Complementary and Alternative Medicine in the Treatment of Rheumatoid Arthritis

Abstract

Treatment of rheumatoid arthritis, a systemic, diverse and dynamic disorder, has made major progress over the past few decades. Early active treatment with disease-modifying anti-rheumatic drugs and biological agents can be highly beneficial for controlling inflammatory activity and preventing disability in many patients. However, the most effective new drugs are expensive and many patients with rheumatoid arthritis continue to have significant pain, restricted mobility, reduced muscle strength and low endurance. In addition, it is increasingly recognized that co-morbid conditions play a pivotal role in rheumatoid arthritis outcomes. For example, cardiovascular complications are the leading contributor to mortality in rheumatoid arthritis, accounting for approximately one half of all deaths. Osteoporosis, resulting in bone fractures, also represents a major source of morbidity in rheumatoid arthritis. Complementary and alternative medicine treatment and lifestyle behavioral modification may play a role in preventing rheumatoid arthritisassociated comorbidities and their complications. Rheumatoid arthritis is characterized by synovial inflammation that leads to joint destruction, resulting in substantial long-term disability and a significantly shorter life expectancy. Many patients with rheumatoid arthritis experience high levels of pain, functional impairment, psychological distress and negative emotions, but these symptoms have limited pharmacological therapeutic options. Given the complexity of the therapeutic armamentarium used in rheumatoid arthritis, non-pharmacological therapies are increasingly attractive to those with chronic rheumatic pain conditions. Recently, complementary and alternative medicine therapies for arthritis have been heavily advertised and increasing numbers of chronic pain patients report utilizing alternative therapies. At the same time, clinical trials and observational studies have provided encouraging evidence that Acupuncture, Mind-body Therapy, Chinese herbs and Tibetan Medicine have some benefits for patients with rheumatoid arthritis. Indeed, integrative approaches combine the best of conventional medicine and the wisdom of complementary and alternative medicine. Thus, this chapter synthesizes the current body of knowledge on the therapeutic benefits of several types of Complementary and Alternative Medicine on pain and symptom relief in patients with rheumatoid arthritis to better inform clinical decision-making for our patients.