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Arthritis Symptoms - Knee Pain - Joint Pain

By the National Institute of Health

Joint pain or knee pain usually results from overuse, poor form during physical activity, not warming up or cooling down, or inadequate stretching. Simple causes of knee pain often clear up on their own with self-care measures. Being overweight can put you at greater risk for knee problems.

Knee pain or joint pain can be caused by:

• Arthritis -- including rheumatoid, osteoarthritis, and gout, or other connective tissue disorders, like lupus.
• Bursitis -- inflammation from repeated pressure on the knee (like kneeling for long periods of time, overuse, or injury).
• Tendinitis -- a pain in the front of your knee that gets worse when going up and down stairs or inclines. Happens in runners, skiers, and cyclists.
• Baker's cyst -- a fluid-filled swelling behind the knee that may accompany an inflammation from other causes, like arthritis. If the cyst ruptures, you can have pain in the back of your knee that travels down your calf.
• Torn or ruptured ligaments or torn cartilage (a meniscus tear) -- can cause severe pain and instability of the knee joint.
• Strain or sprain -- minor injuries to the ligaments caused by sudden or unnatural twisting.
• Dislocation of the kneecap.
• Infection in the joint.
• Knee injuries -- can cause bleeding into your knee, which worsens the pain.
• Hip disorders -- may cause pain that is felt in the knee. Examples include a poor blood supply to the top of the thigh bone, and iliotibial band syndrome (injury to the thick band that runs from your hip to the outside of your knee).

Less common conditions that can lead to knee pain include the following:

• Bone tumors

Children's Knee Pain

• Osgood-Schlatter disease

Do I have Arthritis?

By the National Institute of Health

Use your browser's "back" command to navigate the arthritis menu below.

• What is Arthritis?
• Do I Have Arthritis Symptoms?
• What Can I Do?
• How Will the Doctor Help?
• How Should I Use Arthritis Medicine?
• What If I Still Hurt?
• You Can Feel Better!
• For More Help
• In Appreciation

What Is Arthritis?

Many people start to feel pain and stiffness in their bodies over time. Sometimes their hands or knees or hips get sore and are hard to move. These people may have arthritis (ar-THRY-tis).

Any part of your body can become inflamed or painful from arthritis

Arthritis is an illness that can cause pain and swelling in your joints. Over time, the joint can become severely damaged. Joints are places where two bones meet, such as your elbow or knee. Some kinds of arthritis can cause problems in other organs, such as your eyes, or in your chest. It can affect your skin, too.

These problems may be caused by inflammation (in-flah-MAY-shun), a swelling that can include pain or redness. They are telling you that something is wrong.

Some people may worry that arthritis means they won't be able to work or take care of their children and their family. Others think that you just have to accept things like arthritis.

It's true that arthritis can be painful. But there are things you can do to feel better. This booklet tells you some facts about arthritis and gives you some ideas about what to do, so you can keep doing the things you want to do.

There are several kinds of arthritis. The two most common ones are rheumatoid (ROO-mah-toyd) arthritis and osteoarthritis (AH-stee-oh-ar-THRY-tis).

Osteoarthritis is the most common form of arthritis. This is the form that usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.

A sports injury to a knee when a person is young can lead to arthritis years later.

Rheumatoid Arthritis

Rheumatoid arthritis happens when the body's own defense system doesn't work properly. It affects joints, bones, and organs--often the hands and feet. You may feel sick or tired, and you may have a fever.

Other symptoms can also cause arthritis. Some include:

Gout, in which crystals build up in the joints. It usually affects the big toe.

Lupus (LOOP-us), in which the body's defense system can harm the joints, the heart, the skin, the kidneys, and other organs.

Viral hepatitis (VY-rul HEP-ah-TY-tis), in which an infection of the liver can cause arthritis.

Rheumatoid arthritis can make it hard to hold a pencil or a brush.

Do I Have Arthritis Symptoms?

Pain is the way your body tells you that something is wrong. Most kinds of arthritis cause pain in your joints. You might have trouble moving around. Some kinds of arthritis can affect different parts of your body. So, along with the arthritis, you may:

Have a fever.

Lose weight.

Have trouble breathing.

Get a rash or itch.

These symptoms may also be signs of other illnesses. Having stiffness or pain when you move could be a sign of arthritis.

What Can I Do?

Go see a doctor. Many people use herbs or medicines that you can buy without a prescription for pain. You should tell your doctor if you do. Only a doctor can tell if you have arthritis or a related condition and what to do about it. It's important not to wait.

You'll need to tell the doctor how you feel and where you hurt. The doctor will examine you and may take x rays (pictures) of your bones or joints. The x rays don't hurt and aren't dangerous. You may also have to give a little blood for tests that will help the doctor decide if you have arthritis and what kind you have.

How Will the Doctor Help?

After the doctor knows what kind of arthritis you have, he or she will talk with you about the best way to treat it. The doctor may give you a prescription for medicine that will help with the pain, stiffness, and inflammation. Health insurance or public assistance may help you pay for the medicine, doctor visits, tests, and x rays.

How Should I Use Arthritis Medicine?

Before you leave the doctor's office, make sure you ask about the best way to take the medicine the doctor prescribes. For example, you may need to take some medicines with milk, or you may need to eat something just before or after taking them, to make sure they don't upset your stomach.

