|CRDAMC Homepage | CRDAMC Library Phone #: (254) 288-8366 | CRDAMC Library Fax #: (254) 288-8368|
Rheumatoid arthritis (RA) is an autoimmune disease in the general family of lupus. For reasons that are not understood, in rheumatoid arthritis the immune system goes awry and begins attacking innocent tissues, especially cartilage in the joints. Various joints become red, hot, and swollen under the onslaught. The pattern of inflammation is usually symmetrical, occurring on both sides of the body. Other symptoms include inflammation of the eyes, nodules or lumps under the skin, and a general feeling of malaise.
Rheumatoid arthritis is more common in women than in men and typically begins between the ages of 35 and 60. The diagnosis is made by matching the pattern of symptoms with certain characteristic laboratory results.
Medical treatment consists mainly of two categories of drugs: anti-inflammatory drugs in the ibuprofen family (nonsteroidal anti-inflammatory drugs, or NSAIDs) and drugs that may be able to put rheumatoid arthritis into full or partial remission, the so-called disease-modifying antirheumatic drugs (DMARDs).
Anti-inflammatory drugs relieve symptoms of rheumatoid arthritis but do not change the overall progression of the disease, whereas the DMARDs seem to affect the disease itself. A good analogy might be the various options available to "treat" a house "suffering" from a severe termite infestation. You could remove heavy furniture, tiptoe about instead of holding public dances, and put large beams under the joists. However, none of these methods would do anything to stop the gradual destruction of your house. These methods are like NSAIDs and other supportive techniques in that they treat only the symptoms.
A more definitive approach would be to hire an exterminator and kill the termites. In medical terms, this would be described as a disease-modifying treatment. Because medical treatments for chronic diseases are seldom as completely effective as this example, a closer analogy might be spraying a chemical that slows the spread of termites but does not stop them.
In rheumatoid arthritis, the drugs believed to alter the course of the disease (to slow it down or stop it) include antimalarials (hydroxychloroquine and chloroquine), sulfasalazine, TNF inhibitors (etanercept, infliximab, and adalimumab), interleukin-1 receptor antagonists, leflunomide methotrexate, gold compounds, D-penicillamine, and cytotoxic agents (azathioprine, cyclophosphamide, and cyclosporine). They are unrelated to one another but work somewhat similarly in practice.
Unfortunately, most of the drugs in this category can cause severe side effects. Because of this toxicity, for years a so-called pyramid approach was taken with people with rheumatoid arthritis. Physicians started with NSAIDs to help with the pain and inflammation, and progressed to successively stronger and more toxic medications only when the basic treatments failed. Natural treatments such as those described here might also be useful in early stages.
However, over the last few years, research has found that severe joint damage occurs very early in rheumatoid arthritis. This evidence has caused many authorities to suggest early, aggressive treatment with disease-modifying drugs to prevent joint damage. Nonetheless, this approach has not been universally adopted, and some physicians still prescribe NSAIDs for early stages of rheumatoid arthritis. The treatments described here may be reasonable alternative options.
Principal Proposed Natural Treatments
Rheumatoid arthritis is a difficult disease, and no alternative approach solves it easily. Even if you choose to use alternative methods, you should maintain regular visits to a rheumatologist to watch for serious complications. Finally, keep in mind that medical treatment may be able to slow the progression of rheumatoid arthritis. It is not likely that any of the alternative options have the same power.
Fish oil is the only natural treatment for rheumatoid arthritis with significant documentation. According to the results of at least 13 double-blind, placebo-controlled studies involving a total of over 500 participants, supplementation with omega-3 fatty acids can significantly reduce the symptoms of rheumatoid arthritis.1,2 In addition, at least one small study suggests that it may help rheumatoid arthritis patients lower their dose of nonsteroidal anti-inflammatory medication (eg, ibuprofen).84
However, unlike some of the standard treatments, fish oil has not been shown to slow the progression of rheumatoid arthritis. It has been suggested that omega-3 supplementation is more effective when omega-6 intake (particularly arachidonic acid) is kept low, as occurs with a vegetarian diet.67 The benefits of fish oil may also be enhanced by simultaneous use of olive oil.74 A badly designed human study hints that a relative of fish oil, krill oil, might be helpful as well.79
For more information, including dosage and safety issues, see the full Fish Oil article.
