Abstract
Complementary or alternative therapies for osteoarthritis are commonly used and therefore it is important that health-care providers and patients are aware of the evidence for or against these approaches. In this article, the best available evidence is reviewed. The results suggest that, for several treatments, the risk–benefit profile is encouraging: acupuncture, several herbal medicines and capsaicin cream. For other therapies the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, yoga, imagery and therapeutic touch. Many other treatments have not been scientifically tested. It is concluded that some complementary or alternative therapies have generated sufficiently promising results to warrant further investigation in large-scale, definitive, randomized clinical trials.
Key Points
-
Complementary or alternative medicine is commonly used by patients with osteoarthritis
-
The risk–benefit profile is encouraging for acupuncture, several herbal remedies and capsaicin cream
-
For other treatments the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, imagery and therapeutic touch
-
Most complementary or alternative medicine interventions recommended for osteoarthritis have not been studied in clinical trials
-
Some complementary or alternative medicines seem to merit further study
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ernst E et al. (1995) Complementary medicine—a definition. Br J Gen Pract 45: 506
Barnes PM et al. (2004) Complementary and alternative medicine use among adults: United States, 2002. Advance data from vital and health statistics; no 343. Hyattsville: US Department of Health and Human Services, CDC, National Center for Health Statistics
Ernst E et al. (2001) The desktop guide to complementary and alternative medicine. Edinburgh: Mosby
Rhee SM et al. (2004) Use of complementary and alternative medicines by ambulatory patients. Arch Intern Med 164: 1004–1009
Harrison RA et al. (2004) Are those in need taking dietary supplements? A survey of 21,923 adults. Br J Nutr 91: 617–623
Richardson J (2004) What patients expect from complementary therapy: a qualitative study. Am J Pub Health 94: 1049–1053
Giveon SM et al. (2004) Are people who use “natural drugs” aware of their potentially harmful side effects and reporting to family physician? Patient Educ Couns 53: 5–11
Ernst E and White AR (Eds; 1999). Acupuncture—A Scientific Appraisal. Oxford: Butterworth Heinemann
Ezzo J et al. (2001) Acupuncture for osteoarthritis of the knee. Arthritis Rheum 44: 849–855
Berman BM et al. (2004) Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Ann Intern Med 141: 901–910
Vas J et al. (2004) Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 329: 1216
Tukmachi E et al. (2004) The effect of acupuncture on the symptoms of knee osteoarthritis—an open randomised controlled study. Acupunct Med 22: 14–22
Witt C et al. (2005) Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 366: 136–143
Ernst E and White A (1997) Life-threatening adverse reactions after acupuncture? A systematic review. Pain 71: 123–126
Melchart D et al. (2004) Prospective investigation of adverse effects of acupuncture in 97,733 patients. Arch Intern Med 164: 104–105
Little CV et al. (2000) Herbal therapy for treating rheumatoid arthritis. The Cochrane Database of Systematic Reviews, Issue 4, Art. No CD002947
Ernst E (2003) Avocado–soybean unsaponifiables (ASU) for osteoarthritis—a systematic review. Clin Rheumatol 22: 285–288
Gagnier JJ et al. (2004) Harpagophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med 4: 13
Altman RD and Marcussen KC (2001) Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 44: 2531–2538
Wigler I et al. (2003) The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 11: 783–789
Long L et al. (2001) Herbal medicines for the treatment of osteoarthritis: a systematic review. Rheumatology 40: 779–773
Jung YB et al. (2001) Effect of SKI306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study. Am J Chin Med 29: 485–491
Biegert C et al. (2004) Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind trials. J Rheumatol 31: 2121–2130
Mills SY et al. (1996) Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 35: 874–878
Ferraz MB et al. (1991) Tipi. A popular analgesic tea: a double-blind cross-over trial in osteoarthritis. Clin Exp Rheumatol 9: 205–212
Kulkarni RR et al. (1991) Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 33: 91–95
Ryttig K et al. (1991) Gitadyl versus ibuprofen in patients with osteoarthritis. The result of a double-blind, randomized cross-over study. Ugeskr Laeger 153: 2298–2299
Biswas NR et al. (1998) Treatment of osteoarthritis, rheumatoid arthritis and non-specific arthritis with a herbal drug: a double-blind, active drug controlled parallel study. JK Pract 5: 129–132
Randall C et al. (2000) Randomized controlled trial of nettle sting for treatment of base-of-thumb pain. J R Soc Med 93: 305–309
Kimmatkar N et al. (2003) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial. Phytomedicine 10: 3–7
Rein E et al. (2004) A herbal remedy, Hyben Vital (stand. powder of a subspecies of Rosa canina fruits), reduces pain and improves general wellbeing in patients with osteoarthritis—a double-blind, placebo-controlled, randomised trial. Phytomedicine 11: 383–391
Teekachunhatean S et al. (2004) Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial [ISRCTN70292892]. BMC Complement Altern Med 4: 19
Ernst E (2000) Risks associated with complementary therapies. In Meyler's Side Effects of Drugs, edn 14, 1649–1681 (Eds Dukes MNG and Aronson JK) Amsterdam: Elsevier
Long L (2001) Homeopathic remedies for the treatment of osteoarthritis: a systematic review. Br Homeopath J 90: 37–43
Shang A et al. (2005) Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 366: 726–732
Hulme JM et al. (2002) Electromagnetic fields for the treatment of osteoarthritis. The Cochrane Database of Systematic Reviews, Issue 1, Art. No CD003523.