You should also ask how often to take the medicine or to put cream on the spots that bother you. Creams might make your skin and joints feel better. Sometimes, though, they can make your skin burn or break out in a rash. If this happens, call the doctor.

What If I Still Hurt?

Sometimes you might still have pain after using your medicine. Here are some things to try:

If you still hurt after using your medicine correctly and doing one or more of these things, call your doctor. Another kind of medicine might work better for you. Some people can also benefit from surgery, such as joint replacement.

You Can Feel Better!

Arthritis can damage your joints, organs, and skin. There are things you can do to keep the damage from getting worse. They might also make you feel better.

Where Can People Find More Information About Arthritis?

National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS) Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
(301) 495-4484
Toll free: (877) 22-NIAMS
TTY: (301) 565-2966
Fax: (301) 718-6366
World Wide Web address: http://www.niams.nih.gov/hi/

The NIAMS, a part of the National Institutes of Health (NIH), leads the Federal Government research effort in arthritis and musculoskeletal and skin diseases in the United States. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS.

Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
(800) 283-7800
(404) 872-7100 or your local chapter listed in the telephone book.
World Wide Web address: http://www.arthritis.org/

The Arthritis Foundation is the major voluntary organization devoted to supporting arthritis research and providing education and other services to people with arthritis. This foundation publishes free pamphlets on arthritis, as well as arthritis self-help books in English and Spanish.

American Academy of Orthopedic Surgeons
P.O. Box 2058
Des Plaines, IL 60017
Phone: 800-824-BONE (2663) (free of charge)
World Wide Web address: http://www.aaos.org/

The academy provides education and practice management services for orthopedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopedics. The orthopedist's scope of practice includes disorders of the body's bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site.

American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
(404) 633-3777
Fax: (404) 633-1870
World Wide Web address: http://www.rheumatology.org/

This association provides referrals to doctors and health professionals who work on arthritis, rheumatic diseases, and related conditions. The association also provides educational materials and guidelines.

Calcium (Ac)Counts

Your skeletal calcium bank has to last through old age. Frequent deposits to this retirement account should begin in youth and be maintained throughout life to help minimize withdrawals. Recommendations for daily calcium intakes were established a few years ago by the Institute of Medicine. (See "How Much Calcium Do You Need?") Most women get much less calcium than they need--as little as half.

Nutritionists recommend meeting your calcium needs with foods naturally rich in calcium. Adequate calcium intake in childhood and young adulthood is critical to achieving peak adult bone mass, yet many adolescent girls replace milk with nutrient-poor beverages like soda pop. "Bone health requires a lot of nutrients and you're likely to get most of them in dairy products," says Connie Weaver, Ph.D., who heads the department of foods and nutrition at Purdue University. "They're a huge package rather than just a single nutrient." With so many low-fat and nonfat dairy products available, it's easy to make dairy foods part of a healthy diet. People who have trouble digesting milk can look for products treated to reduce lactose. A serving of milk or yogurt contains about 350 milligrams of calcium. Fortified products have even more.

"People who don't consume dairy foods can meet their calcium needs with foods that are fortified with calcium, such as orange juice, or with calcium supplements," says Mona S. Calvo, Ph.D., a calcium expert in the FDA's Center for Food Safety and Applied Nutrition. Other good sources of calcium are dark-green leafy vegetables like kale and turnip greens, tofu (if made with calcium), canned fish (eaten with bones), and fortified cereal products.

The food label can help you identify foods that are a good source of calcium and other nutrients important for bone health, such as vitamin D. You can use the Nutrition Facts found on the label to see if a food is a good source of these nutrients--that is, if it has at least 10 percent of the Daily Value (DV) per serving. Also, if a food has at least 10 percent of the DV, the label may bear a claim that it is a good source of a nutrient. If it has 20 percent or more, the label can say that it is "high" in or an "excellent source." Some foods that are excellent sources of calcium may also bear a health claim about the role of diet and other factors in reducing the risk of osteoporosis.

But keep in mind that foods with smaller amounts (such as between 5 percent and 10 percent of the DV) can still make significant contributions to your daily calcium intake. This may be especially true if you often eat more than one serving of the food in a day, or if your actual serving size is typically larger than the one on the label.

Finally, remember that label values are based on a single Daily Value established by the FDA for food labeling purposes--1000 milligrams in the case of calcium. They do not take into account that some age groups have lower or higher recommendations for intake.

What about too much calcium? A few years ago, the Institute of Medicine established a level of 2,500 milligrams as an upper intake level for calcium for most people. While intakes considerably above this level may be safe for many, others may be particularly susceptible to calcium's potentially harmful effects at these levels. Those with higher sensitivities, such as people at risk of kidney stones, should discuss calcium with their doctors.

Calcium is critical, but even a high intake won't fully protect you against bone loss caused by estrogen deficiency, physical inactivity, alcohol abuse, smoking, or medical disorders and treatments.

How Much Calcium Do You Need?

For More Information

National Osteoporosis Foundation
1232 22nd St., N.W.
Washington, DC 20037
1-800-223-9994

Osteoporosis and Related Bone Diseases National Resource Center (ORBD-NRC)
1-800-624-BONE (1-800-624-2663)
TTY: (202) 466-4315

Older Women's League (OWL)
1750 New York Ave.
Washington, DC 20001
1-800-825-3695

North American Menopause Society
P.O. Box 94527
Cleveland, OH 44101
1-800-774-5342

This article originally appeared in the September 1996 FDA Consumer and contains revisions made in August 1997, September 2001, and September 2003.

