Data Do Not Justify CAM Use in Rheumatic Diseases | Arthritis Information

BIRMINGHAM, ENGLAND — The use of complementary or alterative medicines in rheumatoid arthritis, osteoarthritis, and fibromyalgia is not supported by credible evidence, according to an expert review of available data.

The review, commissioned by Arthritis Research UK for patients, shows that although there is some consistent suggestion of a benefit of fish-derived topical oil in RA and capsaicin gel in OA, there is no such support for the use of any oral or topical complementary or alterative medicine (CAM) in fibromyalgia.

“Complementary medicines are popular, but considering particularly those taken orally or applied topically, we have relatively little information for most compounds on efficacy,” said Dr. Gary J. MacFarlane at the annual meeting of the British Society for Rheumatology.

“Both positive and negative conclusions are based upon relatively little amounts of evidence,” added Dr. MacFarlane, professor of epidemiology at the University of Aberdeen (Scotland) and head of the Arthritis Research UK working group on complementary and alternative medicines.

The working group consisted of eight expert advisors who looked at the available evidence on 41 CAMs for which there was some evidence from randomized controlled trials. There were a further 38 compounds commonly used by patients for which no suitable trial evidence could be found.

The aim of the review was to determine both the efficacy and safety of the compounds to give patients some idea of which CAMs worked and which probably did not, he said. If a rigid Cochrane Review had been performed, he conceded, the majority of studies that were assessed would probably have been excluded.

“However, patients were saying to us, actually we want you to say something, not just that there is not enough evidence,” Dr. MacFarlane explained.

Efficacy was graded on a 1- to 5-level scale, with level 1 signifying that there is no overall evidence that the compound worked, and level 5 meaning that there was some consistent evidence across several studies.

The only compounds at level 5 were fish body oil for RA and capsaicin gel for OA.

Glucosamine sulfate for OA, was graded at level 3, meaning that there was some promising evidence, despite its not being recommended for the treatment of OA in the 2008 OA clinical guidelines of the U.K. National Institute for Health and Clinical Excellence.

Out of four CAMs used for fibromyalgia, none was graded higher than a level 2.

Dr. MacFarlane said that in his view, “fibromyalgia is a condition that really doesn't have any very effective therapy.” Although there have been a small number of positive CAM studies in fibromyalgia, he added, their lack of replication means that further, higher-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.

The working group's findings on the use of CAM in fibromyalgia have recently been published (Rheumatology 2010;49:1063-8), and publications on the use of CAM in OA and RA will be forthcoming in the coming months.

“Most patients consider complementary medicines as safe,” Dr. MacFarlane observed, adding that there are important safety issues to consider, such as the quality of the preparation, contraindications, and interactions with conventionally prescribed medicines.

“A treatment should not be considered risk free unless the evidence suggests otherwise,” Dr. MacFarlane noted, stressing that the risks associated with CAM are often heightened by patients' neglect to inform their doctors that they are using such therapies.