Other Proposed Treatments for Rheumatoid Arthritis TOP
Boswellia serrata is a shrub-like tree that grows in the dry hills of the Indian subcontinent. It is the source of a resin called salai guggal, which has been used for thousands of years in Ayurvedic medicine, the traditional medicine of the region. It is very similar to a resin from a related tree, Boswellia carteri, which is also known as frankincense. Both substances have been used historically for arthritis.
Recent research has identified boswellic acids as the likely active ingredients in boswellia. In animal studies, boswellic acids have shown anti-inflammatory effects, but their mechanism of action seems to be quite different from that of standard anti-inflammatory medications.10-13
An issue of Phytomedicine that was devoted to boswellia briefly reviewed previously unpublished studies on the herb.14 A pair of placebo-controlled trials involving a total of 81 people with rheumatoid arthritis found significant reductions in swelling and pain over the course of 3 months. Furthermore, a comparative study of 60 participants over 6 months found the boswellia extract relieved symptoms about as well as oral gold therapy. However, keep in mind that while gold shots can induce remission in rheumatoid arthritis, we have no evidence that boswellia can do the same.
Another double-blind study found no difference between boswellia and placebo.15 The bottom line is that we need more research to know for sure whether boswellia is an effective treatment for rheumatoid arthritis.
For more information, including dosage and safety issues, see the full Boswellia article.
The herb devil's claw may be beneficial in rheumatoid arthritis. One double-blind study followed 89 people with rheumatoid arthritis for 2 months. The group given devil's claw showed a significant decrease in pain intensity and an improvement in mobility.16
Another double-blind study of 50 people with various types of arthritis showed that 10 days of treatment with devil's claw provided significant pain relief.17
For more information, including dosage and safety issues, see the full Devil's Claw article.
Other Herbs and Supplements TOP
Glucosamine is best known as a proposed treatment for osteoarthritis. However, it might be helpful for RA as well. A double-blind, placebo-controlled study of 51 people with RA found that glucosamine at a dose of 1,500 mg daily significantly improved symptoms.77 It did not, however, alter measures of inflammation as determined through blood tests.
Some evidence, including small double-blind trials, additionally support the use of the following herbs and supplements for the treatment of rheumatoid arthritis:
Note : Tripterygium wilfordii is believed to be unsafe for pregnant or nursing women, and may present risks in other groups as well.26,27,75
Vitamin E may reduce pain in rheumatoid arthritis, but it does not seem to reduce inflammation.37,54,55 Some evidence suggests that adding vitamin E, or vitamin E plus other antioxidants, to standard rheumatoid arthritis therapy might improve results.39 However, an extremely large randomized trial involving over 39,000 women found that taking 600 IU of vitamin E every other day did not reduce the risk of rheumatoid arthritis.87
Individuals taking the drug methotrexate for treatment of rheumatoid arthritis may benefit by taking folate supplements. Folate appears to reduce methotrexate side effects, including mouth sores, nausea, and liver inflammation.57-59 In addition, folate supplements may help reverse a more subtle methotrexate side-effect: a rise in blood levels of homocysteine.60,61 Elevated levels of homocysteine are thought to increase risk of heart-disease.
The following treatments are also sometimes proposed as effective for rheumatoid arthritis, but there is as yet little to no scientific evidence for or against their use: adrenal extract, beta-carotene, betaine hydrochloride, boron, burdock, cayenne, chamomile, copper, feverfew, folate, ginger, L-histidine, horsetail, magnesium, manganese, molybdenum, pantothenic acid, D-phenylalanine, perilla frutescens, pregnenolone, proteolytic enzymes, sea cucumber, and vitamin C.