In Appreciation

The NIAMS thanks the following people and organizations for their contribution to this project:

Janet Howard, NIAMS/NIH; John Klippel, M.D., NIAMS/NIH; Graciela S. Alarcón, M.D., M.P.H., University of Alabama at Birmingham; Virginia González, M.P.H., Stanford Patient Education Center, Stanford University School of Medicine, Palo Alto, CA; Carlos Lavernia, M.D., Miami, FL; the Arthritis Foundation; the American Academy of Orthopaedic Surgeons; and the American College of Rheumatology for help in preparing and reviewing this booklet. Eagle Design & Management, Inc., Bethesda, MD, designed and illustrated the booklet.

Arthritis Keywords

Analgesic: A medication or treatment that relieves pain.

Ankylosing spondylitis: A rheumatic disease that causes arthritis of the spine and sacroiliac joints and, at times, inflammation of the eyes and heart valves.

Antibodies: Special proteins produced by the body’s immune system that help fight and destroy viruses, bacteria, and other foreign substances (antigens) that invade the body. Occasionally, abnormal antibodies develop that can attack a part of the body and cause autoimmune disease. These abnormal antibodies are called autoantibodies.

Antigen: A foreign substance that stimulates an immune response.

Arthrography: An x-ray procedure that provides a detailed image of the joint when air or a contrast substance is injected into the joint space.

Arthroscopy: A procedure performed with an arthroscope (a small, flexible tube that transmits the image of the inside of a joint to a video monitor). Arthroscopy is used for diagnosis as well as treatment of some types of joint injury. The arthroscope is inserted through a small incision in the skin near the affected joint.

Bursa (plural, bursae): A small sac of tissue located between bone and other moving structures such as muscles, skin, or tendons. The bursa contains a lubricating fluid that allows smooth gliding between these structures.

Bursitis: A condition involving inflammation of the bursae.

Cartilage: A resilient tissue that covers and cushions the ends of the bones and absorbs shock.

Collagen: The main structural protein of skin, bones, tendons, cartilage, and connective tissue.

Connective tissue: The supporting framework of the body and its internal organs.

Computed tomography (CT or CAT): A diagnostic technique that uses a computer and an x-ray machine to take a series of images that can be transformed into a clear and detailed image of a joint.

Corticosteroids: Potent anti-inflammatory hormones that are made naturally in the body or synthetically for use as drugs. The most commonly prescribed drug of this type is prednisone.

Fibromyalgia: A chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas of the neck, spine, shoulders, and hips called “tender points.”

Fibrous capsule: A tough wrapping of tendons and ligaments that surrounds the joint.

Gout: A type of arthritis resulting from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both.

Hydrotherapy: Therapy that takes place in water.

Infectious arthritis: Forms of arthritis caused by infectious agents, such as bacteria or viruses.

Inflammation: A typical reaction of tissue to injury or disease. It is marked by four signs: swelling, redness, heat, and pain.

Joint: The place where two or more bones are joined. Most joints are composed of cartilage, joint space, fibrous capsule, synovium, and ligaments.

Joint space: The area enclosed within the fibrous capsule and synovium.

Juvenile arthritis: A term used to refer to the types of arthritis that affect children. Juvenile rheumatoid arthritis is the most common type.

Ligaments: Stretchy bands of cordlike tissues that connect bone to bone.

Lupus: A type of immune disorder known as an autoimmune disease that can lead to inflammation of and damage to joints, skin, kidneys, heart, lungs, blood vessels, and brain.

Lyme disease: A disease caused by the bacterium Borrelia burgdorferi in which arthritis is often a prominent symptom. Rash, heart disease, and nervous system involvement may also occur.

Magnetic resonance imaging (MRI): A diagnostic technique that provides high-quality cross-sectional images of a structure of the body without X rays or other radiation.

Manipulation: A treatment by which health professionals use their hands to help restore normal movement to stiff joints.

Microwave therapy: A type of deep heat therapy in which electromagnetic waves pass between electrodes placed on the patient’s skin. This therapy creates heat that increases blood flow and relieves muscle and joint pain.

Mobilization therapies: A group of treatments that include traction, massage, and manipulation. When performed by a trained professional, these methods can help control a patient’s pain and increase joint and muscle motion.

Nonsteroidal anti-inflammatory drugs (NSAID’s): A group of medications, including Vioxx, aspirin, ibuprofen, and related drugs, used to reduce inflammation that causes joint pain, stiffness, and swelling.

Osteoarthritis: A type of arthritis that causes the cartilage in the joints to fray and wear. In extreme cases, the cartilage may wear away completely.

Polymyalgia rheumatica: A rheumatic disease that involves tendons, muscles, ligaments, and tissues around the joints. Pain, aching, and morning stiffness in the neck, shoulders, lower back, and hips characterize the disease. It is sometimes the first sign of giant cell arteritis (a disease of the arteries characterized by inflammation, weakness, weight loss, and fever).

Polymyositis: A rheumatic disease that causes weakness and inflammation of muscles.

Psoriatic arthritis: Joint inflammation that occurs in about 5 to 10 percent of people with psoriasis (a common skin disorder).

