NSAIDs and potent cortisone-derived drugs, concludes
There is no single dietary change which will help all arthritis
sufferers and, even if an individual is allergic to certain foods, this
may not always be linked to a worsening of arthritis symptoms (Clin Exp
Rheum, 1995; 13: 167-72). Unfortunately, because conventional medicine
has mostly ignored any links between diet and arthritis, research has
been confined mostly to smallish studies and the work of dedicated
practitioners like Dr Mansfield. Although the point continues to be
debated by many doctors and researchers, it has been known for some
time that altering the diet can help alleviate arthritic symptoms
(Lancet, 1986; i: 236-8).
* Fasting and diet changes. Dr Jens
Kneldsen-Kragh and his colleagues as the University of Oslo have led
the way with some excellent studies into arthritis and diet. They have
found that there may be benefits from a short fast followed by dietary
changes (Lancet, 1991; 338: 899-902; Scand J Rheumatol, 1995; 24:
85-93). Like all 'cures', patient belief in a system of dietary change
can influence its success and how well an individual sticks to the
regime (Br J Rheumatol, 1994; 33: 569-75). In one two-year study,
clinical improvement was noted in sufferers of rheumatoid arthritis
after they fasted and then embarked on an individually adjusted
vegetarian diet for a year. Follow-up one year after the trial showed
that the benefits remained for those who had stuck to the vegetarian
diet (Clin Rheumatol, 1994; 13: 475-82).
* Eliminate allergens.
The most common allergens are dairy, soya, wheat and the nightshade
family (potatoes, peppers, tomatoes and tobacco). In one study of 5000
arthritis patients, 70 per cent reported gradually increasing relief
after the elimination of nightshades (J Int Acad Prev Med, November
1982). It may be worth having a specialist arrange for food allergy
One of the biggest-ever trials of diet took place in three
environmental control units in the US. The first arm involved a
water-only fast of six days, at the end of which improvements were
reported in the vast majority of cases. The second revealed that
patients reacted more frequently to wheat, corn and animal proteins
than fruit or vegetables. A third revealed by first introducing organic
foods, then commercially prepared foods, that chemical sensitivity was
also linked to arthritic symptoms (J Clin Ecol, II: 137-45; J Clin
Ecol, II: 181-9).
* Increase B vitamins. Both B5 (pantothenic
acid) and B3 (niacinamide) have been shown to be beneficial at doses of
25 mg. They should be taken within a balanced B-complex supplement and
should not be taken at night. Niacinamide has been shown to reduce
inflammation and increase joint flexibility, and may help sufferers
reduce the amount of first-line anti-inflammatories they need to take
(Imflam Res, 1996; 45: 330-4). In addition, for those on methotrexate,
folic acid supplements have been shown to reduce the toxicity of this
powerful drug (Arth Rheum, 1990; 33: 9-18).
* More oils for
healthy joints. Omega-3 fatty acids may help to reduce morning
stiffness (J Rheumatol, 1992; 19: 1531-6), as can a diet which is high
in polyunsaturated fats and low in saturated fat (Lancet, 1985; i:
184-7). Blackcurrant seed oil, rich in gamma-linolenic acid (GLA) and
alpha-linolenic acid (ALA), can help alleviate inflammation in patients
with rheumatoid arthritis (Br J Rheumatol, 1994; 33: 847-52). But the
problem is that sufferers need to take several large capsules a day of
whatever supplement they choose, and this puts some off the regime.
Other nutrients. Selenium-ACE failed to show significant efficacy over
placebo at three or six months in one trial (Br J Rheumatol, 1990; 29:
211-3). Nevertheless, the Institute of Optimum Nutrition recommends
that arthritis sufferers should consider taking combined antioxidants
vitamins C, E and selenium. Daily doses of vitamin C can be as high as
3000 mg, and 400 IU of vitamin E and 200 mcg of selenium could also be
taken every day for optimum effect, the Institute recommends.