Battisti E et al. (2004) Efficacy and safety of a musically modulated electromagnetic field (TAMMEF) in patients affected by knee osteoarthritis. Clin Exp Rheumatol 22: 568–572
Nicolakis P et al. (2002) Pulsed magnetic field therapy for osteoarthritis of the knee—a double-blind sham-controlled trial. Wien Klin Wochenschr 114: 678–684
Hinman MR et al. (2002) Effects of static magnets on chronic knee pain and physical function: a double-blind study. Altern Ther Health Med 8: 50–55
Harlow T et al. (2004) Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee. BMJ 329: 1450–1454
Wolsko PM et al. (2004) Double-blind placebo-controlled trial of static magnets for the treatment of osteoarthritis of the knee: results of a pilot study. Altern Ther Health Med 10: 36–43
Richy F et al. (2003) Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 163: 1514–1522
McAlindon TE et al. (2000) Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 283: 1469–1475
Towheed TE et al. (2005) Glucosamine therapy for treating osteoarthritis. The Cochrane Database of Systematic Reviews, Issue 2, Art. No CD002946
Morreale P et al. (1996) Comparison of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 23: 1385–1391
Leeb BF et al. (2000) A meta-analysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol 27: 205–211
Häuselmann HJ (2001) Nutripharmaceuticals for osteoarthritis. Best Pract Res Clin Rheumatol 15: 595–607
Uebelhart D et al. (2004) Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage 12: 269–276
Mathieu P (2002) Radiological progression of internal femoro-tibial osteoarthritis in gonarthrosis. Chondro-protective effect of chondroitin sulfates ACS4–ACS6. Presse Med 31: 1386–1390
Rai J et al. (2004) Efficacy of chondroitin sulfate and glucosamine sulfate in the progression of symptomatic knee osteoarthritis: a randomized, placebo-controlled, double-blind study. Bull Postgrad Inst Med Educ Res Chandigarh 38: 18–22
Michel BA et al. (2005) Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial. Arthritis Rheum 52: 779–786
Cohen M et al. (2003) A randomized, double-blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. J Rheumatol 30: 523–528
Cohen M et al. (2003) A randomized, double-blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee [erratum]. J Rheumatol 30: 2512
Song R et al. (2003) Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol 30: 2039–2044
Hartman CA et al. (2000) Effects of t'ai chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc 48: 1553–1559
Michalsen A et al. (2003) Effectiveness of leech therapy in osteoarthritis of the knee. Ann Intern Med 139: 724–730
McCaffrey R and Freeman E (2003) Effect of music on chronic osteoarthritis pain in older people. J Adv Nurs 44: 517–524
Garpike MS et al. (1994) Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol 21: 2341–2343
Baird CL and Sands L (2004) A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manage Nurs 5: 97–104
Eckes Peck SD (1997) The effectiveness of therapeutic touch for decreasing pain in elders with degenerative arthritis. J Holist Nurs 15: 176–198
Klassen KP et al. (2005) For randomized controlled trials, the quality of reports of complementary and alternative medicine was as good as reports of conventional medicine. J Clin Epidemiol 58: 763–768
Lawson ML et al. (2005) Systematic reviews involving complementary and alternative medicine interventions had higher quality of reporting than conventional medicine reviews. J Clin Epidemiol 58: 777–784
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author declares no competing financial interests.
Rights and permissions
About this article
Cite this article
Ernst, E. Complementary or alternative therapies for osteoarthritis. Nat Rev Rheumatol 2, 74–80 (2006). https://doi.org/10.1038/ncprheum0093
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/ncprheum0093
This article is cited by
-
Rheumatologie und Homöopathie – eine kritische Diskussion
Zeitschrift für Rheumatologie (2023)
-
Effects of yogic intervention on pulmonary function and respiratory muscle strength parameters: A systematic literature review and meta-analysis
Journal of Biosciences (2021)
-
Effects of Baduanjin (八段锦) exercise on knee osteoarthritis: A one-year study
Chinese Journal of Integrative Medicine (2013)
-
The Future of Osteoarthritis Therapeutics: Targeted Pharmacological Therapy
Current Rheumatology Reports (2013)
-
Nonpharmacological Treatment of Pain in Rheumatic Diseases and Other Musculoskeletal Pain Conditions
Current Rheumatology Reports (2013)