I’ve written extensively about alternative arthritis therapies, largely because that is one of the most common conditions for which complementary and alternative treatments are used. While a few are promising (such as fish oils), there is little good evidence to support most such practices. A detailed and very useful new review of alternative therapies for arthritis in humans has just been released. And while extrapolation from humans to pets has dangers and has to be viewed with some skepticism, this at least gives us some guidance as to whether such therapies have proven their value for people, a question for which the evidence is usually much greater in quantity and quality than we often get for veterinary uses.
The review, produced by the non-profit group Arthritis Research UK, is divided into two reports:
I won’t go through all the findings, but in terms of the therapies I’ve covered before, the review pretty much confirms the evidence to date, with a couple of exceptions.
The review assigns a score of 2/4 for glucosamine sulphate, which is defined as:
There’s only a little evidence to suggest the compound might work. The evidence in this category often comes from a single study which has reported positive results, and there are therefore important doubts about whether or not it works.
The evidence for glucosamine hydrochloride is not even as strong as this.
My own assessment is slightly more pessimistic that this based largely on these two findings:
There’s some evidence that more recent trials and those using higher?quality methods are less likely to show a benefit.Trials that used the best methods to make sure that participants didn’t know which treatment they were getting didn’t show significant benefits in pain relief and improved physical function.
So while there is some positive clinical trial evidence the better the controls for bias and error, the less likely positive results will be found, which is usually a signs that the therapy is not actually effective.
No significant risks appeared in the trials evaluated.
This supplement, like glucosamine, is assigned a score of 2/4, indicating claims of a meaningful benefit are dubious.
Overall, evidence from trials with a good study design in allocating participants to treatment groups and trials that used the most appropriate statistical methods had lower estimates of effectiveness of chondroitin, particularly in terms of reduction in joint pain.In the most recent review, the authors concluded that chondroitin (or its combination with glucosamine) didn’t reduce joint pain to any clinically meaningful extent or change clinical aspects of the joint.
Chondroitin appears to have no significant risks.
The evidence is limited, but it is pretty strong for a benefit of fish liver oil in treatment of rheumatoid arthritis. However, the evidence is not sufficient to determine if there is benefit from the more common fish body oil for non-rheumatoid osteoarthritis.
There’s good evidence that fish body oil can result in improvement in the symptoms of rheumatoid arthritis and some unconfirmed evidence that the combined treatment of fish body and liver oils might also be of long-term benefit, particularly in reducing daily NSAID use. Evidence for the use of fish liver oil for osteoarthritis is based on insufficient data.
Side effects appear to be mild, though high-dose or prolonged use of fish liver oil can lead to serious overdoses of Vitamin A.
Despite the fact that there is no plausible reason to believe homeopathy could be an effective therapy for anything, this review took the slightly naïve approach of review the clinical trial research without regard to prior plausibility. Nevertheless, the score for arthritis was a 1/5 for both osteoarthritis and rheumatoid arthritis:
Overall, there’s no evidence to suggest that the compound works or only a little evidence which is outweighed by much stronger evidence that it doesn’t work.
The review only found a couple of studies looking at use of SAMe for osteoarthritis, but it found them to be consistently positive and of reasonable quality, earning a score of 4/5.
There’s some consistency to the evidence, which will come from more than one study, to suggest that the compound works. Although there are still doubts from the evidence that it works, on balance we feel that it’s more likely to be effective than not.Evidence from RCTs suggests that SAMe is effective in reducing functional limitations and, to a lesser extent, pain in osteoarthritis.
Generally, SAMe is believed to be safe, but severe side effects (mania and anxiety) have been seen in some individuals with depression.
The report was very favorable for a positive effect of acupuncture on osteoarthritis. However, the authors based their conclusion mostly on a 2010 Cochrane Review which found < 5% difference in pain scores between real and fake acupuncture:
Pain after 8 weeks:-People who had acupuncture rated their pain to be improved by about 4 points on a scale of 0 to 20. -People who received sham acupuncture rated their pain to be improved by about 3 points on a scale of 0 to 20.-People who received acupuncture had a 1 point greater improvement on a scale of 0-20. (5% absolute improvement).Pain after 26 weeks:-People who had acupuncture rated their pain to be improved by slightly more than 3 points on a scale of 0 to 20. -People who received sham acupuncture rated their pain to be improved by slightly less than 3 points on a scale of 0 to 20.-People who received acupuncture had under a 1 point greater improvement on a scale of 0-20. (2% absolute improvement). Physical function after 8 weeks :-People who had acupuncture rated their function to be improved by about 11 points on a scale of 0 to 68. -People who received sham acupuncture rated their function to be improved by about 8 points on a scale of 0 to 68.-People who received acupuncture had about a 3 point greater improvement on a scale of 0-68. (4% absolute improvement) Physical function after 26 weeks :-People who had acupuncture rated their function to be improved by about 11 points on a scale of 0 to 68. -People who received sham acupuncture rated their function to be improved by about 10 points on a scale of 0 to 68.-People who received acupuncture had about a 1 point greater improvement on a scale of 0-68. (2% absolute improvement)
Not very compelling results. And the other studies the authors reviewed included one large trial, which showed no benefit, and 7 very small trials, two of admittedly poor quality, which showed small but inconsistent benefits. Given this evidence, the score seems excessively positive. And given the concern about significant placebo effects involved in acupuncture therapy, even if this tiny difference is real, it is unlikely to be of real benefit to veterinary patients but very likely to be subject to the caregiver placebo effect.
Only 1 trial was identified, which was not well controlled, so this intervention received a score of 2/5, indicating no compelling evidence of effectiveness. And unlike most of the therapies reviewed, chiropractic received only an intermediate “amber” grade for safety:
Therapies with an amber rating have commonly reported side-effects (even if they’re mainly minor symptoms) or more serious side-effects.