Complementary therapies can ‘harmonize’ with RA treatment
Though data does not support alternative therapies in rheumatoid arthritis, many experts agree complementary therapy – both via lifestyle changes and supplements or nutrition – should be discussed with each patient individually.
Susan M. Goodman, MD, of the Hospital for Special Surgery, spoke with Healio about the role complementary therapies plays in the treatment of RA.
Healio: What are the most common complementary therapies used in RA?
Goodman: Complementary therapies harmonize with traditional therapy, and include diet, acupuncture, massage, and T’ai chi, among others, and all have benefits for some people with RA.
Treatment for RA can be viewed as either treating symptoms by decreasing pain and improving function, or decreasing joint damage over time, and complementary therapies can be very helpful, when taken with prescribed medication. These interventions can relieve pain and help improve function by strengthening muscles and improving balance, thus taking pressure off painful joints.
Healio: How are complementary therapies integrated into patient visits?
Goodman: I like to discuss exercise programs with my patients, which is a topic that can easily include use of therapies such as yoga or Pilates. I typically recommend that people who are unfamiliar with these regimens start with an instructor so they learn proper form, lessening the risk of injury, and that they always tell the instructor that they may not keep up with the class due to their RA. For instance, many people with RA have wrist involvement, and may need to modify any stance that includes pressure on the wrist.
My patients have reported that the instructors have been universally helpful to them as they begin a new discipline. If they are interested in acupuncture, I am happy to guide them to practitioners. For many patients, the combination of a regimen that includes a meditative strengthening program such as yoga or Pilates helps them achieve balance in control of their disease.
Healio: What data is there to support or refute these therapies in RA?
Goodman: There is very little data to support use of these therapies, and none that demonstrate a disease modifying effect – that is slowing the rate of X-ray progression. However, some supplements can help with pain management, such as turmeric and fish oil, and do have a mild anti-inflammatory effect.
Healio: How does lifestyle play into disease management?
Goodman: All people who have a chronic disease, such as RA, function and do better when they are active participants in their therapy. This includes careful shared decision making regarding traditional and biologic disease modifying medications, as well as complementary therapies.
People with RA feel better when they balance rest and activity, and most find that adding an exercise regimen such as yoga or Pilates improves their overall well-being.
Healio: How can rheumatologists encourage health habits in patients with RA?
Goodman: All people with RA can be encouraged in a healthy balance of diet and exercise, maintaining a healthy body weight to avoid both the inflammation that comes from fat tissue as well as the impact on the weight bearing joints. Strengthening the muscles that support the joints protects them and decreases pain, improving function.
Factors known to increase RA damage and decrease the odds of achieving remission include smoking and obesity, so it is important for rheumatologists to council their patients so that their RA can be optimally controlled.