Reactive arthritis: A form of arthritis that develops after an infection involving the lower urinary tract, bowel, or other organs.

Rheumatic: A term referring to a disorder or condition that causes pain or stiffness in the joints, muscles, or bone.

Rheumatoid arthritis: An inflammatory disease of the synovium, or lining of the joint, that results in pain, stiffness, swelling, deformity, and loss of function in the joints.

Rheumatologist: A doctor who specializes in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments, and bones.

Risk factor: Something that increases a person’s chance of developing a disease, such as age, gender, ethnicity, and genetics (family history).

Scleroderma: A disease of the connective tissues and blood vessels that leads to hardening of the skin. Scleroderma can also damage internal organs such as the kidneys, lungs, heart, or gastrointestinal tract.

Synovial fluid: Fluid released into movable joints by surrounding membranes. The fluid lubricates the joint and reduces friction.

Synovium: A thin membrane that lines a joint and releases a fluid that allows the joint to move easily.

Tendinitis (tendonitis): Inflammation of tendons caused by overuse, injury, or related rheumatic conditions.

Tendon: Tough, fibrous cords of tissue that connect muscle to bone.

Transcutaneous: Through the skin.

Ultrasound: A treatment that uses sound waves to provide deep heat and relieve pain.

Rheumatoid Arthritis and Complementary and Alternative Medicine

By the National Center for Complementary and Alternative Medicine

Use your browser's "back" button to navigate the Rheumatoid Arthritis menu below.

• Key Points
• What is rheumatoid arthritis?
• How is rheumatoid arthritis treated in conventional medicine?
• Why do some people with rheumatoid arthritis use CAM, and what do they use?
• What CAM therapies for rheumatoid arthritis are discussed in this report?
• 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?
• Is NCCAM funding research on CAM therapies for rheumatoid arthritis?
• Definitions
• References
• For More Information
• Acknowledgments

Rheumatoid arthritis 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 rheumatoid arthritis are pain, stiffness, fatigue, sleep disturbances, and fever. There are treatments for Rheumatoid Arthritis in conventional medicine, but some people also try complementary and alternative medicine (CAM). This report answers some frequently asked questions on this topic and suggests sources for more information.

CAM 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.

Rheumatoid Arthritis Key Points

• It is very important for people with Rheumatoid Arthritis to ensure that (1) their rheumatoid arthritis was diagnosed by a professional with substantial conventional medical training and (2) their condition is being followed by a rheumatologist (a physician who specializes in rheumatic diseases like Rheumatoid Arthritis ). This is important to minimize damage to the joints and bones, as well as disability.
  
• There are many proven conventional treatments for rheumatoid arthritis. It is important not to replace them with a CAM treatment that is unproven.
  
• Many CAM therapies for arthritis are heavily advertised and make attractive claims, often based on personal stories (testimonials). However, it is important to find out whether any high-quality scientific research has been done on a CAM therapy.
  
• None of the CAM therapies discussed in this report have been proven to be of benefit for Rheumatoid Arthritis . Some--such as thunder god vine (which is not currently available in a safe American-made product), gamma-linolenic acid, fish oil, and mind-body therapies--have shown some possibility of benefit for Rheumatoid Arthritis , but further studies are needed to answer this question for sure.
  
• It is important to tell your health care provider(s) about any CAM therapies you are using or considering for Rheumatoid Arthritis . This is for your safety and a comprehensive treatment plan.

What is rheumatoid arthritis?

Rheumatoid arthritis 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 rheumatoid arthritis, 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. Rheumatoid Arthritis causes pain, swelling, and stiffness in a person's joints and problems with functioning. However, rheumatoid arthritis affects different people in different ways, in terms of the symptoms they have, how serious the symptoms are, and how long the symptoms last. rheumatoid arthritis is different from other types of arthritis (such as osteoarthritis). For example:

• Rheumatoid arthritis usually occurs in a symmetrical pattern; for example, if one hand is affected, usually the other will be, too.
• Rheumatoid arthritis often affects the wrists and fingers, though it can affect other parts of the body.
• Rheumatoid arthritis is an autoimmune disease affecting the entire body. A person with rheumatoid arthritis may feel tired and weak, have fevers at times, lose appetite, lose weight, and generally not feel well.

How is rheumatoid arthritis treated in conventional medicine?

There are many proven treatments in conventional medicine for rheumatoid arthritis. 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 (NSAID's), disease-modifying anti rheumatic drugs (DMARD's), 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 rheumatoid arthritis and in uncovering new and promising treatments.

It is important for people with rheumatoid arthritis 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 rheumatoid arthritis 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 rheumatoid arthritis are:

• Because conventional treatment is not working as well as they would like
• A wish for greater relief of symptoms and/or disability
• Issues with side effects of drug treatment
• A desire to reduce some of the stress that comes from living with a chronic illness and to cope better
• A belief that CAM therapies are safer and more "natural"
• Widespread advertising and attractive claims for many CAM products

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

Many types of CAM are tried for rheumatoid arthritis, such as:

• Preparations made from botanicals (plants and their products, including herbs)
• Vitamins and minerals in unconventional amounts
• Other products taken by mouth, such as fish oil
• Dietary approaches
• Preparations applied to the skin, such as balms and liniments
• Hydrotherapy
• Items that are worn (for example, magnetic clothing or copper bracelets)
• Mind-body therapies such as relaxation techniques, meditation, prayer for health purposes, and tai chi
• Whole medical systems, such as Ayurveda (a traditional medicine of India), traditional Chinese medicine, homeopathy, and chiropractic
• Other therapies delivered by CAM practitioners--for example, acupuncture or massage

It is beyond the scope of this report to discuss the scientific evidence about all CAM therapies used for Rheumatoid Arthritis . 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. 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."

