|Also listed as: Asperger's syndrome||Integrative Therapy Quick Links:|
- ADHD, Asperger, Asperger disorder, Asperger's, Asperger's disorder, AS, ASD, attention deficit hyperactivity disorder, autistic, autism, autism spectrum disorder, brain disorder, HFA, high-functioning autism, neurological disease, neurological disorder, OCD, obsessive-compulsive disorder, PDD, pervasive development disorder, Rett syndrome.
- Asperger syndrome is a mild type of autism spectrum disorder (ASD). These disorders are characterized by problems with communication and social interaction and by unusual, repetitive behaviors. Some professionals use a broader term, called pervasive development disorders (PDDs), to describe autism spectrum disorders. In addition to Asperger syndrome, there are four other disorders that qualify as PDDs: autism, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Rett syndrome.
- Children with Asperger syndrome usually have normal intelligence and do not have the language problems typical of autism. Patients with Asperger syndrome have many of the same social interaction and communication problems as autistic patients. However, patients with Asperger syndrome tend to have normal intelligence and verbal skills. Although these patients typically have strong verbal and grammar skills, they usually have other language problems, such as being too literal and/or having difficulty understanding non-verbal communications, such as body language. Other symptoms may include motor skill problems (e.g., clumsy movements), obsessive or repetitive routines and schedules, and sensitivity to sensory information (e.g., sound, light, or taste).
- Asperger syndrome is named after Hans Asperger, a Viennese pediatrician who, in 1940, first described a set of behavior patterns apparent in some of his patients, most of whom were males. Asperger described these boys as having normal intelligence and language development but having severely impaired social and communication skills and poor coordination.
- Some doctors believe that Asperger syndrome is not a separate and distinct disorder from autism. Instead, they call it high-functioning autism (HFA) and view it as being on the mild end of the ASD spectrum with symptoms that differ only slightly from classic autism.
- The cause of Asperger syndrome is currently unknown, although it may be inherited. Genetic mutations known to cause Asperger syndrome have not been discovered.
- The age of diagnosis of Asperger syndrome is later than what is typical in autism, which may be because people with Asperger syndrome have normal language skills. Most children with Asperger syndrome are diagnosed between the ages of 8 and 11. Motor development delays, such as clumsiness and crawling or walking late, are often the first indications of the disorder. Although diagnosed mainly in children, Asperger syndrome is being increasingly diagnosed in adults who seek medical help for conditions such as depression, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD).
- The number of children diagnosed with autism spectrum disorders has increased over the years. It is unclear whether more children are developing the disorders or if doctors have become better at recognizing the symptoms. Approximately one out of every 5,000 children develops Asperger syndrome. For unknown reasons, boys are three to four times more likely than girls to develop the disorder. All ethnic groups are equally affected.
- Although there is currently no known cure for Asperger syndrome, treatments and therapies have been shown to help patients live healthy, relatively normal lives. With early diagnosis, timely intervention is possible. Some patients are able to live independently once they become adults, while others may need lifelong support.
- Strong scientific evidence:
- Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called chi, circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. There has been substantial research into the efficacy of acupuncture in the treatment of osteoarthritis (OA). Most studies focus on knee, cervical, and hip OA symptoms. In recent years, the evidence has improved and is now considered strong enough to recommend trying acupuncture in OA of the knee, which is one of the most common forms of this condition.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders, or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.
- Chondroitin: Multiple clinical trials have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other joints (spine, hips, and finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatory). The weight of scientific evidence points to a beneficial effect when chondroitin is used for six to 24 months. Longer-term effects are not clear. Preliminary studies of topical chondroitin have also been conducted.
- Avoid with prostate cancer or an increased risk of prostate cancer. Use cautiously if allergic or hypersensitive to chondroitin sulfate products or with shellfish allergy. Use cautiously with bleeding disorders or if taking blood-thinners like warfarin (like Coumadin®). Avoid if pregnant or breastfeeding.
- Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Based on human research, there is strong evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or used products other than glucosamine sulfate. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. More well-designed clinical trials are needed to confirm safety and effectiveness, and to test different formulations of glucosamine.
- Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
- Willow bark: Willow (Salix alba) bark that contains salicin has been used to treat many different kinds of pain. Willow bark is a traditional analgesic (pain relieving) therapy for osteoarthritis. Several studied have confirmed this finding. Additional study comparing willow bark to conventional medicinal agents for safety and effectiveness is warranted.
- Avoid if allergic/hypersensitive to aspirin, willow bark (Salix spp.), or any of its constituents, including salicylates. Avoid operating heavy machinery. Avoid in children with chickenpox and any other viral infections. Avoid with blood disorders or kidney disorders. Avoid if taking other NSAIDs, acetazolamide or other carbonic anhydrase inhibitors. Avoid with elevated serum cadmium levels. Use cautiously with gastrointestinal problems, such as ulcers, hepatic disorders, diabetes, gout, high blood pressure, hyperlipidemia, history of allergy or asthma, or leukemia. Use cautiously if taking protein-bound medications, antihyperlipidemia agents, alcohol, leukemia medications, beta-blockers, diuretics, Phenytoin (Dilantin®), probenecid, spironolactone, sulfonylureas, valproic acid, or methotrexate. Use cautiously if predisposed to headaches. Use cautiously with tannin-containing herbs or supplements. Avoid if pregnant or breastfeeding.
- Good scientific evidence:
- Avocado: A combination of avocado/soybean unsaponifiables (ASU) has been found beneficial in osteoarthritis of the knee and hip. Additional study using avocado (Persea Americana)alone in OA is needed.
- Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Avoid with monoamine oxidase inhibitors (MAOIs). Use cautiously with anticoagulants (like warfarin). Doses greater than found in a normal diet is not recommended if pregnant or breastfeeding. Some types of avocado may be unsafe when breastfeeding.
- Borage seed oil: Preliminary evidence suggests that gamma linolenic acid (GLA) may have anti-inflammatory effects that may make it beneficial in treating rheumatoid arthritis. Additional research is needed to determine the optimal dose and administration.
- Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or in those taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or in those taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid during pregnancy and breastfeeding.
- Devil's claw: Devil's claw (Harpagophytum procumbens) originates from the Kalahari and Savannah desert regions of South and Southeast Africa. There is increasing scientific evidence suggesting that devil's claw is safe and beneficial for the short-term treatment of pain related to degenerative joint disease or osteoarthritis (8-12 weeks), and may be equally effective as drug therapies such as non-steroidal anti-inflammatory drugs like ibuprofen (Advil®, Motrin®), or may allow for dose reductions or stopping of these drugs in some patients. However, most studies have been small with flaws in their designs. Additional well-designed trials are necessary.
- Avoid if allergic to devil's claw or to plants in the Harpagophytum procumbens family. Use cautiously with stomach ulcers or with a history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, ulcers, or with prescription drugs used for these conditions. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
- Glucosamine: Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine, and improved joint function. Overall, these studies have not been well designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.
- Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
- Omega-3 fatty acids, fish oil, alpha-linolenic acid: Multiple randomized controlled trials report improvements in rheumatoid arthritis, including morning stiffness and joint tenderness, with the regular intake of fish oil supplements for up to three months. Benefits have been reported as additive with anti-inflammatory medications such as NSAIDs (like ibuprofen or aspirin). However, because of weaknesses in study designs and reporting, better research is necessary before a strong favorable recommendation can be made. Effects beyond three months of treatment have not been well evaluated.
- People who are allergic to fish should avoid fish oil or omega-3 fatty acid products derived from fish. People who are allergic or hypersensitive to nuts should avoid alpha linolenic acid or omega-3 fatty acid products that are derived from the types of nuts to which they react. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single six-ounce meal per week and less than two ounces per week in young children. For farm-raised, imported or marine fish, the U.S. Food and Drug Administration (FDA) recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat seven ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper or fresh tuna).
- Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injuries. Several techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used. Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Limited available study compared physical therapy to a sham group (sub therapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psychotherapy: Although group therapy may somewhat decrease pain in people with rheumatoid arthritis and depression, individual therapy coupled with anti-depressants may be more effective.
- Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings.
- Rose hip: Rose hips have traditionally been used by herbalists as an anti-inflammatory and antiarthritic agent. A constituent isolated from dried and milled fruits of Rosa canina has demonstrated anti-inflammatory properties, and Hyben Vital®, a standardized rose hips extract, has been shown to have anti-oxidant properties. Rose hip extracts have been studied in patients with osteoarthritis, with some evidence of benefit. Additional high quality clinical research is needed in this area to confirm early study results.
- Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or antiplatelet agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.
- SAMe: S-adenosyl-L-methionine (SAMe) is a naturally occurring molecule that is found in humans. SAMe is present in almost every tissue and fluid in the body, and has been studied extensively in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis and is well tolerated in this patient population. Although an optimal dose has yet to be determined, SAMe appears as effective as non-steroidal anti-inflammatory drugs (NSAIDS). Additional study is warranted to confirm these findings.
- Avoid if allergic or hypersensitive to SAMe. Avoid with bipolar disorder. Avoid during the first trimester of pregnancy or if breastfeeding. Use cautiously with diabetes, anxiety disorders, or during the third trimester of pregnancy.
- TENS(transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Preliminary studies of TENS in knee osteoarthritis report improvements in joint function and pain. However, most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.
- Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.
- Yoga: There is promising early evidence that yoga therapy may help treat rheumatoid arthritis. More research is needed to confirm these results.
- Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
- Unclear or conflicting scientific evidence:
- Acupuncture: Further research is needed before acupuncture can be recommended for the treatment of rheumatoid arthritis.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
- Alpinia: Alpinia, also known as Chinese ginger, has been studied in combination with another ginger species for the treatment of osteoarthritis. Although alpinia shows promise for the reduction in knee pain, more studies using alpinia alone would strengthen the evidence for this indication.
- Avoid if allergic/hypersensitive to alpinia, ginger, or other members of the Zingiberaceae family. Use cautiously with diabetes or if taking hypoglycemic agents. Use cautiously with electrolyte imbalance and low blood pressure. Avoid if pregnant or breastfeeding.
- Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled or applied to the skin. Essential oils are usually mixed with a carrier oil (usually a vegetable oil) or alcohol. There is not enough scientific evidence to determine if aromatherapy improves wellbeing in arthritis patients.
- Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if driving/operating heavy machinery. Use cautiously if pregnant.
- Arnica: Arnica (Arnica montana) gel has been used on the skin for osteoarthritis pain and stiffness, due to its anti-inflammatory constituents. Although early study is promising, additional study is needed.
- Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds, or any related plants like daisies, ragweed, or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.
- Ash: The use of ash as an herbal remedy can be traced to Native Americans and the early settlers of the Americas. Ash has been historically noted for its anti-inflammatory and pain-relieving properties. There is currently little scientific evidence currently available to support its use for gouty arthritis. Future randomized, placebo controlled studies are necessary to confirm these initial results.
- Avoid if allergic or hypersensitive to ash (Fraxinus species), its constituents, or to members of the Oleaceae family. Reviews note ash pollen allergic cross-reactivities with pollen from the Fagales order (birch, alder, hazel, hornbeam, oak, and chestnut), Scrophulariales order (olive, ash, plantain, privet, and lilac), Coniferales order (cedar, cypress, and pine), and fruits and vegetables. Use cautiously if sensitive to anticoagulants (blood thinners). Use cautiously if susceptible to hypouricemia (condition where the level of uric acid is below a certain threshold), including but not limited to hyperthyroidism, inflamed kidneys, multiple sclerosis, and Fanconi syndrome. Avoid if immunocompromised. Avoid if pregnant or breastfeeding.
- Ashwagandha: The use of ashwagandha in osteoarthritis has been suggested based on its reported anti-inflammatory and anti-arthritic properties. Well-designed human research is needed in this area.
