Rheumatoid arthritis (RA) is a chronic systemic disease characterized by autoimmune inflammation in many parts of the body, including the joints. It causes pain and disability, and treatment typically continues lifelong, though there is no reliable way to predict control.
Rheumatoid arthritis fingers. Image Credit: Karen Amundson / Shutterstock
Apart from the pain and functional consequences, RA is often linked to cardiovascular disease, depression, muscle wasting, and visual impairment. As a result, claims for a cure by alternative therapies have abounded over the decades, from magic charms to little-known ancient Chinese plants.
Fish oil is the most commonly taken supplement for RA, and it certainly does supply omega-3 fatty acids, which are not found in adequate levels in the Western diet. These are anti-inflammatory in their effects. Fish oil may favorably affect RA symptoms and progression, especially concerning joint tenderness, morning stiffness, and the reduced need for non-steroidal anti-inflammatory drugs (NSAIDs). The problem is to differentiate the real impact of the fish oil from that of a placebo.
Fish oil capsules. Image Credit: Scarc / Shutterstock
Very high levels of fish oil can cause reduced clotting tendency in some patients, mainly if they are on other medications that cause blood thinning or if they need surgery. Secondly, as with most herbal supplements, fish oil also is unregulated, and therefore the quality depends entirely on the manufacturing standards. Mercury contamination is an added concern, though this applies more especially to young children and pregnant mothers.
Borage, evening primrose and blackcurrant seeds or oil
The seeds of these plants contain gamma-linolenic acid (GLA), which is an omega-6 fatty acid. Unlike other fats in this category, this seems to have a pronounced anti-inflammatory action. Cochrane reviews suggest a role for this in RA. The presence of pyrrozolidone alkaloids in borage oil could cause liver damage in high-risk patients. Bleeding risks are similar to those of fish oil supplements. Evening primrose oil could interact with psychiatric drugs like phenothiazines.
Borage (Borago officinalis). Image Credit: BoxyPics / Shutterstock
Turmeric and ginger
Turmeric is a culinary spice with blazing orange-yellow color and a strong smell. It contains the anti-inflammatory compound curcumin, and there is some weak evidence of a positive effect in RA, with improved walking, reduced swelling and morning stiffness. Ginger is a related root spice with a pleasantly sharp smell and taste, and its use has been associated with a reduction in pain in RA patients.
Turmeric Powder and Turmeric root. Image Credit: SMDSS / Shutterstock
Fasting may help relieve some RA symptoms, though the cause is not clear. It may be because some possibly allergenic foods are thereby eliminated from the diet. However, resuming these foods can bring back the symptoms. A few individuals with low blood pressure, for instance, or fluctuating blood sugar levels could react badly to fasting. Therefore medical supervision is mandatory before taking up such a practice.
Elimination diets are restrictive diets from which one food type is removed after the other, in order to detect the sensitivity to any of these foods. If the RA patient does have such sensitivity, elimination can have a good effect on the disease symptoms. It remains to be proved that RA itself is caused or even predisposed to by food allergies or other hypersensitivities.
A vegetarian or vegan diet
Many European researchers have looked at the effect of vegan or vegetarian diets on RA, with or without fasting. Though all people do not tolerate this equally well, meaning that many drop out, those who persist often report lower levels of inflammation, reduced disease activity, and reduced symptoms.
A single randomized trial of this healthy eating pattern showed better clinical and mental health in RA patients, but more evidence is needed.
Camellia sinensis, the plant from which green tea is obtained, is an anti-inflammatory cocktail and may be useful in treating arthritis. Compounds in green tea like epigallocatechin-3-gallate (EGCG) are responsible for this activity.
Green tea leaf. Image Credit: Artphotoclub / Shutterstock
This polyphenol found most famously in red grapes, and red wine is also known to have modulatory effects on inflammation, both systemic and in inflamed joints.
Other plant products like Boswellia serrata, Harpagophytum procumbens, Rosa canina, Uncaria tomentosa, and Urtica dioica, have also been tested for their content of anti-inflammatory compounds which may render them useful in the treatment of RA.
Though acupuncture has been around for a long time, rigorously tested evidence of its beneficial effect in RA is still lacking, beyond the placebo effect. As a result, the practice is still left to the individual patient to decide.
Acupuncture. Image Credit: NiP STUDIO / Shutterstock
Magnetotherapy has been used to complement other medications to relieve the symptoms of RA. Some evidence indicates that certain types of pain are relieved by the use of magnets, but specific evidence for their use in RA will need further research.
This is one area in which a Cochrane review has shown beneficial findings, mostly for morning stiffness and strength of grip, but also some improvement in a group of patients for pain and quality of life. Lack of sufficient power or inadequate data to decide whether the differences found were statistically significant has hindered the wider application of this treatment. Also called balneotherapy, this practice involves the use of mineral baths. It does not include the performance of prescribed exercises or aerobics in a water pool, which is part of modern medical treatment.
There is no evidence that homeopathy produces any more than a placebo effect, and in a few situations, it may be dangerous, as with diabetics.
Tai Chi and Yoga
This exercise modality may improve function, mood, and general vitality, but randomized trials on these parameters are few. Other effects, such as changes in joint swelling and fatigue, were mixed. Yoga as an exercise can perhaps increase grip strength, but other studies are still ongoing, and only preliminary results are available. However, these indicate a better quality of life and a reduction in joint swelling and tenderness.
While natural remedies for RA are a dime a dozen, it is important to note that all are not of equal quality and should not be considered similarly effective. Natural supplements such as turmeric and ginger are supported by evidence in many other trials for their efficacy in relieving inflammation, though not specifically for RA. Dietary interventions are also promising, as long as they are otherwise healthy and balanced.
Anything which increases strength, balance, and flexibility without undue joint impact is also bound to show a beneficial effect. Stress-relieving measures would also likely be useful for RA patients. Thus, these patients would be wise to use those methods that are attested to by a scientific study and by the plausibility of their biological mechanism.
In addition to these, open communication with healthcare providers and taking advantage of support from family and friends should also be viewed as natural interventions that will increase the patient’s ability to cope with RA. Counseling to overcome psychological tendencies such as poor self-efficacy and catastrophization will also go a long way in helping RA patients manage their disease in healthy ways without overmedication.
- Haaz, S. (2008). Complementary and alternative medicine for patients with rheumatoid arthritis. www.hopkinsarthritis.org/.../
- Natural products for the treatment of autoimmune arthritis: their mechanisms of action, targeted delivery, and interplay with the host microbiome. Steven Dudics, David Langan, Rakeshchandra R. Meka, Shivaprasad H. Venkatesha, Brian M. Berman, Chun-Tao Che, and Kamal D. Moudgil. International Journal of Molecular Sciences, 2018 Sep; 19(9): 2508.doi: 10.3390/ijms19092508. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164747/
- Herbal medicines for the treatment of rheumatoid arthritis: a systematic review. K. L. Soeken, S. A. Miller, E. Ernst. Rheumatology, Volume 42, Issue 5, May 2003, Pages 652–659, https://doi.org/10.1093/rheumatology/keg183. https://academic.oup.com/rheumatology/article/42/5/652/1784589