Zinc supplements have been evaluated as a treatment for rheumatoid arthritis, but overall the study results have not been encouraging.34,35,49-53 Other treatments that have as yet generally failed to prove effective in small double-blind trials include selenium, collagen,46,47-50probiotics,72white willow,73 and an Ayurvedic herbal mixture containing extracts of ashwagandha, boswellia, ginger, and turmeric.45 Two studies commonly cited as evidence that turmeric alone is useful for rheumatoid arthritis actually fail to provide any meaningful supporting evidence.20,21
A 6-month, double-blind, placebo-controlled study of 168 people with rheumatoid arthritis failed to find that elk velvet antler enhanced the effectiveness of conventional treatment for rheumatoid arthritis.83
Other Alternative Therapies TOP
Two separate groups of researchers conducting detailed reviews of 8 randomized controlled trials found some beneficial effects of acupuncture for rheumatoid arthritis, but were unconvinced that it was more beneficial than sham acupuncture or other standard treatments.85,86 Another review of 11 randomized trials did not find that mediation, progressive muscle relaxation, static magnetic therapy, acupuncture or tai chi relieved pain in patients with rheumatoid arthritis. The 11 trials included a total of 607 patients.95
References[ + ]
1. James MJ, Cleland LG. Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum. 1997;27:85-97.
2. Volker D, Fitzgerald P, Major G, et al. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. J Rheumatol. 2000;27:2343-2346.
8. Nordstrom DC, Honkanen VE, Nasu Y, et al. Alpha-linolenic acid in the treatment of rheumatoid arthritis. A double-blind placebo-controlled and randomized study: flaxseed vs. safflower seed. Rheumatol Int. 1995;14:231-234.
9. Shapiro JA, Koepsell TD, Voight LF, et al. Diet and rheumatoid arthritis in women: a possible protective effect of fish consumption. Epidemiology. 1996;7:256-263.
10. Singh GB, Atal CK. Pharmacology of an extract of salai guggal ex- Boswellia serrata, a new non-steroidal anti-inflammatory agent. Agents Actions. 1986;18:407-412.
11. Wildfeuer A, Neu IS, Safayhi H, et al. Effects of boswellic acids extracted from an herbal medicine on the biosynethsis of leukotrienes and the course of experimental autoimmune encephalomyelitis. Arzneimittelforschung. 1998;48:668-674.
12. Safayhi H, Sailer ER, Ammon HPT. 5-lipoxygenase inhibition by acetyl-11-keto—boswellic acid (AKBA) by a novel mechanism. Phytomedicine. 1996;3:71-72.
13. Safayhi H, Boden SE, Schweizer S, et al. Concentration-dependent potentiating and inhibitory effects of Boswellia extracts on 5-lipoxygenase product formation in stimulated PMNL. Planta Med. 2000;66:110-113.
14. Etzel R. Special extract of Boswellia serrata (H 15) in the treatment of rheumatoid arthritis. Phytomedicine. 1996;3:91-94.
15. Sander O, Herborn G, Rau R. Is H15 (resin extract of Boswellia serrata, "incense") a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study [in German; English abstract]. Z Rheumatol. 1998;57:11-16.
16. European Scientific Cooperative on Phytotherapy Harpagophyti radix (devil's claw). Exeter, UK: ESCOP, 1997:5. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 2.
17. European Scientific Cooperative on Phytotherapy Harpagophyti radix (devil's claw). Exeter, UK: ESCOP, 1997:4. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 2.
20. Satoskar RR, Shah SJ, Shenoy SG. Evaluation of anti-inflammatory property of cucurmin (diferuloyl methane) in patients with postoperative inflammation. Int J Clin Pharmacol Ther. 1986;24:651-654.
21. Deodhar SD, Sethi R, Srimal RC. Preliminary study on antirheumatic activity of curcumin (diferuloyl methane). Indian J Med Res. 1980;71:632-634.
25. Tao X, Lipsky PE. The Chinese anti-inflammatory and immunosuppressive herbal remedy Tripterygium wilfordii Hook F. Rheum Dis Clin North Am. 2000;26:29-50.