- Avoid if allergic or hypersensitive to ashwagandha. Dermatitis (allergic skin rash) has been reported.There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used.Avoid with peptic ulcer disease. Ashwagandha may cause abortion based on anecdotal reports. Avoid if pregnant or breastfeeding.
- Astaxanthin: More well-designed clinical trials are necessary before astaxanthin can be recommended for the treatment of rheumatoid arthritis.
- Avoid if allergic/hypersensitive to astaxanthin, related carotenoids, or astaxanthin algal sources. Use cautiously if taking 5-alpha-reductase inihibitors, hypertensive agents, asthma medications, cytochrome P450 metabolized agents, menopause agents or oral contraception, or Helicobacter pylori agents. Use cautiously with hypertension, parathyroid disorders, and osteoporosis. Avoid with hormone-sensitive conditions, immune disorders, or if taking immunosuppressive therapies. Avoid with previous experience of visual changes while taking astaxanthin and with low eosinophil levels. Avoid if pregnant or breastfeeding.
- Ayurveda: There is some evidence that a traditional Ayurvedic herbal formula RA-1 may reduce joint swelling but not other symptoms in rheumatoid arthritis. RA-1 contains Withania somnifera (ashwagandha), Boswellia serrata (gugulla), Zingiberis officinale (ginger) and Curcuma longa (turmeric). A resin that is extracted from Boswellia serrata (H15, indish incense) is regarded in Ayurvedic medicine as having anti-inflammatory properties. However, evidence from one study showed no benefit in patients with rheumatoid arthritis. More studies are needed to determine efficacy of these treatments for rheumatoid arthritis.
- There is early evidence that an Ayurvedic formula containing roots of Withania somnifera, the stem of Boswellia serrata, rhizomes of Curcuma longa, and a zinc complex (Articulin-F®) may significantly improve symptoms of osteoarthritis. Other research suggests that taking guggul (Commiphora mukul) daily as a powder capsule supplement may reduce pain and improve functioning in OA. Further research is needed before a recommendation can be made.
- Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking.
- Beta carotene: Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Beta-carotene supplementation does not appear to prevent osteoarthritis, but it may slow progression of the disease. Well-designed clinical trials are needed before a conclusion can be drawn.
- Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
- Beta sitosterol: Beta-sitosterol and beta-sitosterol glucoside have been observed to lower blood levels of IL-6 and, therefore, have been studied as a treatment for rheumatoid arthritis. Larger populations of patients with rheumatoid arthritis should be evaluated in well-conducted clinical study if conclusions are to be made.
- Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinsonism or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
- Black cohosh: There is not enough human research to make a clear recommendation regarding the use of black cohosh for rheumatoid arthritis pain.
- Use cautiously if allergic to members of the Ranunculaceaefamily such as buttercups or crowfoot. Avoid with hormone conditions (breast cancer, ovarian cancer, uterine cancer, endometriosis). Avoid if allergic to aspirin products, non-steriodal anti-inflammatories (NSAIDs, Motrin®, ibuprofen, etc.), blood-thinners (like warfarin) or with a history of blood clots, stroke, seizures, or liver disease. Stop use before surgery/dental/diagnostic procedures with bleeding risk and avoid immediately after these procedures. Avoid if pregnant or breastfeeding.
- Black currant: Early study shows promise for the use of black currant seed oil in reducing the signs and symptoms of rheumatoid arthritis. However, additional study is needed to confirm these findings.
- Avoid if allergic or hypersensitive to black currant, its constituents, or plants in the Saxifragaceae family. Avoid in patients with hemophilia or those on blood thinners unless otherwise recommended by a qualified healthcare provider. Use cautiously with venous disorders or gastrointestinal disorders. Use cautiously if taking MAOIs (antidepressants) or vitamin C supplements. Avoid if pregnant or breastfeeding.
- Boron: Boron is a trace element, which is found throughout the global environment. Based on human population research, individuals who eat foods rich in boron (including green vegetables, fruits, and nuts) appear to have fewer joint disorders. It has also been proposed that boron deficiency may contribute to the development of osteoarthritis. However, there is a lack of human evidence that supplementation with boron is beneficial as prevention against or as a treatment for osteoarthritis.
- Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, chronic obstructive pulmonary disease (COPD), or hormone-sensitive conditions (e.g., breast cancer or prostate cancer). Avoid if pregnant or breastfeeding.
- Boswellia: Boswellia has been noted in animal and laboratory studies to possess anti-inflammatory properties. Based on these observations, boswellia has been suggested as a potential treatment for rheumatoid arthritis and osteoarthritis. However, data is conflicting, and combination products were used in some studies. Therefore, there is currently insufficient evidence to recommend for or against the use of boswellia for rheumatoid arthritis.
- Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble medications, agents metabolized by the liver's cytochrome P450 enzymes, or sedatives. Use cautiously with impaired liver function or liver damage or lung disorders. Use cautiously in children. Avoid if pregnant due to potential abortifacient effects or if breastfeeding.
- Bowen therapy: Bowen therapy is a technique that involves gentle but precise soft tissue manipulation. Early research suggests that Bowen therapy may improve the range of motion in patients with frozen shoulder.
- Bowen therapy is generally believed to be safe in most people. However, safety has not been thoroughly studied. Bowen therapy should not be used for severe conditions or in place of more proven treatments. Use cautiously in patients with cancer or in those who are undergoing surgery.
- Bromelain: Results of a study found a combination supplement called ERC (enzyme-rutosid combination -rutosid, bromelain, trypsin) may be considered as an effective and safe alternative to prescription anti-inflammatory drugs (NSAIDs), such as diclofenac, in the treatment of knee pain associated with osteoarthritis. Further well-designed clinical trials of bromelain alone are needed to confirm these results. Bromelain also cannot be recommended for the treatment of rheumatoid arthritis until further research is conducted.
- Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceaefamily. Use cautiously with history of a bleeding disorder, stomach ulcers, heart disease, or liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
- Cat's claw: Several laboratory and animal studies suggest that cat's claw may reduce inflammation, and this has led to research of cat's claw for conditions such as rheumatoid arthritis. Early research also suggests that cat's claw may reduce pain from osteoarthritis of the knee. Large, high-quality human studies are needed before a conclusion can be drawn.
