: Further research is needed before acupuncture can be recommended for the treatment of rheumatoid arthritis.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
: Alpinia, also known as Chinese ginger, has been studied in combination with another ginger species for the treatment of osteoarthritis. Although alpinia shows promise for the reduction in knee pain, more studies using alpinia alone would strengthen the evidence for this indication.
- Avoid if allergic/hypersensitive to alpinia, ginger, or other members of the Zingiberaceae family. Use cautiously with diabetes or if taking hypoglycemic agents. Use cautiously with electrolyte imbalance and low blood pressure. Avoid if pregnant or breastfeeding.
: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled or applied to the skin. Essential oils are usually mixed with a carrier oil (usually a vegetable oil) or alcohol. There is not enough scientific evidence to determine if aromatherapy improves wellbeing in arthritis patients.
- Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if driving/operating heavy machinery. Use cautiously if pregnant.
: Arnica (Arnica montana) gel has been used on the skin for osteoarthritis pain and stiffness, due to its anti-inflammatory constituents. Although early study is promising, additional study is needed.
- Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds, or any related plants like daisies, ragweed, or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.
: The use of ash as an herbal remedy can be traced to Native Americans and the early settlers of the Americas. Ash has been historically noted for its anti-inflammatory and pain-relieving properties. There is currently little scientific evidence currently available to support its use for gouty arthritis. Future randomized, placebo controlled studies are necessary to confirm these initial results.
- Avoid if allergic or hypersensitive to ash (Fraxinus species), its constituents, or to members of the Oleaceae family. Reviews note ash pollen allergic cross-reactivities with pollen from the Fagales order (birch, alder, hazel, hornbeam, oak, and chestnut), Scrophulariales order (olive, ash, plantain, privet, and lilac), Coniferales order (cedar, cypress, and pine), and fruits and vegetables. Use cautiously if sensitive to anticoagulants (blood thinners). Use cautiously if susceptible to hypouricemia (condition where the level of uric acid is below a certain threshold), including but not limited to hyperthyroidism, inflamed kidneys, multiple sclerosis, and Fanconi syndrome. Avoid if immunocompromised. Avoid if pregnant or breastfeeding.
: The use of ashwagandha in osteoarthritis has been suggested based on its reported anti-inflammatory and anti-arthritic properties. Well-designed human research is needed in this area.
- Avoid if allergic or hypersensitive to ashwagandha. Dermatitis (allergic skin rash) has been reported.
There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used.
Avoid with peptic ulcer disease. Ashwagandha may cause abortion based on anecdotal reports. Avoid if pregnant or breastfeeding.
: More well-designed clinical trials are necessary before astaxanthin can be recommended for the treatment of rheumatoid arthritis.
- Avoid if allergic/hypersensitive to astaxanthin, related carotenoids, or astaxanthin algal sources. Use cautiously if taking 5-alpha-reductase inihibitors, hypertensive agents, asthma medications, cytochrome P450 metabolized agents, menopause agents or oral contraception, or Helicobacter pylori agents. Use cautiously with hypertension, parathyroid disorders, and osteoporosis. Avoid with hormone-sensitive conditions, immune disorders, or if taking immunosuppressive therapies. Avoid with previous experience of visual changes while taking astaxanthin and with low eosinophil levels. Avoid if pregnant or breastfeeding.
: There is some evidence that a traditional Ayurvedic herbal formula RA-1 may reduce joint swelling but not other symptoms in rheumatoid arthritis. RA-1 contains Withania somnifera (ashwagandha), Boswellia serrata (gugulla), Zingiberis officinale (ginger) and Curcuma longa (turmeric). A resin that is extracted from Boswellia serrata (H15, indish incense) is regarded in Ayurvedic medicine as having anti-inflammatory properties. However, evidence from one study showed no benefit in patients with rheumatoid arthritis. More studies are needed to determine efficacy of these treatments for rheumatoid arthritis.
- There is early evidence that an Ayurvedic formula containing roots of Withania somnifera, the stem of Boswellia serrata, rhizomes of Curcuma longa, and a zinc complex (Articulin-F®) may significantly improve symptoms of osteoarthritis. Other research suggests that taking guggul (Commiphora mukul) daily as a powder capsule supplement may reduce pain and improve functioning in OA. Further research is needed before a recommendation can be made.
- Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking.
- Beta carotene
: Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Beta-carotene supplementation does not appear to prevent osteoarthritis, but it may slow progression of the disease. Well-designed clinical trials are needed before a conclusion can be drawn.
- Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
- Beta sitosterol
: Beta-sitosterol and beta-sitosterol glucoside have been observed to lower blood levels of IL-6 and, therefore, have been studied as a treatment for rheumatoid arthritis. Larger populations of patients with rheumatoid arthritis should be evaluated in well-conducted clinical study if conclusions are to be made.
- Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinsonism or Alzheimer’s disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
- Black cohosh
: There is not enough human research to make a clear recommendation regarding the use of black cohosh for rheumatoid arthritis pain.
- Use cautiously if allergic to members of the Ranunculaceae
family such as buttercups or crowfoot. Avoid with hormone conditions (breast cancer, ovarian cancer, uterine cancer, endometriosis). Avoid if allergic to aspirin products, non-steriodal anti-inflammatories (NSAIDs, Motrin®, ibuprofen, etc.), blood-thinners (like warfarin) or with a history of blood clots, stroke, seizures, or liver disease. Stop use before surgery/dental/diagnostic procedures with bleeding risk and avoid immediately after these procedures. Avoid if pregnant or breastfeeding.
- Black currant
: Early study shows promise for the use of black currant seed oil in reducing the signs and symptoms of rheumatoid arthritis. However, additional study is needed to confirm these findings.
- Avoid if allergic or hypersensitive to black currant, its constituents, or plants in the Saxifragaceae family. Avoid in patients with hemophilia or those on blood thinners unless otherwise recommended by a qualified healthcare provider. Use cautiously with venous disorders or gastrointestinal disorders. Use cautiously if taking MAOIs (antidepressants) or vitamin C supplements. Avoid if pregnant or breastfeeding.
: Boron is a trace element, which is found throughout the global environment. Based on human population research, individuals who eat foods rich in boron (including green vegetables, fruits, and nuts) appear to have fewer joint disorders. It has also been proposed that boron deficiency may contribute to the development of osteoarthritis. However, there is a lack of human evidence that supplementation with boron is beneficial as prevention against or as a treatment for osteoarthritis.
- Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, chronic obstructive pulmonary disease (COPD), or hormone-sensitive conditions (e.g., breast cancer or prostate cancer). Avoid if pregnant or breastfeeding.
: Boswellia has been noted in animal and laboratory studies to possess anti-inflammatory properties. Based on these observations, boswellia has been suggested as a potential treatment for rheumatoid arthritis and osteoarthritis. However, data is conflicting, and combination products were used in some studies. Therefore, there is currently insufficient evidence to recommend for or against the use of boswellia for rheumatoid arthritis.
- Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble medications, agents metabolized by the liver’s cytochrome P450 enzymes, or sedatives. Use cautiously with impaired liver function or liver damage or lung disorders. Use cautiously in children. Avoid if pregnant due to potential abortifacient effects or if breastfeeding.
- Bowen therapy
: Bowen therapy is a technique that involves gentle but precise soft tissue manipulation. Early research suggests that Bowen therapy may improve the range of motion in patients with frozen shoulder.
- Bowen therapy is generally believed to be safe in most people. However, safety has not been thoroughly studied. Bowen therapy should not be used for severe conditions or in place of more proven treatments. Use cautiously in patients with cancer or in those who are undergoing surgery.
: Results of a study found a combination supplement called ERC (enzyme-rutosid combination -rutosid, bromelain, trypsin) may be considered as an effective and safe alternative to prescription anti-inflammatory drugs (NSAIDs), such as diclofenac, in the treatment of knee pain associated with osteoarthritis. Further well-designed clinical trials of bromelain alone are needed to confirm these results. Bromelain also cannot be recommended for the treatment of rheumatoid arthritis until further research is conducted.
- Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceae
family. Use cautiously with history of a bleeding disorder, stomach ulcers, heart disease, or liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
- Cat’s claw
: Several laboratory and animal studies suggest that cat’s claw may reduce inflammation, and this has led to research of cat’s claw for conditions such as rheumatoid arthritis. Early research also suggests that cat’s claw may reduce pain from osteoarthritis of the knee. Large, high-quality human studies are needed before a conclusion can be drawn.
- Avoid if allergic to cat’s claw, Uncaria plants, or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system. Use cautiously with bleeding disorders or with a history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Cat’s claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic Texan grown plant, Acacia gregii, being substituted for cat’s claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Further research is needed to determine if chiropractic therapy is an effective treatment for hip pain or osteoarthritis.
- Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers.
: Diets high in chlorophyll have been hypothesized to modify intestinal flora resulting in improved management of immune disorders including rheumatoid arthritis. More evidence is needed to support the use of chlorophyll in autoimmune diseases.
- Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
: The use of copper bracelets in the treatment of arthritis has a long history of traditional use, with many anecdotal reports of effectiveness. There are research reports suggesting that copper salicylate may reduce arthritis symptoms more effectively than either copper or aspirin alone. Further study is needed before a recommendation can be made.
- Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson’s disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.
: Preliminary evidence suggests that DHEA (dehydroepiandrosterone) may not offer benefit to individuals with rheumatoid arthritis. Further research is needed in this area.
- Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
- DMSO (dimethyl sulfoxide)
: Applying DMSO to the skin may help treat rheumatoid arthritis. More research is needed before a conclusion can be drawn.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Dong quai
: Dong Quai (Angelica sinensis), also known as Chinese angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. Dong quai is traditionally used to treat arthritis. However, there is insufficient reliable human evidence to recommend the use of Dong quai alone or in combination with other herbs for osteoarthritis or rheumatoid arthritis.
- Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is unknown. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Avoid before dental or surgical procedures. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Avoid if pregnant or breastfeeding.
- Eucalyptus oil
: Aromatherapy using eucalyptus has been studied for its effects on pain, depression, and feelings of satisfaction in life in arthritis patients. Aromatherapy may help reduce pain and depression, but does not appear to alter the feeling of satisfaction in life. Additional study is needed to clarify these findings.
- Avoid if allergic to eucalyptus oil or with a history of seizures, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Avoid with a history of acute intermittent porphyria. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Evening primrose oil
: Benefits of evening primrose oil in the treatment of rheumatoid arthritis have not clearly been shown. More research is needed before a conclusion can be made.
- Avoid if allergic to plants in the Onagraceae family (willow’s herb, enchanter’s nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
: There is currently not enough evidence to support the use of feverfew for rheumatoid arthritis. Further research is warranted.
- Avoid if allergic to feverfew and other plants of the Compositae
family (chrysanthemums, daisies, marigolds, ragweed). Stop use prior to surgery and dental or diagnostic procedures. Avoid with drugs that increase bleeding risk. Avoid stopping feverfew use all at once. Avoid if history of heart disease, anxiety or bleeding disorders. Caution is advised with a history of mental illness, depression and headaches. Avoid if pregnant or breastfeeding.
- Gamma linolenic acid (GLA)
: Several clinical studies indicate significant therapeutic improvements in rheumatoid arthritis symptoms with use of gamma linolenic acid (GLA).
Additional study is needed before a conclusion can be made.
- Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
: Well-designed clinical trials are necessary before ginger can be recommended for the treatment of rheumatoid arthritis or osteoarthritis.
- Avoid if allergic to ginger or other members of the Zingiberaceae
family. Avoid with anticoagulation therapy. Avoid large quantities of fresh cut ginger with inflammatory bowel disease or a history of intestinal obstruction. Use cautiously prior to surgery and with gastric or duodenal ulcers, gallstones, cardiovascular disease, and diabetes. Use cautiously long-term and in underweight patients. Use cautiously if taking heart medications or sedatives and if driving or operating heavy machinery. Use cautiously if pregnant or breastfeeding.
: Preliminary human research reports benefits of glucosamine in the treatment of joint pain and swelling in rheumatoid arthritis patients. However, additional research is needed before a conclusion can be made.
- Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use caution with diabetes or a history of bleeding disorders. Avoid if pregnant or breastfeeding.
- Green lipped mussel
: The green-lipped mussel is native to the New Zealand coast and is a staple in the diet of the indigenous Maori culture. There is conflicting evidence of the effect of green-lipped mussel supplementation for treating osteoarthritis. Reliable evidence is needed to determine whether green-lipped mussel is effective for this use.
- Green-lipped mussel is generally considered safe. Avoid with allergy or sensitivity to green-lipped mussel or other shellfish. Avoid with liver disease. Use cautiously with anti-inflammatory agents. Use cautiously with asthma. Avoid if pregnant or breastfeeding.
- Green tea
: Green tea is made from the dried leaves of Camellia sinensis, an evergreen shrub. Research indicates that green tea may benefit arthritis by reducing inflammation and slowing cartilage breakdown. Further studies are required before a recommendation can be made.
- Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.
: There is currently insufficient evidence to support the use of guggul or guggul derivatives for the management of rheumatoid arthritis or osteoarthritis.
- Avoid if allergic to guggul. Avoid with a history of thyroid disorders, anorexia, bulimia, or bleeding disorders. Signs of allergy to guggul may include itching and shortness of breath.
Avoid if pregnant or breastfeeding.
- Guided imagery
: Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with osteoarthritis or juvenile rheumatoid arthritis. Further research is needed to confirm these results.
- Guided imagery is usually intended to supplement medical care, not to replace it, and should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. Speak with a qualified health care provider before practicing guided imagery if feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse.
: Early clinical research suggests that a combination formula containing hops may help reduce symptoms of rheumatic diseases. However, well-designed human trials using hops alone are needed to determine if these positive effects are specifically the result of hops.
- Avoid if allergic to hops, its constituents, members of the Cannabaceae family, peanuts, chestnuts, or bananas. Use cautiously if driving or operating heavy machinery. Use cautiously with hormone-sensitive conditions (e.g. breast cancer, uterine cancer, cervical cancer, prostate cancer, or endometriosis) and diabetes. Use cautiously if taking hormonal agents (e.g. contraceptives or fertility agents). Use cautiously if pregnant or breastfeeding; some hops preparations contain high levels of alcohol and should be avoided during pregnancy.
: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. Historically, hydrotherapy has been used to treat symptoms related to rheumatoid arthritis and osteoarthritis. Multiple studies have been published, largely based on therapy given at Dead Sea spa sites in Israel. Although most studies report benefits in pain, range of motion, or muscle strength, due to design flaws, there is not enough reliable evidence to draw a firm conclusion.
- Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud’s disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
: Although multiple trials report diminished pain levels or requirements for pain-relieving medications after hypnotherapy, there is limited research for rheumatoid arthritis pain specifically. Other signs of rheumatoid arthritis, such as joint mobility or blood tests for rheumatoid factor, have not been adequately assessed.
- Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
: Early human studies have found conflicting results on the use of massage with lavender aromatherapy for rheumatoid arthritis pain. More research is needed to make a conclusion.
- Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia) or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
- Magnet therapy
: Initial evidence has failed to show improvements in pain from rheumatoid arthritis or osteoarthritis with the use of magnet therapy. However, due to methodological weaknesses of this research, the conclusions cannot be considered definitive.
- Avoid with implantable medical devices like heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
: Massage may be of benefit for rheumatoid arthritis, but there is currently not enough scientific data on which to base a strong conclusion for this indication.
- Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. According to a retrospective case study, mistletoe injections may help manage arthritis. Further research is needed before a firm conclusion can be made.
- Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening, shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking cholinergics.
: There is preliminary evidence suggesting that patients suffering from rheumatoid arthritis may experience improved immune function as a result of acupuncture and moxibustion. However, evidence is insufficient at this time for making conclusions.
- Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of “heat syndrome,” cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, over allergic skin conditions or ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or if taking a hot bath or shower. Caution with elderly people with large vessels. It is advised to not bathe or shower for up to 24 hours after a moxibustion treatment.