26. Chan WY, Ng TB. Adverse effect of Tripterygium wilfordii extract on mouse embryonic development. Contraception. 1995;51:65-71.
27. Takei A, Nagashima G, Suzuki R, et al. Meningoencephalocele associated with Tripterygium wilfordii treatment. Pediatr Neurosurg. 1997;27:45-48.
28. Bingham R, Bellew BA, Bellew JG. Yucca plant saponin in the management of arthritis. J Appl Nutr. 1975;27:45-50.
29. Huber B. Therapy of degenerative rheumatic diseases. Need for additional analgesic medication with Phytodolor N [translated from German]. Fortschr Med. 1991;109:248-250.
30. Zurier RB, Rossetti RG, Jacobson EW, et al. gamma-Linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum. 1996;39:1808-1817.
31. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with blackcurrant seed oil. Br J Rheumatol. 1994;33:847-852.
32. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med. 1993;119:867-873.
33. Rothman D, DeLuca P, Zurier RB. Botanical lipids: Effects on inflammation, immune responses and rheumatoid arthritis. Semin Arthritis Rheum. 1995;25:87-96.
34. Peretz A, Neve J, Jeghers O, et al. Zinc distribution in blood components, inflammatory status, and clinical indexes of disease activity during zinc supplementation in inflammatory rheumatic diseases. Am J Clin Nutr. 1993;57:690-694.
35. Rasker JJ, Kardaun SH. Lack of beneficial effect of zinc sulphate in rheumatoid arthritis. Scand J Rheumatol. 1982;11:168-170.
36. Simkin PA. Treatment of rheumatoid arthritis with oral zinc sulfate. Agents Actions Suppl. 1981;8:587-596.
37. Edmonds SE, Winyard PG, Guo R, et al. Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double blind trial. Ann Rheum Dis. 1997;56:649-655.
38. Knekt P, Heliovaara M, Aho K, et al. Serum selenium, serum alpha-tocopherol, and the risk of rheumatoid arthritis. Epidemiology. 2000;11:402-405.
39. Helmy M, Shohayeb M, Helmy MH, et al. Antioxidants as adjuvant therapy in rheumatoid disease. Arzneimittelforschung. 2001;51:293-298.
40. Murav'ev IuV, Venikova MS, Pleskovskaia GN, et al. Effect of dimethyl sulfoxide and dimethyl sulfone on a destructive process in the joints of mice with spontaneous arthritis [in Russian]. Patol Fiziol Eksp Ter. 1991;2:37-39.
41. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338:899-902.
42. Nenonen M, Helve T, Hanninen O. Effects of uncooked vegan food "living food" on rheumatoid arthritis, a three-month controlled and randomised study [abstract]. Am J Clin Nutr. 1992;56:762.
43. Darlington LG, Ramsey NW. Review of dietary therapy for rheumatoid arthritis. Br J Rheumatol. 1993;32:507-514.
44. Sarzi-Puttini P, Comi D, Boccassini L, et al. Diet therapy for rheumatoid arthritis. A controlled double-blind study of two different dietary regimens. Scand J Rheumatol. 2000;29:302-307.
45. Chopra A, Lavin P, Patwardhan B, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol. 2000;27:1365-1372.
46. Cazzola M, Antivalle M, Sarzi-Puttini P, et al. Oral type II collagen in the treatment of rheumatoid arthritis. A six-month double blind placebo-controlled study. Clin Exp Rheumatol. 2000;18:571-577.
47. Tarp U. Selenium in rheumatoid arthritis. A review. Analyst. 1995;120:877-881.
48. Peretz A, Siderova V, Neve J. Selenium supplementation in rheumatoid arthritis investigated in a double blind, placebo-controlled trial. Scand J Rheumatol. 2001;30:208-212.