- Avoid if allergic to cat's claw, Uncaria plants, or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system. Use cautiously with bleeding disorders or with a history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic Texan grown plant, Acacia gregii, being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
- Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Further research is needed to determine if chiropractic therapy is an effective treatment for hip pain or osteoarthritis.
- Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers.
- Chlorophyll: Diets high in chlorophyll have been hypothesized to modify intestinal flora resulting in improved management of immune disorders including rheumatoid arthritis. More evidence is needed to support the use of chlorophyll in autoimmune diseases.
- Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
- Copper: The use of copper bracelets in the treatment of arthritis has a long history of traditional use, with many anecdotal reports of effectiveness. There are research reports suggesting that copper salicylate may reduce arthritis symptoms more effectively than either copper or aspirin alone. Further study is needed before a recommendation can be made.
- Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.
- DHEA: Preliminary evidence suggests that DHEA (dehydroepiandrosterone) may not offer benefit to individuals with rheumatoid arthritis. Further research is needed in this area.
- Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
- DMSO (dimethyl sulfoxide): Applying DMSO to the skin may help treat rheumatoid arthritis. More research is needed before a conclusion can be drawn.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Dong quai: Dong Quai (Angelica sinensis), also known as Chinese angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. Dong quai is traditionally used to treat arthritis. However, there is insufficient reliable human evidence to recommend the use of Dong quai alone or in combination with other herbs for osteoarthritis or rheumatoid arthritis.
- Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is unknown. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Avoid before dental or surgical procedures. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Aromatherapy using eucalyptus has been studied for its effects on pain, depression, and feelings of satisfaction in life in arthritis patients. Aromatherapy may help reduce pain and depression, but does not appear to alter the feeling of satisfaction in life. Additional study is needed to clarify these findings.
- Avoid if allergic to eucalyptus oil or with a history of seizures, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Avoid with a history of acute intermittent porphyria. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Evening primrose oil: Benefits of evening primrose oil in the treatment of rheumatoid arthritis have not clearly been shown. More research is needed before a conclusion can be made.
- Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
- Feverfew: There is currently not enough evidence to support the use of feverfew for rheumatoid arthritis. Further research is warranted.
- Avoid if allergic to feverfew and other plants of the Compositaefamily (chrysanthemums, daisies, marigolds, ragweed). Stop use prior to surgery and dental or diagnostic procedures. Avoid with drugs that increase bleeding risk. Avoid stopping feverfew use all at once. Avoid if history of heart disease, anxiety or bleeding disorders. Caution is advised with a history of mental illness, depression and headaches. Avoid if pregnant or breastfeeding.
- Gamma linolenic acid (GLA): Several clinical studies indicate significant therapeutic improvements in rheumatoid arthritis symptoms with use of gamma linolenic acid (GLA).
Additional study is needed before a conclusion can be made.
- Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
- Ginger: Well-designed clinical trials are necessary before ginger can be recommended for the treatment of rheumatoid arthritis or osteoarthritis.
- Avoid if allergic to ginger or other members of the Zingiberaceaefamily. Avoid with anticoagulation therapy. Avoid large quantities of fresh cut ginger with inflammatory bowel disease or a history of intestinal obstruction. Use cautiously prior to surgery and with gastric or duodenal ulcers, gallstones, cardiovascular disease, and diabetes. Use cautiously long-term and in underweight patients. Use cautiously if taking heart medications or sedatives and if driving or operating heavy machinery. Use cautiously if pregnant or breastfeeding.
- Glucosamine: Preliminary human research reports benefits of glucosamine in the treatment of joint pain and swelling in rheumatoid arthritis patients. However, additional research is needed before a conclusion can be made.
- Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use caution with diabetes or a history of bleeding disorders. Avoid if pregnant or breastfeeding.
- Green lipped mussel: The green-lipped mussel is native to the New Zealand coast and is a staple in the diet of the indigenous Maori culture. There is conflicting evidence of the effect of green-lipped mussel supplementation for treating osteoarthritis. Reliable evidence is needed to determine whether green-lipped mussel is effective for this use.
- Green-lipped mussel is generally considered safe. Avoid with allergy or sensitivity to green-lipped mussel or other shellfish. Avoid with liver disease. Use cautiously with anti-inflammatory agents. Use cautiously with asthma. Avoid if pregnant or breastfeeding.
- Green tea: Green tea is made from the dried leaves of Camellia sinensis, an evergreen shrub. Research indicates that green tea may benefit arthritis by reducing inflammation and slowing cartilage breakdown. Further studies are required before a recommendation can be made.
- Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.
- Guggul: There is currently insufficient evidence to support the use of guggul or guggul derivatives for the management of rheumatoid arthritis or osteoarthritis.
- Avoid if allergic to guggul. Avoid with a history of thyroid disorders, anorexia, bulimia, or bleeding disorders. Signs of allergy to guggul may include itching and shortness of breath.
Avoid if pregnant or breastfeeding.
- Guided imagery: Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with osteoarthritis or juvenile rheumatoid arthritis. Further research is needed to confirm these results.
- Guided imagery is usually intended to supplement medical care, not to replace it, and should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. Speak with a qualified health care provider before practicing guided imagery if feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse.
- Hops: Early clinical research suggests that a combination formula containing hops may help reduce symptoms of rheumatic diseases. However, well-designed human trials using hops alone are needed to determine if these positive effects are specifically the result of hops.
- Avoid if allergic to hops, its constituents, members of the Cannabaceae family, peanuts, chestnuts, or bananas. Use cautiously if driving or operating heavy machinery. Use cautiously with hormone-sensitive conditions (e.g. breast cancer, uterine cancer, cervical cancer, prostate cancer, or endometriosis) and diabetes. Use cautiously if taking hormonal agents (e.g. contraceptives or fertility agents). Use cautiously if pregnant or breastfeeding; some hops preparations contain high levels of alcohol and should be avoided during pregnancy.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. Historically, hydrotherapy has been used to treat symptoms related to rheumatoid arthritis and osteoarthritis. Multiple studies have been published, largely based on therapy given at Dead Sea spa sites in Israel. Although most studies report benefits in pain, range of motion, or muscle strength, due to design flaws, there is not enough reliable evidence to draw a firm conclusion.
- Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
- Hypnotherapy: Although multiple trials report diminished pain levels or requirements for pain-relieving medications after hypnotherapy, there is limited research for rheumatoid arthritis pain specifically. Other signs of rheumatoid arthritis, such as joint mobility or blood tests for rheumatoid factor, have not been adequately assessed.
- Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
- Lavender: Early human studies have found conflicting results on the use of massage with lavender aromatherapy for rheumatoid arthritis pain. More research is needed to make a conclusion.
- Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia) or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
- Magnet therapy: Initial evidence has failed to show improvements in pain from rheumatoid arthritis or osteoarthritis with the use of magnet therapy. However, due to methodological weaknesses of this research, the conclusions cannot be considered definitive.
- Avoid with implantable medical devices like heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Massage: Massage may be of benefit for rheumatoid arthritis, but there is currently not enough scientific data on which to base a strong conclusion for this indication.
- Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
- Mistletoe: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. According to a retrospective case study, mistletoe injections may help manage arthritis. Further research is needed before a firm conclusion can be made.
- Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening, shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking cholinergics.
- Moxibustion: There is preliminary evidence suggesting that patients suffering from rheumatoid arthritis may experience improved immune function as a result of acupuncture and moxibustion. However, evidence is insufficient at this time for making conclusions.
- Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, over allergic skin conditions or ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or if taking a hot bath or shower. Caution with elderly people with large vessels. It is advised to not bathe or shower for up to 24 hours after a moxibustion treatment.
- MSM: Methylsulfonylmethane, or MSM, is a form of organic sulfur that occurs naturally in a variety of fruits, vegetables, grains, and animals. MSM is a normal oxidation product of dimethyl sulfoxide (DMSO). Preliminary study has used MSM, alone or in combination with glucosamine, in the treatment of osteoarthritis. The combination may provide pain relief and reduction in inflammation. Further studies on MSM and its effects on patients with osteoarthritis are warranted.
- Avoid if allergic or hypersensitive to MSM. Long-term effects of supplementation with MSM are unknown. Avoid if pregnant or breastfeeding.
- Niacin: Vitamin B3 is made up of niacin (nicotinic acid) and its amide, niacinamide, and can be found in many foods, including yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Preliminary human studies suggest that niacinamide may be useful in the treatment of osteoarthritis. Further research is needed.
- Avoid niacin/vitamin B3 if allergic to niacin or niacinamide. Avoid with a history of liver disease or dysfunction, irregular heartbeats, heart disease, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
- Pantothenic acid (vitamin B5): It has been reported that pantothenic acid levels are lower in the blood of rheumatoid arthritis patients than healthy individuals. However, it is not clear if this is a cause, effect or a beneficial adaptive reaction. There is currently insufficient scientific evidence in this area in order to form a clear conclusion.
- Pantothenic acid has also been suggested as a possible treatment for osteoarthritis. However, further research is needed to determine whether or not this treatment is effective.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Review study found that proteolytic enzymes, including papain, may reduce pain and inflammation in rheumatic disorders. Additional research is needed to confirm these results.
- Use cautiously in patients sensitive to papain, being treated for prostatitis, with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease or in those using immunosuppressive therapy.
- Peony: Peony's anti-inflammatory effects may benefit patients with rheumatoid arthritis. However, there is currently not enough evidence for or against this use of peony.
- Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
- Physical therapy: Several studies have indicated that treatment of rheumatoid arthritis with physical therapy may help improve morning stiffness and grip strength. Some experts have suggested a long-term, high-intensity exercise program. Beneficial effects may last up to one year. Despite promising early evidence, better-designed studies are needed to draw a firm conclusion. More research is also needed to determine if physical therapy is an effective treatment for frozen shoulder, hip pain, joint problems (including rotator cuff and sacroiliac joint dysfunction), or osteoarthritis.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Podophyllum: Preliminary research suggests that podophyllum may be helpful for rheumatoid arthritis. Research is limited due to the possible adverse effects like severe diarrhea associated with oral podophyllum. Additional research is needed before a firm conclusion can be drawn.
- Avoid if allergic/hypersensitive to podophyllum or to members of the Berberidaceae family. Podophyllum, when applied topically, may be absorbed through the skin and cause irritation of the stomach and intestines. Podophyllum toxicity may cause heart palpitations and blood pressure changes, muscle paralysis, difficulty walking, confusion, and convulsions. Using podophyllum and laxatives may result in dehydration and electrolyte depletion. Use cautiously with arrhythmia, Crohn's disease, cardiovascular problems, gallbladder disease or gallstones, high blood pressure, irritable bowel syndrome, liver insufficiency, muscular, and neurologic disorders, psychosis, or kidney insufficiency. Use cautiously if taking antimiotic agents like vincristine, anti-psychotic agents, or laxatives. Avoid if pregnant or breastfeeding.
- Prayer, distant healing: Initial research suggests that in-person intercessory prayer (praying by others in the presence of patients) may reduce pain, fatigue, tenderness, swelling and weakness in rheumatoid arthritis when it is used in addition to standard care. Better quality research is necessary before a firm conclusion can be drawn.
- Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers. Based on limited clinical study, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.
- Probiotics: In limited study, Lactobacillus GG was associated with improved subjective well-being, as well as reduced symptoms of rheumatoid arthritis. However, these findings were not statistically significant. More studies on the effects of probiotics in rheumatoid arthritis are needed.
- Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
- Propolis: Based on anti-inflammatory action observed in laboratory research, propolis has been proposed as a possible treatment for rheumatic diseases. However, there is currently not enough scientific human study to make a conclusion.
- Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, and Balsam of Peru. Severe allergic reactions have been reported. Use cautiously with asthma or gastrointestinal disorders. Avoid if pregnant or breastfeeding because of the high alcohol content in some propolis products.
- Reishi mushroom: A combination of reishi mushroom and San Miao San (a mixture of several Chinese herbs) may help reduce the pain of rheumatoid arthritis. However, these herbs did not reduce swelling. More research with reishi mushroom alone is needed.
- Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Avoid if pregnant or breastfeeding.
- Relaxation therapy: Limited preliminary research reports that muscle relaxation training may improve function and well being in patients with rheumatoid arthritis. Additional research is necessary before a conclusion can be reached.
- In a randomized study of patients with osteoarthritis pain, Jacobson relaxation was reported to lower the level of subjective pain over time. The study concluded that relaxation might be effective in reducing the amount of analgesic medication taken by participants. Further well-designed research is needed to confirm these results.
- Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.
- Selenium: Selenium supplementation has been studied in rheumatoid arthritis patients with mixed results. Additional research is necessary before a clear conclusion can be drawn.
- Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
- Shark cartilage: Chondroitin sulfate, a component of shark cartilage, has been shown to benefit patients with osteoarthritis. However, the concentrations of chondroitin in shark cartilage products may be too small to be helpful. The ability of shark cartilage to block new blood vessel growth or reduce inflammation is suggested to be helpful in rheumatoid arthritis. However, there is limited research in these areas, and more studies are needed before a recommendation can be made.
- Avoid if allergic to shark cartilage or any of its ingredients (including chondroitin sulfate and glucosamine). Use cautiously with sulfur allergy. Avoid with a history of heart attack, vascular disease, heart rhythm abnormalities (arrhythmias) or heart disease. Use cautiously with a history of liver or kidney disorders, tendency to form kidney stones, breast cancer, prostate cancer, multiple myeloma, breathing disorders (like asthma), cancers that raise calcium levels (like breast, prostate, multiple myeloma or squamous cell lung cancer) and diabetes. Avoid if pregnant or breastfeeding.
- Soy: It is unclear if soy is an effective treatment for rheumatoid arthritis or osteoarthritis. Additional research is warranted in this area.
- Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy supplements.
- Spiritual healing: There is currently not enough evidence that spiritual healing adds any benefit to conventional treatment in rheumatoid arthritis. Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
- Stinging nettle: Stinging nettle is widely used as a folk remedy to treat arthritis and rheumatic conditions throughout Europe and Australia. Pre-clinical evidence suggests that certain constituents in the nettle plant have anti-inflammatory and/or immunomodulatory activity and may be of benefit in rheumatoid arthritis. Well-designed, randomized controlled trials are needed to further support its use in humans.
- Avoid if allergic or hypersensitive to nettle, members of the Urticaceae family, or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
- Tai chi: There is not enough scientific evidence showing that tai chi reduces rheumatoid arthritis symptoms, although tai chi may help improve range of motion of the lower extremities. A small trial in women with osteoarthritis reported that treatment with tai chi significantly decreased pain and stiffness compared with a sedentary lifestyle. Women in the tai chi group also reported fewer perceptions of difficulties in physical functioning. More research is needed in this area.
- Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
- TENS (Transcutaneous Electrical Nerve Stimulation): Preliminary studies of TENS in rheumatoid arthritis report improvements in joint function and pain. However, most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Thymus extract is commonly used to treat primary immunodeficiencies, bone marrow failure, autoimmune disorders, chronic skin diseases, recurrent viral and bacterial infections, hepatitis, allergies, chemotherapy side effects, and cancer. Further research is needed to determine whether or not thymus extract can effectively treat symptoms of rheumatoid arthritis.
- Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to the potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking hormonal therapy or immunosuppressants. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
- Turmeric: Turmeric has been used historically to treat rheumatoid arthritis and osteoarthritis. Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin, however, reliable human research is lacking.
- Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
- Zinc: The majority of trials do not show significant improvements in rheumatoid arthritis symptoms following zinc treatment. Interpretation of some data is difficult because patients in the studies were permitted to continue their previous arthritis medication and most studies used a small number of participants. Well-designed clinical trials are needed before a definitive conclusion can be made.
- Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Green lipped mussel: There is conflicting evidence of the effect of green-lipped mussel supplementation for treating rheumatoid arthritis. Overall, the evidence does not support this use.
- Green-lipped mussel is generally considered safe. Use cautiously with anti-inflammatory agents. Use cautiously with asthma. Avoid in patients with liver disease. Avoid with allergy or sensitivity to green-lipped mussel or other shellfish. Avoid if pregnant or breastfeeding.
- Selenium: Selenium-ACE, a formulation containing selenium with three vitamins, has been promoted for the treatment of arthritis. Research has failed to demonstrate significant benefits, with a possible excess of side effects compared to placebo.
- Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
- Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma and delta tocopherol; and alpha, beta, gamma and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Vitamin E does not appear to reduce symptoms or prevent cartilage loss in osteoarthritis.
- Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.
- Willow bark: Based on limited clinical study, willow bark extract has not shown efficacy in treating rheumatoid arthritis. More high-quality studies of larger design are needed to make a conclusion.
- Avoid if allergic/hypersensitive to aspirin, willow bark (Salix spp.), or any of its constituents, including salicylates. Use cautiously with gastrointestinal problems, such as ulcers, hepatic disorders, diabetes, gout, hypertension, hyperlipidemia, history of allergy or asthma, and leukemia. Use cautiously if taking protein-bound medications, antihyperlipidemia agents, alcohol, leukemia medications, beta-blockers, diuretics, Phenytoin (Dilantin®), probenecid, spironolactone, sulfonylureas, valproic acid, or methotrexate. Use cautiously if pre-disposed to headaches. Avoid operating heavy machinery. Avoid in children with chickenpox and any other viral infections. Avoid with blood disorders, and renal disorders. Avoid if taking other NSAIDs, acetazolamide or other carbonic anhydrase inhibitors. Avoid with elevated serum cadmium levels. Avoid if pregnant or breastfeeding.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Alopecia (hair loss)
- Overview: Symptoms of alopecia vary among patients. Patients may experience subtle hair thinning, extensive hair loss, or baldness. Balding may be regional or more generalized. Males, females, and children can experience alopecia.
