From the Guidelines
Alternative medication therapies for rheumatoid arthritis (RA) should prioritize disease-modifying antirheumatic drugs (DMARDs) and biologic agents, as recommended by the European League Against Rheumatism (EULAR) in their 2019 update 1. The EULAR recommendations emphasize the use of conventional synthetic DMARDs, such as methotrexate, leflunomide, and sulfasalazine, as well as biologic DMARDs, including tumor necrosis factor inhibitors, interleukin-6 inhibitors, and Janus kinase inhibitors. Some key points to consider when discussing alternative medication therapies with patients include:
- The primary goal of treatment is to achieve clinical remission or low disease activity, as defined by the absence of signs and symptoms of significant inflammatory disease activity 1.
- Treatment selection should be based on disease severity, comorbidities, and previous treatment responses.
- Regular monitoring of disease activity and side effects is crucial to adjust treatment strategies and minimize risks.
- Patients should be informed about the treatment target and the strategy planned to reach this target under the supervision of a rheumatologist 1. In terms of specific medications, options may include:
- Biologic DMARDs, such as adalimumab, etanercept, and infliximab, which target specific components of the immune system to reduce inflammation and prevent joint damage.
- JAK inhibitors, such as tofacitinib, baricitinib, and upadacitinib, which block multiple inflammatory pathways and are available as oral options. It is essential to note that the scientific evidence does not support the effectiveness of common traditional/folk remedies, such as chondroitin, shark cartilage, or magnet therapy, in the treatment of RA. Therefore, patients should be advised to focus on evidence-based treatments and to discuss any concerns or questions with their healthcare provider.
From the Research
Alternative Medication Therapies for Rheumatoid Arthritis (RA)
The healthcare provider (HCP) may discuss the following alternative medication therapies with the patient:
- Mind-body interventions, such as yoga and meditation, which have been found to be helpful in reducing pain, improving mood, and increasing energy in RA patients 2
- Natural products, such as cat's claw and omega-3 fatty acids, which have shown some efficacy in managing OA and RA symptoms 3
- Dietary supplements, such as glucosamine-chondroitin-quercetin glucoside, which have been found to improve synovial fluid properties in OA patients, but have limited evidence for efficacy in RA patients 4
Safety and Efficacy Concerns
The HCP should also discuss the potential risks and limitations of alternative therapies, including:
- The lack of sufficient reliable information on the effect of shark cartilage on immunocompetent cells, and the potential health risks involved 5
- The potential for interactions between alternative products and prescription products, and the importance of communicating with healthcare providers about additional therapies or products used by patients 6
- The limited evidence for efficacy and safety of many alternative therapies, and the need for further research to provide evidence-based recommendations 2, 3
Response to Patient Inquiry
Based on the available evidence, the HCP may respond to the patient's inquiry by stating that:
- There is limited evidence to support the effectiveness of shark cartilage in decreasing joint swelling 5
- Chondroitin may have some benefits in improving synovial fluid properties in OA patients, but the evidence for RA patients is limited 4
- Magnet therapy has not been shown to be effective in decreasing joint pain, and more research is needed to support its use 2