: Methylsulfonylmethane, or MSM, is a form of organic sulfur that occurs naturally in a variety of fruits, vegetables, grains, and animals. MSM is a normal oxidation product of dimethyl sulfoxide (DMSO). Preliminary study has used MSM, alone or in combination with glucosamine, in the treatment of osteoarthritis. The combination may provide pain relief and reduction in inflammation. Further studies on MSM and its effects on patients with osteoarthritis are warranted.
- Avoid if allergic or hypersensitive to MSM. Long-term effects of supplementation with MSM are unknown. Avoid if pregnant or breastfeeding.
: Vitamin B3 is made up of niacin (nicotinic acid) and its amide, niacinamide, and can be found in many foods, including yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Preliminary human studies suggest that niacinamide may be useful in the treatment of osteoarthritis. Further research is needed.
- Avoid niacin/vitamin B3 if allergic to niacin or niacinamide. Avoid with a history of liver disease or dysfunction, irregular heartbeats, heart disease, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
- Pantothenic acid (vitamin B5)
: It has been reported that pantothenic acid levels are lower in the blood of rheumatoid arthritis patients than healthy individuals. However, it is not clear if this is a cause, effect or a beneficial adaptive reaction. There is currently insufficient scientific evidence in this area in order to form a clear conclusion.
- Pantothenic acid has also been suggested as a possible treatment for osteoarthritis. However, further research is needed to determine whether or not this treatment is effective.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
: Review study found that proteolytic enzymes, including papain, may reduce pain and inflammation in rheumatic disorders. Additional research is needed to confirm these results.
- Use cautiously in patients sensitive to papain, being treated for prostatitis, with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease or in those using immunosuppressive therapy.
: Peony’s anti-inflammatory effects may benefit patients with rheumatoid arthritis. However, there is currently not enough evidence for or against this use of peony.
- Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
- Physical therapy
: Several studies have indicated that treatment of rheumatoid arthritis with physical therapy may help improve morning stiffness and grip strength. Some experts have suggested a long-term, high-intensity exercise program. Beneficial effects may last up to one year. Despite promising early evidence, better-designed studies are needed to draw a firm conclusion. More research is also needed to determine if physical therapy is an effective treatment for frozen shoulder, hip pain, joint problems (including rotator cuff and sacroiliac joint dysfunction), or osteoarthritis.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
: Preliminary research suggests that podophyllum may be helpful for rheumatoid arthritis. Research is limited due to the possible adverse effects like severe diarrhea associated with oral podophyllum. Additional research is needed before a firm conclusion can be drawn.
- Avoid if allergic/hypersensitive to podophyllum or to members of the Berberidaceae family. Podophyllum, when applied topically, may be absorbed through the skin and cause irritation of the stomach and intestines. Podophyllum toxicity may cause heart palpitations and blood pressure changes, muscle paralysis, difficulty walking, confusion, and convulsions. Using podophyllum and laxatives may result in dehydration and electrolyte depletion. Use cautiously with arrhythmia, Crohn’s disease, cardiovascular problems, gallbladder disease or gallstones, high blood pressure, irritable bowel syndrome, liver insufficiency, muscular, and neurologic disorders, psychosis, or kidney insufficiency. Use cautiously if taking antimiotic agents like vincristine, anti-psychotic agents, or laxatives. Avoid if pregnant or breastfeeding.
- Prayer, distant healing
: Initial research suggests that in-person intercessory prayer (praying by others in the presence of patients) may reduce pain, fatigue, tenderness, swelling and weakness in rheumatoid arthritis when it is used in addition to standard care. Better quality research is necessary before a firm conclusion can be drawn.
- Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers. Based on limited clinical study, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.
: In limited study, Lactobacillus GG was associated with improved subjective well-being, as well as reduced symptoms of rheumatoid arthritis. However, these findings were not statistically significant. More studies on the effects of probiotics in rheumatoid arthritis are needed.
- Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
: Based on anti-inflammatory action observed in laboratory research, propolis has been proposed as a possible treatment for rheumatic diseases. However, there is currently not enough scientific human study to make a conclusion.
- Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, and Balsam of Peru. Severe allergic reactions have been reported. Use cautiously with asthma or gastrointestinal disorders. Avoid if pregnant or breastfeeding because of the high alcohol content in some propolis products.