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.

Arthritis Therapies Discussed in This Report

• Botanical supplements and other dietary supplements
• Thunder god vine
• Gamma-linolenic acid (GLA)
• Fish oil
• Valerian
• Four Other Botanicals
• Ginger
• Curcumin
• Boswellia
• Feverfew
• Glucosamine and chondroitin
• Special diets
• Acupuncture
• Magnets
• Hydrotherapy
• Homeopathy
• Selected mind-body techniques

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

• It is important to make sure you have been diagnosed with Rheumatoid Arthritis by a health care provider who has substantial conventional medical training and experience with arthritis patients. Rheumatoid Arthritis can be hard to diagnose, there is no single test for it, and its symptoms can be similar to those of other conditions.
  
• Proven conventional treatments for Rheumatoid Arthritis should not be replaced with a CAM treatment that is unproven. This is especially important in the early stages of rheumatoid arthritis, when researchers believe the most damage to joints and bones occurs.
  
• Tell your health care provider(s) about any supplements or medications (prescription or over-the-counter) that you are using or considering. Prescribed medicines may need to be adjusted if you are also using a CAM therapy. Supplements can interact with medications (whether prescription or over-the-counter) and can affect how the body responds to them. Pharmacists can also be a helpful source of information about dietary supplements (though their advice is not a substitute for that of your provider).
  
• If you decide to use supplements, what you see on the label may not reflect what is in the bottle. For example, some botanical supplements have been found to be contaminated with heavy metals or prescription drugs, and some have been found to have much more or much less of the featured ingredient than their label states.
  
• The claims for many CAM therapies can be attractive, ranging from enhancing well-being, to helping with difficult chronic conditions, to achieving unbelievable results. It is important to know whether scientific research has proven that a therapy works and, if so, why.
  
• Women who are pregnant or nursing, or people who are thinking of using CAM to treat a child, should use extra caution and be sure to consult their health care provider.

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 rheumatoid arthritis. 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.

• Some anti-inflammatory and immune-system-suppressing activity for TGV has been seen in laboratory and animal studies. The first clinical trial on TGV in the United States (the earlier ones were done in China) was carried out at the University of Texas Southwestern Medical Center and the National Institutes of Health (NIH). Its results were published in 2002. Twenty-one patients for whom conventional rheumatoid arthritis treatment had not worked completed the trial. Eighty percent of those who received a high-dose TGV extract and 40 percent of those who received a low-dose TGV extract experienced improvement in Rheumatoid Arthritis symptoms and physical functioning. No one in the placebo group improved. Longer and larger studies are needed to confirm these findings and to find out more about TGV.
  
• Parts of the TGV plant are dangerous. The leaves, the flowers, the main stem, and the skin covering the root are poisonous, to a point that they could cause death. People should never try to make TGV medications themselves.
  
• Currently, there are no consistent, high-quality TGV products being manufactured in the United States. Preparations of TGV made outside the United States (for example, in China) can sometimes be obtained, but it is not possible to verify whether they are safe and effective. An expert from the University of Texas/NIH study advises that consumers not use TGV until reliable TGV preparations become available.
  
• If taken for a long time (according to one study, for more than 5 years), TGV may decrease the density of the minerals in women's bones, which would be of special concern for women who have osteoporosis or are at risk for it. If taken at high doses, TGV could suppress the immune system and increase the effects of immune-suppressing drugs.
  
• The TGV extract made for the NIH study discussed above was well tolerated by study participants. However, side effects can occur and may include stomach upset, diarrhea, skin rash, changes in menstrual periods, and hair loss.

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.

• A 2000 Cochrane Collaboration review analyzed seven placebo-controlled studies of GLA (from evening primrose, borage, and black currant oils) for Rheumatoid Arthritis . The authors noted there were issues with these studies that made it difficult to draw conclusions. However, they thought the better studies indicated potential relief for rheumatoid arthritis pain, morning stiffness, and joint tenderness.
  
• There are potential side effects and risks to know about with GLA. First, these plant seed oils may affect certain medical conditions and interact with prescription medications. Specifically:
• Some borage seed oil preparations contain ingredients called PAs (for pyrrolizidine alkaloids) that can harm the liver or worsen liver disease. Only preparations that are certified and labeled as "PA-free" should be used.
• Borage oil and evening primrose oil might increase the risk of bleeding and bruising, especially in people taking blood-thinning drugs, such as aspirin, clopidogrel, NSAIDs, or warfarin.
• Evening primrose oil may cause problems for people taking a class of psychiatric drugs called phenothiazines, such as chlorpromazine or prochlorperazine.
• Side effects of these oils can include nausea, diarrhea, soft stool, intestinal gas, burping, and stomach bloating.

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.