- If hair loss is excessive, it may lead to baldness. Hair loss and baldness can occur for a number of different reasons.
- Causes: There are two main types of hair loss: alopecia areata and androgenetica alopecia.
- Alopecia areata is an immune system disorder. Normally, the immune system helps protect the body against disease and infection. However, the immune system in patients with alopecia areata mistakes the openings in the skin where hair grows, called hair follicles, as harmful invaders. As a result, the immune system launches an attack against the hair follicles, causing hair loss.
- Androgenetica alopecia is an inherited form of baldness. This means the condition is passed down through families. An estimated 60% of patients with androgenetica alopecia are male. Androgenetica alopecia in men is also called male-pattern baldness or hair loss.
- Other causes: Hair loss may be temporary or permanent. It is normal for some hair to fall out as a result of aging. This type of hair loss is permanent. Newborns experience temporary hair loss during the first several months of life. They lose their baby hair, also called vellus, when they are several months old. This baby hair is replaced with more permanent hair. Other common causes of temporary hair loss include illnesses, surgery, medications, medical treatments (such as chemotherapy), pregnancy, poorly performed hair treatments (such as dying or bleaching), and poor nutrition.
- Symptoms: Patients with alopecia areata usually lose small round patches of hair on the scalp, face, and chest. Other parts of the body, including the eyelashes, eyebrows, and genitals, may also be affected.
- Males with androgenetica alopecia may experience hair loss during adolescence. This type of hair loss usually starts at the temples and crown of the head. Eventually, the patient may become partially or completely bald. Females with androgenetic alopecia usually experience hair loss at the front, sides, or top of the head. Unlike males, females rarely develop complete baldness. Females usually only experience hair thinning.
- Some patients with hair loss may have a difficult time coping with their appearance and may experience a decrease in their quality of life or suffer from low self-esteem. These patients may benefit from medical or non-medical hair replacements. Treatment may include hair pieces, surgery, or medications.
- Patients who experience hair loss have an increased risk of developing sunburn, especially if they have light or fair skin.
- Diagnosis: In most cases, alopecia does not require testing for a diagnosis. The healthcare provider can usually determine the cause of hair loss after a physical examination and medical history. If there is a family history of alopecia, androgenetica alopecia is suspected. The healthcare provider will also ask questions about recent infections, new medications, diet, and hair treatments
(such as dying or bleaching)
to determine if such factors are causing hair loss. If alopecia areata is suspected, a fluorescent antinuclear antibody (FANA) test may be used to confirm a diagnosis.
- Treatment: It is normal for infants to lose their hair, and it should not raise concern. If other factors, such as hair treatments, are causing hair loss, the condition is temporary, and the hair will begin to grow back over time. If a medication (such as birth control pills) or medical treatment (such as chemotherapy) is causing hair loss, the hair will grow back once the treatment is completed. If a doctor confirms that poor nutrition or an illness is causing hair loss, the hair will grow back once the underlying cause is treated. There is currently no cure for alopecia areata or androgenetica alopecia. Although some patients with alopecia areata or androgenetica alopecia prefer to let the hair loss run its course, treatments are available.
- Individuals may choose non-medical treatments, such as wigs or hairpieces, to replace lost hair.
- Several treatments, such as hair replacement/restoration surgery and hair transplants, are available to replace lost hair. Hair replacement surgery is used to fill in balding areas with a patient's own hair, and hair transplant surgery involves transplanting hair from an area of thick growth to bald areas.
- In addition, medications, such as spironolactone (Aldactone®), minoxidil (Rogaine®), finasteride (Propecia®), finasteride (Proscar®), and cimetidine (Tagamet®), may help prevent or minimize hair loss.
- If patients with alopecia areata decide to pursue pharmacological treatment, they typically receive drugs called corticosteroids for the rest of their lives. These drugs help reduce the body's immune response, which limits the number of hair follicles that are attacked. Patients may receive injections with corticosteroids, such as betamethasone (Celestone®), into the scalp. Patients typically receive these injections monthly. Some patients with extensive hair loss may take corticosteroid pills. Corticosteroid creams and ointments, such as betamethasone (Diprolene®), have been applied to affected areas of the skin. However, creams and ointments are generally less effective than injections.
- Patients who are bald or have bald patches of skin on the scalp should put sunblock on the scalp to prevent sunburn and skin cancer. Patients should choose a sunblock with a sun protection factor (SPF) of 15 or higher. The sunblock should offer protection against both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Patients with hair loss should wear hats in the sun and try to minimize sun exposure, if possible. An umbrella or parasol may also be beneficial.
- Overview: Dandruff is characterized by dry, flaky, and itchy skin on the scalp. It is estimated that 15-20% of people worldwide have dandruff.
- Causes: A yeast-like fungus on the scalp, called malassezia, causes dandruff. This fungus, which feeds on the oils secreted by the hair follicles, is normally found on most healthy adults. Dandruff develops if the organism grows uncontrollably. Scientists have not discovered what causes an overgrowth of the fungus. It has been suggested that changes in hormone levels, stress, illnesses, neurological disorders (such as Parkinson's disease), a weakened immune system, increased oil production, and increased sensitivity to the malassezia fungus may lead to the development of dandruff.
- Symptoms: Dandruff causes dry, itchy, and excessive flaking of skin on the scalp. White flakes of skin may be visible on clothing.
- Diagnosis: A medical diagnosis is not required for dandruff.
- Treatment: Patients can purchase medicated shampoos to treat dandruff. For instance, zinc pyrithione shampoos (Selsun Salon® or Head & Shoulders®), tar-based shampoos (Neutrogena® or T/Gel®), salicylic acid shampoos (Ionil T®), selenium sulfide shampoos (Selsun Blue®), and ketoconazole shampoos (Nizoral®) have been used to treat dandruff.