49. Pandey SP, Bhattacharya SK, Sundar S. Zinc in rheumatoid arthritis. Indian J Med Res. 1985;81:618-620.
50. Mattingly PC, Mowat AG. Zinc sulphate in rheumatoid arthritis. Ann Rheum Dis. 1982;41:456-457.
51. Dixon JS, Bird HA, Martin MF, et al. Biochemical and clinical changes occurring during the treatment of rheumatoid arthritis with novel antirheumatoid drugs. Int J Clin Pharmacol Res. 1985;5:25-33.
52. Job C, Menkes CJ, Delbarre F. Zinc sulphate in the treatment of rheumatoid arthritis. Arthritis Rheum. 1980;23:1408-1409.
53. Simkin PA. Oral zinc sulphate in rheumatoid arthritis. Lancet. 1976;2:539-542.
54. Kolarz G, Scherak O, El Shohoumi M, Blankenhorn G. High-dose vitamin E for chronic arthritis. Akt Rheumatol. 1990;15:233-237.
55. Scherak O, Kolarz G. Vitamin E and rheumatoid arthritis. Arthrit Rheum. 1991;34:1205-1206.
56. Tao X, Younger J, Fan FZ, et al. Benefit of an extract of Tripterygium wilfordii Hook F in patients with rheumatoid arthritis: A double-blind, placebo-controlled study. Arthritis Rheum. 2002;46:1735-1743.
57. van Ede AE, Laan RF, Rood MJ, et al. Effect of folic or folinic acid supplementation on the toxicity and efficacy of methotrexate in rheumatoid arthritis: a forty-eight week, multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2001;44:1515-1524.
58. Griffith SM, Fisher J, Clarke S, et al. Do patients with rheumatoid arthritis established on methotrexate and folic acid 5 mg daily need to continue folic acid supplements long term? Rheumatology (Oxford). 2000;39:1102-1109.
59. Ortiz Z, Shea B, Suarez-Almazor ME, et al. The efficacy of folic acid and folinic acid in reducing methotrexate gastrointestinal toxicity in rheumatoid arthritis. A metaanalysis of randomized controlled trials. J Rheumatol. 1998;25:36-43.
60. Van Ede AE, Laan RF, Blom HJ, et al. Homocysteine and folate status in methotrexate-treated patients with rheumatoid arthritis. Rheumatology (Oxford). 2002;41:658-665.
61. Morgan SL, Baggott JE, Lee JY, Alarcon GS. Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia during longterm, low dose methotrexate therapy for rheumatoid arthritis: implications for cardiovascular disease prevention. J Rheumatol. 1998;25:441-446.
62. Huskisson EC, Scott J, Bryans R. Seatone is ineffective in rheumatoid arthritis. BMJ. 1981;282:1358-1359.
63. Caughey DE, Grigor RR, Caughey EB, et al. Perna canaliculus in the treatment of rheumatoid arthritis. Eur J Rheumatol Inflamm. 1983;6:197-200.
64. Larkin JG, Capell HA, Sturrock RD. Seatone in rheumatoid arthritis: a six-month placebo controlled study. Ann Rheum Dis. 1985;44:199-201.
65. Highton TC, McArthur A. W. Pilot study on the effect of New Zealand green mussel on rheumatoid arthritis. N Z Med J. 1975;81:261-262.
66. Gibson SLM, Gibson RG. The treatment of arthritis with a lipid extract of Perna canaliculus: a randomized trial. Comp Ther Med. 1998;6:122-126.
67. Adam O, Beringer C, Kless T, et al. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. 2003;23:27-36.
68. Mur E, Hartig F, Eibl G, et al. Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol. 2002;29:678-681.
69. Cibere J, Deng Z, Lin Y, et al. A randomized double blind, placebo controlled trial of topical Tripterygium wilfordii in rheumatoid arthritis: Reanalysis using logistic regression analysis. J Rheumatol. 2003;30:465-467.
70. Segal NA, Toda Y, Huston J, et al. Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: double-blind clinical trial. Arch Phys Med Rehabil. 2001;82:1453-1460.
71. David J, Townsend S, Sathanathan R, et al. The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-controlled cross-over study. Rheumatology (Oxford). 1999;38:864-869.
