Arthritis FAQs, Rheumatoid Arthritis and Complementary and Alternative Medicine, Health Encyclopedia

Rheumatoid Arthritis

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Rheumatoid arthritis (RA) is a chronic disease that affects the joints, often those in a person's wrists, fingers, and feet. (Terms that are underlined are defined "Definitions".) The common symptoms of RA are pain, stiffness, fatigue, sleep disturbances, and fever. There are treatments for RA in conventional medicine, but some people also try complementary and alternative medicine (CAM).a This report answers some frequently asked questions on this topic and suggests sources for more information.

aCAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians. Some practitioners of conventional medicine are also practitioners of CAM.

Key Points


What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is what is called an autoimmune disease. In this type of disease, a person's immune system (the system in the body responsible for fighting disease) mistakenly attacks the person's own body. In RA, the parts attacked are the linings of the joints (places in the body where two bones connect). The reasons that this happens are complex and not fully understood. RA causes pain, swelling, and stiffness in a person's joints and problems with functioning. However, RA affects different people in different ways, in terms of the symptoms they have, how serious the symptoms are, and how long the symptoms last. RA is different from other types of arthritis (such as osteoarthritis). For example:

To find out more about RA, contact the National Institute of Arthritis and Musculoskeletal and Skin Diseases (see "For More Information").


How is rheumatoid arthritis treated in conventional medicine?

There are many proven treatments in conventional medicine for RA. They are used to relieve pain, reduce swelling, slow down or stop the damage to joints, help the person function better, and improve the person's sense of well-being. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biological response modifiers, and corticosteroids. Non-drug treatments include physical therapy; modified exercise programs; devices such as canes, special shoes, and splints (rigid supports that keep a part of the body from moving while it heals); and lifestyle changes--such as balancing activity with rest, eating a healthy diet, and reducing stress. Scientific research is advancing in understanding the many complexities of RA and in uncovering new and promising treatments.

It is important for people with RA to have their condition followed by a rheumatologist (a physician who specializes in diseases of the bones, muscles, and joints). This helps prevent or minimize damage to the joints and disability, which can occur if RA is left untreated over time.


Why do some people with rheumatoid arthritis use CAM, and what do they use?

Among the many reasons that some people use CAM for RA are:


What CAM therapies for rheumatoid arthritis are discussed in this report?

Many types of CAM are tried for RA, such asb:

It is beyond the scope of this report to discuss the scientific evidence about all CAM therapies used for RA. The therapies listed below were selected because they are among those most frequently discussed in the scientific literature and inquired about at the NCCAM Clearinghouse.c In reading about them, you will also see some general points to consider about similar therapies (for example, other botanicals). You can seek science-based information on any CAM therapy that interests you through some of the resources listed in "For More Information."

b Information on these or any other CAM therapies can be obtained from the NCCAM Clearinghouse (see "For More Information").

cReferences for the discussions on therapies are listed at the end of this report. They consist of recent peer-reviewed literature in English in the National Library of Medicine's PubMed database; two evidence-based databases on natural products; and other Federal Government publications.


Therapies Discussed in This Report


About Dietary Supplements

Dietary supplements were defined in a law passed by Congress in 1994. A dietary supplement must meet all of the following conditions:

  • It is a product (other than tobacco) intended to supplement the diet, which contains one or more of the following: vitamins; minerals; herbs or other botanicals; amino acids; or any combination of the above ingredients.
  • It is intended to be taken in tablet, capsule, powder, softgel, gelcap, or liquid form.
  • It is not represented for use as a conventional food or as a sole item of a meal or the diet.
  • It is labeled as being a dietary supplement.

Other important information about dietary supplements:

  • They are regulated as foods, not drugs, so there could be quality issues in the manufacturing process.
  • Supplements can interact with prescribed or over-the-counter medicines, and other supplements.
  • "Natural" does not necessarily mean "safe" or "effective."
  • Consult your health care provider before starting a supplement, especially if you are pregnant or nursing, or considering giving a supplement to a child.


What are some important points to keep in mind if I have rheumatoid arthritis and am thinking about using CAM?


What is known from the scientific research about whether these CAM treatments for rheumatoid arthritis are effective and safe?

1. Botanical Supplements and Other Dietary Supplements

Overall, there is not much rigorous research available on the effectiveness and safety of botanical and other supplements that people try for RA. It is also important to know that while supplements are regulated by the U.S. Food and Drug Administration (FDA) as a category of foods, supplements made from plants and used for medicinal purposes (sometimes referred to as herbal medicines) can have effects as powerful as those of drugs. In fact, many conventional drugs first came from plants, such as digitalis (from the foxglove plant), used to treat heart failure and heart rhythm, and paclitaxel (from the yew tree), a cancer chemotherapy drug.

