Many people who have the chronic inflammatory disease rheumatoid arthritis are looking for extra help with the painful symptoms.
The fatigue, joint swelling and agony that can come with disorder, which is caused by a person's own immune system attacking the joints, can’t be completely banished.
While there are drugs that help slow joint damage and ease the symptoms, they often come with side effects, such as nausea, anemia, high blood sugar, bone loss and a heightened risk for infection.
To avoid those possible risks, some patients seek out alternative therapies to supplement prescription medications they are already taking.
“Over 50 percent of patients I see will have tried or want to try them,” said Dr. Dana DiRenzo, an instructor of medicine in the division of rheumatology at Johns Hopkins University.
Although no large clinical trials have studied these therapies, some, like omega-3 fatty acids are supported by smaller studies, DiRenzo said.
Often, patients are hoping that complementary and alternative therapies might allow them to reduce the amount of medication they take, said Dr. Wei Wei Chi, a rheumatologist and an assistant professor at The Mount Sinai Medical Center.
"Patients like being able to take charge of their own health and this is a way for them to do that,” Chi said.
Because it’s not possible to predict in advance which will be the most helpful for a particular person, Dr. Elizabeth Volkmann encourages patients interested in alternative therapies to try multiple options.
“My approach is to tell patients to do a combination,” said Volkmann, an assistant professor of medicine in the division of rheumatology at the University of California, Los Angeles.
“Very often patients feel they have to choose,” she added. “I don’t think so. Just make sure, whatever you are using, that you tell your doctor so you can be checked for kidney and liver function.”
Below is a list of therapies for which there is some evidence of efficacy in rheumatoid arthritis patients:
A 2018 review article recommended both the Mediterranean diet and fish oil for patients with RA. Any diet that cuts out foods that might have inflammatory effects can help, DiRenzo said.
“Basically you want to avoid processed foods that are high in enriched flours,” she explained. “You want to include a good amount of vegetables, and lean meats and olive oil. The Mediterranean diet fits that bill.”
Another possible addition: foods high in antioxidants, such as blueberries, DiRenzo said.
DiRenzo recommends a yoga programmed designed for those dealing with arthritis.
“Yoga is good for strengthening the core, improving overall mobility and on top of that it is stress reducing,” she said. “There are a lot of studies coming out now looking at how stress impacts disease activity. Doing an exercise that is good for the joints and reduces stress is a win win.”
A small 2019 randomized control trial backs DiRenzo up. That trial found yoga improved markers of inflammation in RA patients.
Recent data have suggested that problems with the microbiome may be involved in the development of RA, said Armin Alaedini, an assistant professor in the department of medicine and the Institute of Human Nutrition at Columbia University Medical Center.
“So certain probiotics and prebiotics may indeed have a beneficial effect on RA, in part by acting on the immune system to reduce inflammation,” Alaedini said in an email. “This is an exciting area and more research is needed to better understand the mechanisms and potential therapeutic opportunities.”
Omega-3 fatty acids
These are among the best studied anti-inflammatories. Several review articles combining data from small clinical trials found that these supplements may ease pain in patients with RA.
Omega-3 supplements have the added benefit of being heart healthy, DiRenzo said, cautioning patients to keep their doctors in the loop if they opt to use Omega-3 since this supplement can thin the blood, which could be a problem if you’re already taking blood thinners.
Gamma linolenic acid
GLA is another fatty acid with anti-inflammatory properties. It’s found in evening primrose oil, black current seed and borage oil. A small 18-month clinical trial in 2014 found that the supplement improved symptoms, allowing some patients to reduce their medication doses.
This spice also has anti-inflammatory properties. In some small studies it’s been associated with pain relief, DiRenzo said.
“It has few side effects, but in large quantities it can cause gastrointestinal upset,” she said.
On the plus side, it can be used in cooking.