Arthritis patients search for effective treatments that have the least potential for side effects. Some patients believe solely in a traditional approach, focusing largely on arthritis medications. Others believe medications are unnatural and toxic. How can a patient determine what's a hokey alternative treatment versus an alternative treatment which may have real benefit?
What is Alternative Medicine?
The use of complementary and alternative medicine among arthritis patients is on the rise. Alternative medicine is defined as the use of medical innovations other than those widely taught in medical schools and includes:
- botanicals
- acupuncture
- dietary supplements
- nutrition
- chiropractic care
- homeopathy
- mind-body connections
Traditional therapy such as prescription medications has been reviewed by the FDA so the benefits and risks of the medications are more apparent. Alternative treatments such as herbs or supplements have not been extensively studied. As a result, the risk benefit is less clear.
Glucosamine and Chondroitin: An Example
One example of this is glucosamine and chondroitin. These supplements appear to be relatively safe. Side effects reported include heartburn, stomach discomfort and diarrhea.
While allergic reactions might occur due to the fact that glucosamine is made from the shells of shrimp, this does not appear to be a problem. Caution is advised and I avoid recommending it to patients who have a significant allergy to shell fish. Glucosamine may increase blood sugar due to a blocking effect on insulin and should be avoided by pregnant women and nursing mothers due to limited safety data.
While felt by some to be "the arthritis cure," recent data has shown that chondroitin may not be helpful at all and glucosamine may not be as helpful as previously thought. Nonetheless, because it appears relatively safe, it is reasonable to try glucosamine for osteoarthritis or to continue with the combination of glucosamine and chondroitin if someone is already taking it and feels it helps.
Traditional v. Alternative Treatment Regimens
Less or little information is available on many of the supplements available. Because there are not cures for most types of arthritis and the existing treatments may be of limited benefit or not tolerated by many patients, doctors who treat arthritis can help their patients by being knowledgeable about alternative therapies.
By having an interest in this area, they can at least steer their patients away from potentially harmful therapies. In addition, with a little reading, they can guide their patients to what are felt to be reasonably safe treatments. I suggest a 5-point patient counseling plan for alternative medicine:
1 - Keep in mind that alternative medicine can be effective for some patients.
2 - Keep lines of communication open so that patients are comfortable with being guided toward sensible decisions.
3 - Ask patients what therapies they have tried. Although patients rarely volunteer information, many welcome the opportunity to discuss their experience when asked. The physician is in a good position to explain the inherent dangers of over-the-counter supplements including purity, toxicity, and labeling issues; advise proper dosages; and discuss the lack of scientific evidence proving the benefit of some forms of alternative medicine.
4 - Encourage conventional care if it would benefit the patient in conjunction with alternative therapy.
5 - Recommend alternative care if it would be beneficial in conjunction with conventional care.
Some references which are useful for doctors and patients alike are the following:
- PDR for Nutritional Supplements
- PDR for Herbal Medicines
- The Complete German Commission E Monographs
Sources:
"5 point patient counseling plan for alternative medicine". Reprinted from Scott J. Zashin. The Journal of Musculoskeletal Medicine, June 2000.
Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book and also visit Dr. Zashin's website.