• There is some encouraging evidence from a number of laboratory studies, animal studies, and clinical trials about the potential usefulness of fish oil or omega-3 supplementation for various aspects of Rheumatoid Arthritis --such as the number of tender joints, morning stiffness, and the need for NSAIDs. However, more research is needed to definitively answer various questions, including what the most effective dosage or length of treatment would be, which patients would benefit most, and whether a placebo effect is at work.
  
• In some people, the high amounts of omega-3s that are present in fish oil can increase the risk of bleeding or affect the time it takes blood to clot. If a person is taking drugs that affect bleeding or is going to have surgery, this is of special concern. Fish oil supplements interact with medicines for high blood pressure, so taking them together might lower a person's blood pressure too much.
  
• Certain species of fish can contain high levels of contaminants, such as mercury, from the environment. Thus, their oils could pose a health risk, especially for pregnant or nursing women and for children. The fish that the Federal Government has found to have the highest levels of mercury are shark, swordfish, king mackerel, and tilefish. People who decide to use fish oil should look for products made from fish with lower mercury levels. Government information on this topic is available. You may have to contact the manufacturer to find out the type(s) of fish used in a product. Also, it is desirable to find out whether the manufacturer tests the product for contaminating substances and if the results of those tests are available.
  
• Another point to note about safety is that a product called fish liver oil can contain more vitamin A than the recommended daily dosage, which could cause problems.
  
• Generally, for low doses of fish oil supplements, the side effects are mild and can include a fishy aftertaste, belching, stomach disturbances, and nausea.

^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.

Valerian
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.

• The evidence suggests that valerian has at least mild benefits for sleep problems in the general population, including insomnia. It has been theorized that valerian may have benefit for people with sleep problems from Rheumatoid Arthritis . However, research on valerian for rheumatoid arthritis specifically has not been done to answer this question.
  
• There is not much evidence on how long it is safe to take valerian and which dose to use.
  
• There is not enough reliable evidence to declare whether valerian is effective for muscle and joint pain, including pain from rheumatoid arthritis. There may be some biological basis for the theory that valerian could be beneficial for musculoskeletal pain.
  
• Valerian is considered generally safe. However, it should not be taken with sedative drugs (for example, alcohol, benzodiazepines, or narcotics) or other sedative herbs (such as melatonin, SAMe, or St. John's wort). Valerian will increase sedative effects. People who are taking antifungal drugs, statins, or certain anti-arrhythmia drugs should not take valerian. Valerian may not be safe for people who have a liver disorder or are at risk for one. After taking valerian, caution should be used in driving or using dangerous machinery. Side effects of valerian can include drowsiness in the morning, headache, stomach problems, excitability or anxiety, and sleeplessness.

Four Other Botanicals

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

• Ginger
• Curcumin (a component of the spice turmeric)
• Boswellia (also called Indian frankincense, made from the resin of a tree that grows in India)

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 rheumatoid arthritis symptoms.

• Ginger's possible side effects include stomach upset, diarrhea, and irritation to the mouth and throat. Ginger is not recommended for people who have a bleeding disorder, a heart condition, or diabetes. Ginger may further slow blood clotting when combined with other herbs and drugs that slow blood clotting; add to the blood-pressure-lowering effects of drugs for high blood pressure and heart disease; and add to the blood-sugar-lowering effects of diabetes drugs.
  
• Curcumin can have side effects of stomach problems, including nausea and diarrhea. Curcumin could add to the effects of other herbs and drugs that slow blood clotting. Curcumin can cause gallbladder contractions and should not be used by people with gallbladder disease or gallstones.
  
• Boswellia can have side effects of stomach pain, stomach upset, nausea, and diarrhea. It is not known whether boswellia interacts with any drugs, supplements, or diseases and conditions.
  
• Feverfew appears to be safe for short-term use, but the safety of long-term use is not known. Feverfew can cause an allergic reaction, especially in people who are allergic to the daisy family. Side effects can include diarrhea and other stomach upsets. Chewing fresh leaves of feverfew may cause mouth irritation and sores. Feverfew might interact with medications broken down by the liver and increase the actions of drugs that slow blood clotting. Pregnant women should not take feverfew.

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.

• Both glucosamine and chondroitin have shown anti-inflammatory effects in animal studies. In humans, they have been studied only for osteoarthritis so far, not for rheumatoid arthritis. Osteoarthritis is a different form of arthritis than rheumatoid arthritis, with different causes, although the symptoms are similar (such as joint pain and problems with function). One cannot assume that if a treatment is helpful for one type of arthritis, it will also be helpful for another type. The studies of glucosamine and chondroitin for osteoarthritis mostly found a modest benefit. However, some design flaws have been noted in those studies. In sum, there is no evidence that glucosamine and chondroitin are helpful for rheumatoid arthritis.
  
• Glucosamine appears to be safe for most people. However, it might worsen asthma through an allergic reaction. Also, glucosamine might cause higher blood sugar and insulin levels in people with diabetes, and those who decide to use it need to carefully monitor their blood sugar. Glucosamine could possibly decrease the effectiveness of certain medications--acetaminophen, some anticancer drugs, and antidiabetes drugs. Generally, side effects of glucosamine can include mild stomach problems and nausea; less commonly, there can be sleepiness, a skin reaction, or a headache. Some people who are allergic to shellfish are concerned about an allergic reaction to glucosamine. However, most shellfish allergies are to proteins in the meat, not to the shell material from which glucosamine supplements are made.
  