It is important to be as informed as possible about the safety of any supplement you are considering or using. Some information already exists from a long history of botanical use outside conventional medicine. This knowledge is being strengthened as NCCAM supports rigorous studies on botanicals and other supplements that have shown promise in early studies to find out more about their molecular structure, their safety, how they may work, and for what diseases or conditions.

Thunder God Vine
Thunder god vine (TGV for short; botanical name Tripterygium wilfordii Hook F) is a perennial vine native to China, Japan, and Korea. Preparations made from the skinned root of TGV have been used in traditional Chinese medicine to treat inflammatory and autoimmune diseases. Interestingly, TGV also has a history of use to kill insects in farm fields.

Effectiveness and safety

Gamma-Linolenic Acid (GLA)
GLA is an omega-6 fatty acid that is found in the oils of some plant seeds, including evening primrose (Oenothera biennis L.), borage (Borago officinalis L.), and black currant (Ribes nigrum L.). GLA can be used by the body to make substances that reduce inflammation.

Effectiveness and safety

Fish Oil
Fish oil contains high amounts of two omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). As with GLA, the body can use omega-3s to make substances that reduce inflammation.

Effectiveness and safety

dTwo Federal publications are "Mercury Levels in Commercial Fish and Shellfish" and "What You Need to Know About Mercury in Fish and Shellfish: Advice for Women Who Might Become Pregnant, Women Who Are Pregnant, Nursing Mothers, and Young Children" are available online. They are copublished by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency.

The herb valerian has a history of use for sleep problems and anxiety disorders. Disrupted sleep has been called a common and often neglected symptom of arthritis. A large, nationally representative survey of people over 65 with arthritis in 2000 found that disruption of sleep, among all the disruptions of arthritis, was the main reason that people sought a variety of CAM, self-care, and conventional medical treatments. Valerian has also been taken for other reasons, such as the intent to relieve muscle and joint pain. The species of valerian most used in American supplements is Valeriana officinalis.

Effectiveness and safety

Four Other Botanicals

Three of the other botanicals marketed with claims to benefit arthritis pain are:

These three botanicals have a history of use in Ayurveda to treat inflammatory conditions. Based on some early findings that may indicate promise, NCCAM is supporting studies at the University of Arizona on these three botanicals, to increase scientific knowledge about them and determine whether they are helpful for chronic inflammatory conditions such as arthritis and asthma.

A fourth botanical, feverfew, has been used in folk medicine with an intent to treat arthritis, migraine, and other conditions. One small published clinical trial was located for this report. It found no more benefit from feverfew than from the placebo. Overall, feverfew has not been proven to help RA symptoms.


Glucosamine and Chondroitin
Glucosamine sulfate (glucosamine for short) and chondroitin sulfate (chondroitin) are popular dietary supplements for arthritis. They are sold separately, in combination with each other, and in other combinations.

Glucosamine is a substance found in the fluid around the joints. It can also be obtained from the shells of shrimp, lobster, and crabs, or made in the laboratory. The body uses glucosamine to make and repair cartilage, a firm but flexible tissue that covers the ends of bones, keeps them from rubbing against each other, and absorbs the force of impact.

Chondroitin is a substance found in the cartilage around joints. As a supplement, it is obtained from sources such as sharks and cattle.

Effectiveness and safety

2. Special Diets

Many people with RA are interested in whether certain foods can affect their symptoms. Examples of foods that are believed to possibly worsen the symptoms of arthritis (including RA) are the nightshade family of plants (white potatoes, tomatoes, eggplant, and peppers), dairy, citrus fruits, acidic foods, sweets, coffee, and animal protein. There are various theories about how foods may affect RA, including:

Effectiveness and Safety

3. Acupuncture

Acupuncture is a practice that developed as a part of traditional Chinese medicine. Some people try acupuncture to treat RA pain or to treat the RA itself. For more about acupuncture, see Acupuncture

Effectiveness and Safety

4. Magnets

Magnets are objects that produce a type of energy called magnetic fields. The term "magnets" is also used to refer to consumer products that contain magnets. Examples include shoe insoles, clothing, wraps for parts of the body, and mattress pads. These are of a type called static magnets, because their magnetic fields are unchanging.

