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Research on the Treatment of Rheumatoid and OsteoArthritis: Rheumatoid arthritis (RA) is a terrible auto-immune disease where you get allergic to your own joint linings. Osteoarthritis is the wear and tear type of arthritis we all get as we get older: after age 65, 60% of men and 70% of women have it with increased rates in obesity, certain occupations, and trauma. OA indicates the degeneration of joint cartilage together with changes in subchondral bone and mild intraarticular inflammation. Both diseases can be very debilitating. My interest in rheumatoid arthritis dates from 1993 when I developed a painful arthritis of my hands and feet which was unrelieved by any of the NSAID non-addictive pain medicine (ibuprofen, naproxen, etc.). I diagnosed a case of possible rheumatoid arthritis. Steroids worked fine, but you don't want to take them very long due to serious side-effects. The primary medicines for rheumatoid arthritis don't work very well and most have terrible potential side-effects. Prevention is the best idea. When I read that going on a vegan diet helped, I became vegan that very day. Two years later, I read research showing fish oil helps, so I started eating fish or taking fish oil capsules daily. Glucosamine with chondroitin is also very well researched and very helpful for arthritis with very few side-effects. Both have been proven to protect the cartilage from deterioration. I am unaware of evidence that any other treatment is protective of joint cartilage in osteoporosis. Two triple strength tablets can cost as little as $6 per month. I now have very little problem any more with arthritis despite doing a lot of vigorous exercising. I discourage individuals from taking SAMe until first trying folic acid, because you can probably get the same benefits much more cheaply by taking an adequate amount of folic acid (folate). Folic acid increases the body's own production of SAMe by 43%. SAMe is quite expensive although many studies have found it of benefit (see the SAMe webpage). Risdronate (Actonel) may be worth a try in view of a recent study. However, Vitamin K may have the same benefits as Actonel or Fosamax as a much lower cost. Anyone on long-term steroids for rheumatoid arthritis should probably also take vitamins K and D or Actonel or Fosamax. Physiotherapy and debridement are of no benefit. Cox-II inhibitor pain killers (Celebrex, Vioxx, etc.) are an expensive waste of money in my opinion. Vioxx was recently pulled off the market due to a side-effect of premature death (The evidence of danger was well known long before it was pulled off the market). Celebrex and naproxen have also been reported to cause a lesser increase in the death rate, at least at higher dosages. Aspirin, ibuprofen, naproxen and other NSAIDs temporarily provide a small amount of pain relief but do nothing to protect the cartilage. They may even worsen joint deterioration, while causing many side-effects including hypertension, kidney failure, congestive heart failure, and gastro-intestinal bleeding, all of which can and do cause early death. These drugs should be used sparingly and not on a regular basis unless all other options have proven inadequate. Addictive pain killers are definitely inferior as pain killers and should never be used, not even short-term (see Pain). Devil's Claw or harpagophytum, from a tree in South Africa, appears to be as good as NSAIDs for osteoarthritis or lower back pain with far fewer side-effects and a very low cost. While more research is needed, a dozen double-blind studies have been done. The small number of patients I gave Devil's Claw to to try out did not report benefit. Diacerhein, an ingedient in Devil's Claw, has been found helpful as well. Fruits and vegetables, selenium, zinc, and vitamin B-12 have all been shown to help prevent or reduce arthritis. Small doses of the anti-depressant amitriptyline can lower the pain but probably does not affect disease progression. Yogurt is helpful for rheumatoid arthritis and vitamin D prevents many cases from developing. As I have frequently noted, what is good for one disease is very often good for the whole body. The above list is another example of this. Magnet therapy has also been shown helpful in several studies, but I'm not impressed. Ginger is of at least some value. I could find no human research on tea or green tea for arthritis as of March, 2005, although one dietary study study reported that tea drinkers had somewhat less arthritis. Rutosid-bromelain-trypsin has one and cat's claw has two double-blind studies showing benefit. The first is an herbal enzymatic treatment available without a prescription for a modest price and has very few side-effects. Cat's claw (una de gato) is a Peruvian folk remedy. Avoid high heeled shoes which damage the knees. This includes platform shoes. Surgeons operate on 650,000 Americans per year doing debridement operations despite research proving the surgery worthless for osteoarthritis. Pharmaceutical companies have come out with numerous extremely expensive treatments for rheumatoid arthritis but don't dare compare them against the above approaches which are 100 times cheaper and help the whole body, not just the cartilage. Doxycycline is a worthwhile and very inexpensive medication for rheumatoid arthritis although it is unclear if it halts disease progression. Methotrexate is still the standard treatment and slows disease progression with several other treatments also available (chloroquine or salazopyrine). No matter what the treatment, starting treatment very early considerably improves with results. Unfortunately, results are less than desired for many patients. Statins and boswellia have been found to help in small studies. And, yes, mud compresses did help in one Israeli study. Etanercept (Immunex), Infliximab (Remicade), and Adalimumab (Humira) are extremely expensive antibodies against tumor necrosis factor which are of some benefit for rheumatoid arthritis compared to placebo but they have never been compared to well researched treatments like a vegan diet, glucosamine and chondroitin, and appropriate supplements combined with less expensive standard medication approaches. Hyaluronan injections are a real waste of money since they are minimally better than placebo and quite expensive. Leflunomide (Arava) may be of value for methotrexate resistant rheumatoid arthritis. Use of a Prosorba column may help by eliminating harmful antibodies. I have not tried to cover the studies on the above standard treatments since these are readily available elsewhere. Do review the studies supporting the above statements at The Research.
Thomas E. Radecki, M.D., J.D. |