Rheumatoid Arthritis: In Depth
What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a disease that causes pain, swelling, and stiffness in the joints. It occurs when the immune system attacks the membrane lining the joints. RA is more common in women than men and often begins in middle age, although it can also occur in younger people.
More About Rheumatoid Arthritis and How It’s Treated
RA is an autoimmune disease—a condition in which the immune system attacks the joints for unknown reasons. RA is different from other types of arthritis such as osteoarthritis, a wear-and-tear condition that most commonly occurs as people age.
Early treatment to avoid permanent joint damage is key for preventing disability and progression of RA. Treatment for RA combines a variety of approaches and is aimed at relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the person’s sense of well-being and ability to function. Medicines used for RA include disease-modifying antirheumatic drugs (DMARDs) to slow the progress of the disease and nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to reduce inflammation.
What the Science Says About Complementary Approaches for Rheumatoid Arthritis
Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:
- Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
- Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
- Physical (e.g., acupuncture, massage, spinal manipulation).
- Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).
Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.
Psychological and Physical Approaches
- At least 11 studies of acupuncture for RA, with more than 1,300 total participants, have been completed. These studies have not shown clear evidence of a beneficial effect.
- Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.
- For more information, see the NCCIH webpage on acupuncture.
A single study with 42 participants, conducted in 2013, has indicated that moderate pressure massage therapy may reduce pain and increase grip strength in people who have RA that affects their arms and shoulders.
The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious injuries. Some of the reported cases have involved vigorous types of massage, such as deep tissue massage, or patients who might be at increased risk of injury, such as elderly people.
For more information, see the NCCIH webpage on massage therapy.
Four studies (401 total participants) have looked at the effects of mindfulness-based interventions in people with RA, and all found evidence of some improvement in subjective symptoms such as pain or in the ability to cope with the illness.
Mindfulness meditation may involve staying in one position for a prolonged period of time. This can be difficult or painful for a person with arthritis. If you’re interested in trying mindfulness meditation, tell the instructor about your physical limitations so that the instructor can modify the practice to make it comfortable for you.
For more information, see the NCCIH webpage on meditation.
Autogenic training, biofeedback, and other relaxation techniques have been studied in people with RA, but only a small amount of research has been done on each approach. Some results have been promising, but the amount of research is so small that no definite conclusions can be reached.
Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.
For more information, visit the NCCIH webpage on relaxation techniques.
Several studies have looked at the effects of practicing tai chi on people with RA. Some studies showed improvements in participants’ physical functioning, but others did not. Most of these studies are more than 10 years old (some much older than that), so the study participants would not have been taking the types of drugs used in RA treatment today. Because of the inconsistent findings and the changes in RA treatment over the years, it’s uncertain whether tai chi has benefits in RA.
Studies of tai chi for RA indicate that it doesn’t make symptoms worse. However, traditional forms of tai chi may need to be adapted so that people with RA can participate safely and comfortably.
For more information, visit the NCCIH webpage on tai chi.
Yoga incorporates several elements of exercise that may be beneficial for arthritis, including activities that may help improve strength and flexibility. However, only a few studies have examined yoga for RA, and they have not been of high quality. They haven’t clearly shown whether it’s helpful.
Yoga exercises should be performed with caution by people with RA who have limited mobility or spinal problems. People with RA may need assistance in modifying some yoga postures to minimize joint stress and may need to use props to help with balance.
For more information, see the NCCIH webpage on yoga.
Omega-3 Fatty Acids
- Omega-3 fatty acids are a kind of fat found in foods and in the human body. They are also sold as dietary supplements. Different types of omega-3s are found in different foods. Much research has focused on the long-chain omega-3s found in seafood (fish and shellfish).
- A 2017 review of 22 studies (956 total participants) that tested supplements of long-chain omega-3s found a favorable effect on pain in patients with RA.
- Omega-3 supplements usually produce only mild side effects, if any. There’s conflicting evidence on whether omega-3 supplements might influence the risk of prostate cancer. If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.
- For more information, visit the NCCIH webpage on omega-3s.
Gamma-Linolenic Acid (GLA)
GLA is an omega-6 fatty acid found in the oils from some plants, including evening primrose (Oenothera biennis), borage (Borago officinalis), and black currant (Ribes nigrum). Oils containing GLA may have some benefit in relieving RA symptoms; however, only a few studies have been conducted on each of the oils.
In short-term studies, oils containing GLA produced only mild side effects, such as upset stomach or headache. The long-term safety of GLA supplements is uncertain. Some borage products may contain substances called pyrrolizidine alkaloids that can harm the liver.
A few preliminary studies have tested various probiotics in patients with RA, but the types of probiotics used differed from study to study, and the results differed as well. No conclusions about the effects of probiotics can be reached on the basis of the current evidence.
In people who are generally healthy, probiotics have a good safety record. Side effects, if they occur at all, usually consist only of mild digestive symptoms such as gas. However, information on the long-term safety of probiotics is limited, and safety may differ from one type of probiotic to another. Probiotics have been linked to severe side effects, such as dangerous infections, in people with serious underlying medical problems.
For more information, visit the NCCIH webpage on probiotics.
Thunder God Vine
Thunder god vine (Tripterygium wilfordii) is an herb used in traditional Chinese medicine. There have been only a few high-quality studies of oral thunder god vine for RA. These studies indicate that thunder god vine may improve some RA symptoms. In two studies, thunder god vine was at least as helpful as a conventional drug. Promising results have also been seen in studies in China where thunder god vine was used in combination with a conventional drug.
Thunder god vine can have serious side effects, including loss of bone density and male infertility. Thunder god vine can be extremely poisonous if the extract is not prepared properly. The risks of using this herb may exceed its benefits.
For more information, see the NCCIH webpage on thunder god vine.
Other Dietary Supplements
Other dietary supplements that have been studied for RA include cat’s claw, deer or elk antler velvet, feverfew, flaxseed oil, green-lipped mussel, rose hip, and willow bark extract. For all of these supplements, only a very small amount of research has been done in people, and it isn’t possible to reach any conclusions about their effects.
Other Complementary Health Approaches
Ayurvedic medicine is a system of health care that originated in India. Two preliminary studies (161 total participants) have compared Ayurvedic herbal preparations with conventional drugs used to treat RA. Both indicated that some Ayurvedic preparations may be comparable in effectiveness to the drugs. However, the two studies used different Ayurvedic preparations and compared them with different drugs.
Ayurvedic medicine uses a variety of products and practices. Some products may be harmful, particularly if used improperly or without the direction of a trained practitioner.
For more information, see the NCCIH webpage on Ayurvedic medicine.
Balneotherapy is the technique of bathing in tap or mineral water for health purposes; it also includes related practices such as mud packs. A 2016 review of 8 studies of balneotherapy for RA (496 total participants) was unable to reach definite conclusions because of the variability in the types of balneotherapy used in different studies as well as variability in study designs.
Balneotherapy has a good safety record.
The effects of special diets—such as vegetarian, Mediterranean, or elimination diets—on RA are uncertain because very little research has been done.
In studies that tested special diets for RA, some people lost weight even though they didn’t intend to, an effect that is undesirable in people who are already at or below normal weight. Some special diets, especially those that eliminate one or more major food groups, are so restrictive that they may put people at risk of developing nutritional deficiencies.
More To Consider
If you’re considering dietary supplements, keep in mind that they can cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or the child’s) health care provider. To learn more, visit the NCCIH webpage on dietary supplements.
Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.
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NCCIH thanks D. Craig Hopp, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of the 2019 update of this publication.
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