• Chondroitin appears to be safe for most people. However, chondroitin may possibly worsen asthma (through an allergic response), blood clotting disorders, and prostate cancer. The side effects of chondroitin can include stomach pain and nausea; less commonly, diarrhea, constipation, swelling, and problems with heart rate.
  
• Both supplements could affect the action of the drug warfarin, but this is not definite.

2. Special Diets

Many people with rheumatoid arthritis are interested in whether certain foods can affect their symptoms. Examples of foods that are believed to possibly worsen the symptoms of arthritis (including rheumatoid arthritis) 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 rheumatoid arthritis, including:

• The foods one eats and how the digestive system handles them are known to affect the immune system. Because rheumatoid arthritis is a disease of the immune system, a connection between diet and the disease has been proposed.
  
• Certain fats (mostly from animal sources, but also from corn and sunflower oils) break down in the body into substances that can cause inflammation.
  
• rheumatoid arthritis and/or medications to treat it may affect the way a person's digestive system handles foods.
  
• rheumatoid arthritis can affect a person's ability to prepare and eat food, leading to nutritional problems.

• There is no strong, reproducible evidence that any foods or diets have a specific role in causing or treating rheumatoid arthritis.
  
• It is important for people who have rheumatoid arthritis to eat a healthy, balanced diet.
  
• If one or more foods are eliminated from the diet, it is possible to miss key nutrients and not get enough calories. It is important to discuss any major dietary changes with your health care provider or a registered dietitian.
  
  
• A true food allergy may exist in a small percentage of patients with rheumatoid arthritis. Many people think they have food allergies when they do not have them or when they have a different condition called food intolerance.

3. Acupuncture

Acupuncture is a practice that developed as a part of traditional Chinese medicine. Some people try acupuncture to treat rheumatoid arthritis pain or to treat the rheumatoid arthritis itself.

• Good research studies have shown that acupuncture can help relieve pain associated with osteoarthritis. However, not much is known about its effectiveness for symptoms of rheumatoid arthritis. A handful of small studies have been conducted, and the findings do not clearly answer this question. Issues with the studies have included design problems, a small number of participants, variations in where acupuncture was given on the body, and how many treatments were given and for how long. More and better research is needed.
  
• Acupuncture tends to have minimal side effects, if any. Relatively few complications from acupuncture have been reported to the FDA. If a person decides to use acupuncture, it is important to find a licensed and certified practitioner, as any complications have usually occurred from inadequate practitioner training and experience.

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.

• The research so far does not firmly support claims that static magnets are effective for treating pain, including pain from rheumatoid arthritis. In those cases where some benefit was seen, it has not been proven why; many scientists think it may be due to a placebo effect. If someone does experience a benefit from a magnet, it will tend to occur quickly.
  
• Static magnets should not be used by pregnant women; people who have a condition--such as an acute sprain, inflammation, infection, or wound--that could be affected by dilation of the blood vessels; and people who use a device such as a pacemaker, defibrillator, or insulin pump, or who use a medication patch.

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, rheumatoid arthritis, and mental disorders). Some consumer products using EMs are available.

• EMs are being studied because there have been some encouraging early findings indicating the possibility of benefits for pain, physical function, and stiffness. However, it is too early to know for sure whether EMs are of benefit for patients with rheumatoid arthritis.
  
• EMs should not be used by pregnant women; people who have a condition--such as an acute sprain, inflammation, infection, or wound--that could be affected by dilation of the blood vessels; and people who use a device such as a pacemaker, defibrillator, or insulin pump, or who use a medication patch. It may be advisable for people who have a history of cancer or seizure disorder to avoid using EMs until more is known about their effects on these medical conditions.

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.

• A small number of controlled studies have been done on hydrotherapy for rheumatoid arthritis, most based on sea-bath treatments given in Israel's Dead Sea area. Most of these studies reported benefit. However, there have been quality issues noted with these studies, and it is not considered proven that the hydrotherapy itself provided the benefits for rheumatoid arthritis claimed in these studies. Larger and better studies are needed to answer this question. Study authors have noted that there could be other reasons for any benefit, such as traveling to a spa, being removed from one's daily routine, relaxation, socializing, etc.
  
  
• The safety of hydrotherapy has not been well studied. Overall, it appears to be a low-risk practice for most people if common-sense precautions are taken, such as not exposing the body to too much heat or cold or for too long a time, and being sure to drink enough fluid. However, hydrotherapy is riskier and could even be dangerous for certain people:
• Those who have a condition that could be worsened by exposure to extremes of heat or cold (for example, heart disease, lung disease, circulation disorder, Raynaud's phenomenon, or chilblains) or by strong motions from water jets
• Those who have difficulty perceiving temperature (for example, from neuropathy, or damage to the nerves)
• Women who are pregnant
• People who have implanted medical devices such as pacemakers or pumps
  
  
• Some people may get a skin irritation or infection from hydrotherapy water, either as a reaction to something in the water or if the water is not in sanitary condition.

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."

• Little rigorous research has been done on homeopathy for rheumatoid arthritis. The results have been mixed. It appears from some studies that homeopathy might be more effective than a placebo for rheumatic diseases and syndromes (including rheumatoid arthritis), but this evidence is not strong. Larger, better-designed studies are needed to resolve this question.
  