72. Hatakka K, Martio J, Korpela M, et al. Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis—a pilot study. Scand J Rheumatol. 2003;32:211-5.
73. Biegert C, Wagner I, Ludtke R, et al. Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. J Rheumatol. 2004;31:2121-2130.
74. Berbert AA, Kondo CR, Almendra CL, et al. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition. 2005;21:131-136.
75. Canter PH, Lee HS, Ernst E, et al. A systematic review of randomised clinical trials of Tripterygium wilfordii for rheumatoid arthritis. Phytomedicine. 2006 Feb 15. [Epub ahead of print]
76. Chiang EP, Selhub J, Bagley PJ, et al. Pyridoxine supplementation corrects vitamin B6 deficiency but does not improve inflammation in patients with rheumatoid arthritis. Arthritis Res Ther. 2005;7:R1404-1411.
77. Nakamura H, Masuko K, Yudoh K, et al. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int. 2006 Sep 5. [Epub ahead of print]
78. Verhagen AP, Bierma-Zeinstra SM, Cardoso JR, et al. Balneotherapy for rheumatoid arthritis. Cochrane Database Syst Rev. 2003;CD000518.
79. Deutsch L. Evaluation of the effect of neptune krill oil on chronic inflammation and arthritic symptoms. J Am Coll Nutr. 2007;26:39-48.
80. Pradhan EK, Baumgarten M, Langenberg P, et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Rheum. 2007 Sep 28. [Epub ahead of print]
81. Lundgren S, Stenstrom CH. Muscle relaxation training and quality of life in rheumatoid arthritis. A randomized controlled clinical trial. Scand J Rheumatol. 1999;28:47-53.
82. Stenstrom CH, Arge B, Sundbom A, et al. Dynamic training versus relaxation training as home exercise for patients with inflammatory rheumatic diseases. A randomized controlled study. Scand J Rheumatol. 1996;25:28-33.
83. Allen M, Oberle K, Grace M, et al. A randomized clinical trial of elk velvet antler in rheumatoid arthritis. Biol Res Nurs. 2008;9:254-261.
84. Galarraga B, Ho M, Youssef HM, et al. Cod liver oil (n-3 fatty acids) as a non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxford). 2008 Mar 24
85. Lee MS, Shin BC, Ernst E. Acupuncture for rheumatoid arthritis: a systematic review. Rheumatology (Oxford). 2008 Aug 18.
86. Wang C, de Pablo P, Chen X, et al. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Rheum. 2008;59:1249-1256.
87. Karlson EW, Shadick NA, Cook NR, et al. Vitamin E in the primary prevention of rheumatoid arthritis: the Women's Health Study. Arthritis Rheum. 2008;59:1589-1595.
88. Willich SN, Rossnagel K, Roll S, et al. Rose hip herbal remedy in patients with rheumatoid arthritis - a randomised controlled trial. Phytomedicine. 2010;17(2):87-93.
89. Gibson RG, Gibson SLM, MacNeill AD, Buchanan WW. Homeopathic therapy in rheumatoid arthritis: evaluation by double blind clinical therapeutic trial. Br J Clin Pharmacol. 1980;9:453-459.
90. Wiesenauer M, Gaus W. A randomized double blind trial on the efficiency of a homeopathic drug for rheumatoid arthritis [translated from German]. Aktuel Rheumatol. 1991;16:1-9.
91. Fisher P, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology (Oxford). 2001;40:1052-1055.
92. Andrade LE, Ferraz MB, Atra E, et al. A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand J Rheumatol. 1991;20:204-208.
93. Brien S, Lachance L, Prescott P, McDermott C, Lewith G. Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology (Oxford). 2010 Nov 13.
94. Macfarlane GJ, El-Metwally A, De Silva V, et al. dence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology (Oxford). 2011;50(9):1672-1683.
95. Macfarlane GJ, Paudyal P, et al. A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis. Rheumatology (Oxford).2012;51(9):1707-1713.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015