- Overview: Hirsutism occurs when a woman develops excessive amounts of dark coarse hair on parts of the body where men usually grow hair, including the face (cheeks, upper lip, and chin), back, and chest. Researchers estimate that about 10% of Americans have hirsutism.
- Causes: Hirsutism may develop if a woman has too many male hormones, called androgens. This is the case for about half of all women who have hirsutism. There are many conditions that may lead to high levels of androgens, including polycystic ovary syndrome, an adrenal gland disorder called Cushing's syndrome, congenital adrenal hyperplasia, and, in rare cases, tumors. Some medications that have androgenic activity, such as danazol (Danocrine®), may also lead to hirsutism.
- Other cases of hirsutism are genetically inherited. The hair follicles of these individuals are unusually sensitive to androgens. The inherited form of hirsutism is most common in southern European and South Asian countries.
- In some cases, there is no identifiable cause of the disorder. This is commonly called idiopathic hirsutism.
- Symptoms: Coarse, dark hair develops on areas of the body, such as the face, back, and chest. If the condition is caused by high levels of androgens, women may also experience acne, decreased breast size, enlarged clitoris, increased muscle mass, amenorrhea (absence of menstruation), and deepening of the voice.
- Diagnosis: A healthcare provider first takes a detailed medical and family history. During a physical examination, the doctor looks for excessive hair growth. The doctor may also look for additional physical symptoms that indicate an androgen imbalance, such as acne, decreased breast size, enlarged clitoris, increased muscle mass, amenorrhea (absence of menstruation), and deepening of the voice.
- Blood tests may be performed to see if the patient has high levels of certain hormones in the blood, including testosterone and androgen. This helps the healthcare provider determine if high levels of androgens are causing the condition. An ultrasound may also be performed to determine if there are tumors or cysts on the ovaries or adrenal glands.
- If high levels of androgens are detected, additional tests may be performed to determine the underlying cause. For instance, a computerized tomography (CT) scan of the adrenal glands may be performed to determine if an adrenal gland disorder, called Cushing's syndrome, is causing the disorder.
- Treatment: A combination of self-care and medical therapies has been shown to effectively treat many patients with hirsutism.
- Plucking, shaving, waxing, and threading may be used to remove unwanted hair. However, these procedures do not have long-lasting effects. Some women bleach their unwanted hair in order to make it less noticeable.
- Patients may also undergo a procedure called electrolysis to permanently remove unwanted hair. During the procedure, a tiny needle is inserted into each hair follicle. An electrical pulse is used to destroy the hair follicle. Although this treatment is effective, it is painful and time consuming. There are some anesthetic creams available to help reduce the pain. Side effects of this treatment generally include lightening or darkening of the treated skin. In rare cases, it may cause scarring.
- Laser therapy may also be used to remove unwanted hair. This therapy uses an intensely powerful beam of light to destroy hair follicles and prevent hair from growing. Treatment may last anywhere from a few minutes to hours, depending on the amount of hair that is being removed. Some patients may not grow any hair for long periods of time. Others may need to undergo repeat treatments from time to time. Because the laser beams are attracted to pigment, people with light skin and dark hair might benefit the most from this treatment. Laser therapy may be uncomfortable for some patients. Side effects may include color changes in the skin, redness and swelling on the treated areas, and sometimes burns on the skin.
- Some patients may benefit from birth control pills or other medications
that contain female hormones (estrogen and progestin), such as Cenestin®, Enjuvia®, or Gynodiol®. These medications stop the ovaries from producing androgen.
- Medications, called anti-androgens, may also be beneficial. Anti-androgens, such as spironolactone (Aldactone®), prevent androgens from attaching to receptors in the body.
- A prescription-strength cream, called elfornithine (Vaniqa®), is designed to reduce the growth of facial hair in women. The medication is applied to areas of the face that have unwanted hair. It may take up to two months before results are seen. This is because it slows the growth of new hair, but does not get rid of existing hair. The hair will start to grow back within eight weeks of stopping treatment. Common side effects include tingling or stinging sensations on the treated skin or a rash.
- Overview: Poliosis is a condition that is characterized by a small patch of white hair. Poliosis can develop at any age and may affect hair on any part of the body. In some cases, poliosis may be a sign of an underlying medical condition.
- Causes: Poliosis may be present at birth or occur later in life. Some cases are genetically inherited and are not a cause for concern.
- Poliosis may also occur if the patient suffers from autoimmunity. This happens when the immune system, which is supposed to fight against disease an infection, mistakenly destroys the pigment cells in a localized area. This causes patches of white, colorless hair to grow.
- Poliosis may also be a sign of underlying medical conditions, such as Marfan's syndrome, Waardenburg's syndrome, or a skin disorder called vitiligo.
- Symptoms: Individuals with poliosis have white patches of hair that may develop anywhere on the body. However, most patients develop white patches on the front of the hairline.
- Diagnosis: A healthcare provider will take a detailed medical and family history. A blood test may be performed to determine if an autoimmune or genetic disorder is causing the symptoms. A sample of skin may also be analyzed to determine if the patient has a skin disorder, such as vitiligo.
- Treatment: There is currently no cure for poliosis. Individuals can choose to dye their hair so it matches their normal hair color. They may also style their hair in a way that covers or hides the white patch of hair.
- Overview: Premature graying occurs when more than half of the hair on the head is white before the age of 40. Other hair on the body, including the facial, pubic, chest, and back hair, may also turn gray. Although the condition may be upsetting for some people, it is not a cause for concern.
- Causes: Premature graying is an inherited condition that is passed down among families. People with family histories of premature graying have an increased risk of developing the condition.
- Symptoms: The hair located near the temples is most likely to turn gray first. The gray hair may spread around the sides and to the crown over time. Other hair on the body, including facial, pubic, chest, and back hair may turn gray. Facial hair may also turn gray early, but chest and pubic hair usually turns gray a few years after the hair on the scalp does.
- Diagnosis: A medical diagnosis is not necessary for premature graying.
- Treatment: There is no cure for premature graying. Individuals can choose to dye their hair.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.