Effectiveness and Safety: Static Magnets

The second type of magnets used for health purposes are called electromagnets (EMs), because they produce magnetic fields only when electric current flows through them. EMs are used in conventional medicine to treat bone fractures that have not healed well, and they are being studied in research settings for a number of other conditions (including cancer, epilepsy, RA, and mental disorders). Some consumer products using EMs are available.

Effectiveness and Safety: Electromagnets

For more about magnets, see the NCCAM fact sheet "Questions and Answers About Using Magnets To Treat Pain."

5. Hydrotherapy

Hydrotherapy is the use of water for therapeutic purposes. A few examples of hydrotherapy include bathing in heated water, as from hot springs or the sea; mineral baths; and water-jet massages. Another term used for hydrotherapy baths is balneotherapy.

Hydrotherapy dates back to ancient Greece and Rome. In recent centuries, it has been a popular treatment in Europe and Israel. Some forms of hydrotherapy are used in conventional medicine in the United States, such as whirlpool baths for athletic injuries and ice for sprains. As CAM, hydrotherapy is often combined with other treatments, such as exercises, massage, diets, herbs, and/or mud packs. It is used with the intent to benefit arthritis, circulation, and various other health issues, and to enhance feelings of relaxation and well-being. Some also claim that hydrotherapy "detoxifies" the body. In this report, the term hydrotherapy refers to external water treatments and not to internal treatments using water, such as colon irrigation or drinking specially treated water.

Effectiveness and Safety

6. Homeopathy

Homeopathy is a whole medical system that was developed in Germany and brought to the United States in the 19th century. Homeopathy involves giving very small doses of substances called remedies that would produce the same or similar symptoms of illness in healthy people when given in larger doses. This approach is called "like cures like." The remedies are diluted very highly, often to a point where not one molecule of the original substance remains. For more about homeopathy, see NCCAM's fact sheet "Questions and Answers About Homeopathy."

Effectiveness and Safety

7. Selected Mind-Body Techniques

Mind-body techniques draw upon the interactions that exist in health and disease between the mind, the emotions, the body as a whole, and various body systems (such as the immune, nervous, and endocrine systems). Some mind-body techniques are part of ancient healing traditions, others have emerged in recent times. Examples of mind-body techniques include meditation, tai chi, relaxation techniques, and spirituality for health purposes.

Effectiveness and Safety

e In this study, spirituality was described as something "often viewed as an intrinsic quality of the individual, a desire for personal connectedness with a transcendence reality." This was different from religiousness, "an outward practice of a particular spiritual understanding and/or the framework of beliefs, values, and rituals," although the authors noted that this distinction is difficult. Spirituality was measured using a scale designed to evaluate "the capacity of an individual to stand outside of his/her immediate sense of time and place and to view life from a larger, more detached perspective."


Is NCCAM funding research on CAM therapies for rheumatoid arthritis?

Yes. Examples of recent studies include:

Recently published NCCAM-supported research on RA has included:

These and many other reports on NCCAM-supported research may be located in the CAM on PubMed database (See "For More Information").



Acupuncture: A family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of anatomical points on the body by a variety of methods, including the insertion and manipulation of thin steel needles or the use of pressure from the practitioner's hands. It is intended to remove blockages in the flow of qi. American practice of acupuncture incorporates medical traditions from China, Japan, Korea, and other countries.

Botanical: A plant or plant part that is used for its flavor, scent, and/or therapeutic properties. Examples include flowers, leaves, bark, fruits, seeds, stems, and roots; substances produced by plants; and algae.

Chiropractic: A whole medical system based on the concept that the body has a powerful self-healing ability, and its structure (primarily the spine), function, and health are closely related. The goal of therapy is to correct structural alignment problems and allow the body to heal itself.

Chronic disease: A disease that lasts a long period of time or comes back frequently.

Clinical trial: A research study in which a treatment or therapy is tested in people to see whether it is safe and effective. Clinical trials are a key part of the process in finding out which treatments work, which do not, and why. Clinical trial results also contribute new knowledge about diseases and medical conditions.

Herb: A plant or plant part used for its scent, flavor, and/or therapeutic properties. Also called a botanical. Herbal supplements are a type of dietary supplement that contains herbs, either singly or in mixtures.

Inflammation: The body's response to injury or infection. Chemicals are released from white blood cells to increase the blood flow to the area, which results in swelling, redness, and warmth.

Insomnia: A condition in which a person cannot fall asleep, cannot remain asleep, or wakes up not feeling restored or refreshed after sleeping.