  
• Homeopathic remedies are considered safe and unlikely to cause severe side effects. The FDA has learned of a few reports of illness associated with the use of these remedies, but determined that the remedies were not likely to be the cause. Homeopathic remedies are not known to interfere with conventional drugs.

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.

• Mind-body therapies have been applied to and studied for various types of pain. Results from clinical trials indicate that mind-body therapies may be effective additions to the treatment and management of arthritis, including rheumatoid arthritis and its pain.
  
  
• One analysis of clinical trials on mind-body therapies for rheumatoid arthritis has been published. These authors, who evaluated 25 trials and published their findings in 2002 also concluded that mind-body approaches may be effective additions to rheumatoid arthritis treatment. They noted that mind-body practices led to significant improvements in rheumatoid arthritis pain, disability, overall psychological state (psychological status), coping, and belief in one's own ability to handle situations (self-efficacy). Mind-body therapies appeared to be more helpful for people who had rheumatoid arthritis for a shorter period of time, not a longer period.
  
  
• There are still questions about mind-body therapies and rheumatoid arthritis that need to be answered by research, such as which among these therapies are most effective and, if they work, how they work.
  
  
• Spirituality may help people with rheumatoid arthritis in their quality of life, coping, and how they feel about their health, although the research so far has been limited, and often it has not looked at rheumatoid arthritis only. A 2003 study at Johns Hopkins University of people with moderate rheumatoid arthritis found that those who had "spiritual transcendence" had more happiness, joy, and positive perceptions of their own health. This was regardless of how severe their rheumatoid arthritis was or how well they could function.
  
  
• There have been some small studies on tai chi for rheumatoid arthritis. Tai chi is a practice from traditional Chinese medicine that uses specific postures along with gentle, slow movements; meditation; and coordinated breathing. These studies on rheumatoid arthritis have had conflicting results; some found improvement in daily functioning and certain symptoms, others did not. NCCAM is co-sponsoring a clinical trial that compares tai chi chih (a type of tai chi) to relaxation therapy for symptoms of rheumatoid arthritis. An earlier clinical trial by this team found tai chi chih improved physical functioning and immunity in healthy older adults. Other research as well has supported benefit from tai chi to older people on such outcomes as balance, postural stability, frailty, and prevention of falls. Tai chi is a relatively safe practice. It is done slowly and at low impact to the body.
  
  
• In mind-body therapies, there are relatively few physical and emotional risks, if any. A helpful aspect of most mind-body therapies is that they can be taught to users and practiced by them at times and places of their choice.

^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:

• Fish oil, borage seed oil, or a combination of both, to determine if they affect rheumatoid arthritis symptoms
• Mindfulness-based stress reduction (a type of meditation), to determine if it affects rheumatoid arthritis symptoms
• Low-strength electromagnetic fields, to see whether they have an effect on pain, fatigue, sleep quality, mood, and inflammation in postmenopausal women with rheumatoid arthritis

Recently published NCCAM-supported research on rheumatoid arthritis has included:

• A 2004 review of valerian for sleep disturbances from rheumatoid arthritis
• A 2003 review of studies on selected CAM therapies for arthritis-related pain, including rheumatoid arthritis pain
• A 2002 review of studies on mind-body therapies for rheumatoid arthritis

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

National Institutes of Health - U.S. Department of Health and Human Services
NCCAM Publication No. D282 - September 2005

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Arthritis Remedies - Science Based Supplement Information

Chondroitin Sulfate
Glucosamine
SAMe
Vitamin B3

Arthritis Herbal Remedies - Science Based Herb Information

Boswellia in combination with Ashwagandha , Turmeric and Zinc

Cats Claw

Cayenne - topical, for pain only

Ginger Anti-Inflamitory pain relief

Arthritis Definitions

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.

References

Agency for Healthcare Research and Quality. Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis. Evidence Report/Technology Assessment no. 89. Rockville, MD: Agency for Healthcare Research and Quality; 2004. 04-E012-1.

Ariza-Ariza R, Mestanza-Peralta M, Cardiel MH. Omega-3 fatty acids in rheumatoid arthritis: an overview.* Seminars in Arthritis and Rheumatism. 1998;27(6):366-370.

Astin JA. Mind-body therapies for the management of pain.* Clinical Journal of Pain. 2004;20(1):27-32.

Astin JA, Beckner W, Soeken K, et al. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials.* Arthritis and Rheumatism. 2002;47(3):291-302.

Balick MJ, Lee R. Digging in the herb garden: responding to a patient's query about thunder god vine.* Alternative Therapies in Health and Medicine. 2001;7(6):100-103.

Berbert AA, Kondon CR, Almendra AL, et al. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis.* Nutrition. 2005;2:131-136.

Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.* Annals of Internal Medicine. 2004;141(12):901-910.

Berman JD, Straus SE. Implementing a research agenda in complementary and alternative medicine.* Annual Review of Medicine. 2004;55:239-254.

Brinker AM, Raskin I. Determination of triptolide in root extracts of Tripterygium wilfordii by solid-phase extraction and reverse-phase high-performance liquid chromatography.* Journal of Chromatography. 2005;1070:65-70

Capriotti T. Any science behind the hype of "natural" dietary supplements?* Medsurg Nursing. 2004;13(5):339-350.