- Reishi mushroom
: A combination of reishi mushroom and San Miao San (a mixture of several Chinese herbs) may help reduce the pain of rheumatoid arthritis. However, these herbs did not reduce swelling. More research with reishi mushroom alone is needed.
- Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Avoid if pregnant or breastfeeding.
- Relaxation therapy
: Limited preliminary research reports that muscle relaxation training may improve function and well being in patients with rheumatoid arthritis. Additional research is necessary before a conclusion can be reached.
- In a randomized study of patients with osteoarthritis pain, Jacobson relaxation was reported to lower the level of subjective pain over time. The study concluded that relaxation might be effective in reducing the amount of analgesic medication taken by participants. Further well-designed research is needed to confirm these results.
- Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.
: Selenium supplementation has been studied in rheumatoid arthritis patients with mixed results. Additional research is necessary before a clear conclusion can be drawn.
- Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
- Shark cartilage
: Chondroitin sulfate, a component of shark cartilage, has been shown to benefit patients with osteoarthritis. However, the concentrations of chondroitin in shark cartilage products may be too small to be helpful. The ability of shark cartilage to block new blood vessel growth or reduce inflammation is suggested to be helpful in rheumatoid arthritis. However, there is limited research in these areas, and more studies are needed before a recommendation can be made.
- Avoid if allergic to shark cartilage or any of its ingredients (including chondroitin sulfate and glucosamine). Use cautiously with sulfur allergy. Avoid with a history of heart attack, vascular disease, heart rhythm abnormalities (arrhythmias) or heart disease. Use cautiously with a history of liver or kidney disorders, tendency to form kidney stones, breast cancer, prostate cancer, multiple myeloma, breathing disorders (like asthma), cancers that raise calcium levels (like breast, prostate, multiple myeloma or squamous cell lung cancer) and diabetes. Avoid if pregnant or breastfeeding.
: It is unclear if soy is an effective treatment for rheumatoid arthritis or osteoarthritis. Additional research is warranted in this area.
- Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow’s milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplements.
- Spiritual healing
: There is currently not enough evidence that spiritual healing adds any benefit to conventional treatment in rheumatoid arthritis. Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
- Stinging nettle
: Stinging nettle is widely used as a folk remedy to treat arthritis and rheumatic conditions throughout Europe and Australia. Pre-clinical evidence suggests that certain constituents in the nettle plant have anti-inflammatory and/or immunomodulatory activity and may be of benefit in rheumatoid arthritis. Well-designed, randomized controlled trials are needed to further support its use in humans.
- Avoid if allergic or hypersensitive to nettle, members of the Urticaceae family, or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
- Tai chi
: There is not enough scientific evidence showing that tai chi reduces rheumatoid arthritis symptoms, although tai chi may help improve range of motion of the lower extremities. A small trial in women with osteoarthritis reported that treatment with tai chi significantly decreased pain and stiffness compared with a sedentary lifestyle. Women in the tai chi group also reported fewer perceptions of difficulties in physical functioning. More research is needed in this area.
- Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
- TENS (Transcutaneous Electrical Nerve Stimulation)
: Preliminary studies of TENS in rheumatoid arthritis report improvements in joint function and pain. However, most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Thymus extract
: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Thymus extract is commonly used to treat primary immunodeficiencies, bone marrow failure, autoimmune disorders, chronic skin diseases, recurrent viral and bacterial infections, hepatitis, allergies, chemotherapy side effects, and cancer. Further research is needed to determine whether or not thymus extract can effectively treat symptoms of rheumatoid arthritis.
- Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to the potential for exposure to the virus that causes “mad cow disease.” Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking hormonal therapy or immunosuppressants. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
: Turmeric has been used historically to treat rheumatoid arthritis and osteoarthritis. Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin, however, reliable human research is lacking.
- Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
: The majority of trials do not show significant improvements in rheumatoid arthritis symptoms following zinc treatment. Interpretation of some data is difficult because patients in the studies were permitted to continue their previous arthritis medication and most studies used a small number of participants. Well-designed clinical trials are needed before a definitive conclusion can be made.
- Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.