Joint: The place where two bones meet.

Mind-body therapies: Practices that focus on the relationships of brain, mind, body, and behavior and how they affect health. Examples include meditation and yoga.

Omega-3 fatty acids: A group of polyunsaturated fatty acids that come from food sources, such as fish, fish oil, some vegetable oils (primarily canola and soybean), walnuts, wheat germ, and certain dietary supplements. Polyunsaturated fatty acids are one of the three types of fatty acids. They contain a chain of carbon atoms and hydrogen and oxygen molecules, with two or more double bonds between the carbon atoms.

Omega-6 fatty acids: A group of essential fatty acids found in cereals, vegetable and seed oils, eggs, and poultry. Essential fatty acids are needed for human health and cannot be made by the body.

Osteoporosis: A condition in which bones become thin and brittle and more likely to break.

Placebo: A placebo is designed to resemble as much as possible the treatment being studied in a clinical trial, except that the placebo is inactive. An example of a placebo is a pill containing sugar instead of the drug or other substance being studied. By giving one group of participants a placebo and the other group the active treatment, the researchers can compare how the two groups respond and get a truer picture of the active treatment's effects. In recent years, the definition of placebo has been expanded to include other things that could have an effect on the results of health care, such as how a patient and a health care provider interact and what the patient expects to happen from the care.

Placebo effect: The physical or psychological benefits that can occur with the use of an inert or sham treatment (a placebo), such as a sugar pill.

Relaxation techniques: Use of methods such as guided imagery to help calm the mind and release the muscles. It is used to reduce physical tension and promote emotional well-being.

Rheumatic disease: A type of disease in which inflammation and loss of function are present in one or more connecting or supporting structures of the body. These diseases especially affect the joints, tendons, ligaments, bones, and muscles. Common symptoms are pain, swelling, and stiffness, and some rheumatic diseases can also involve internal organs.

Rheumatologist: A medical doctor who specializes in treating conditions that affect the joints and muscles, such as rheumatoid arthritis.

Sedative: A substance used for medicinal purposes (such as a drug or herb) that depresses the central nervous system, producing feelings of calmness, relaxation, and drowsiness.

Tai chi: An exercise program that is part of traditional Chinese medicine. The exercises consist of a series of slow, gentle movements coordinated with breathing and meditation.

Traditional Chinese medicine: A whole medical system that was documented in China by the 3rd century B.C. Traditional Chinese medicine is based on a concept of vital energy, or qi, that is believed to flow throughout the body. It is proposed to regulate a person's spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin (negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi being disrupted and yin and yang becoming unbalanced. Among the components of traditional Chinese medicine are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage.

Whole medical systems: A general term for medical and health care systems that employ practices from among the following four domains: mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine. To find out more, see the NCCAM Web site.



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*Links to a PubMed abstract.


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For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and on NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. Examples of publications available include "What's in the Bottle? An Introduction to Dietary Supplements," "Herbal Supplements: Consider Safety, Too," "Questions and Answers About Homeopathy," and "Acupuncture."

Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

NIAMS supports research on these diseases, training of scientists, and information (including publications on RA) based on scientific evidence.

Toll-free in the U.S.: 1-877-22-NIAMS
Web site:


A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) abstracts of articles from biomedical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of NLM's PubMed system and focuses on the topic of CAM.

Web site:
CAM on PubMed:

National Institute of Allergy and Infectious Diseases

A brochure, "Food Allergies: An Overview," is available.

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NCCAM thanks the following people for their technical expertise and review of this publication: Carol Pontzer, Ph.D., and Richard L. Nahin, Ph.D., M.P.H., NCCAM; Barbara Mittleman, M.D., and Peter E. Lipsky, M.D., National Institute of Arthritis and Musculoskeletal and Skin Diseases; Diana M. Taibi, M.S.N, R.N., and Cheryl Bourguignon, Ph.D., R.N., University of Virginia School of Nursing; Donald M. Marcus, M.D., Baylor College of Medicine; Barbara N. Timmermann, Ph.D., University of Arizona College of Pharmacy; and Robert Zurier, M.D., University of Massachusetts Medical School.


NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.



"Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggest that:

Mechanisms may exist by which the brain and central nervous system influence immune, endocrine, and autonomic functioning, which is known to have an impact on health.

Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral
interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.

Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be effective adjuncts in the management of a variety of chronic conditions. An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed presurgically, may improve recovery time and reduce pain following surgical procedures."


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