title: Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review.
abstract: OBJECTIVE
  To critically evaluate the evidence regarding complementary and alternative medicine (CAM) taken orally or applied topically (excluding fish oil) in the treatment of RA.
  
  
  METHODS
  Randomized controlled trials (RCTs) of RA using CAMs, in comparison with other treatments or placebo, published in English up to August 2010, were eligible for inclusion. They were identified using systematic searches of bibliographic databases and manual searching of reference lists. Information was extracted on outcomes and statistical significance, in comparison with alternative treatments, and reported side effects. The methodological quality of the primary studies was determined using the Jadad scoring system.
  
  
  RESULTS
  Reported RCTs were available for 18 CAMs in the management of RA. There was no consistent evidence available for any of the reviewed substances to suggest that they were efficacious as complementary medicines to standard treatment. Nevertheless, the studies conducted on borage seed oil (n = 2) and thunder god vine (n = 3) have been positive and may warrant further investigation. Not all CAM compounds studied were free of major adverse effects.
  
  
  CONCLUSIONS
  The major limitation in reviewing the evidence for CAMs is the paucity of RCTs in the area. The available evidence does not support their current use in the management of RA.
authors.affiliation: Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building (Room 1:071), Foresterhill, Aberdeen, Scotland AB25 2ZD, UK. g.j.macfarlane@abdn.ac.uk
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.forename: Ashraf
authors.initials: A
authors.lastname: El-Metwally
authors.forename: Vijitha
authors.initials: V
authors.lastname: De Silva
authors.forename: Edzard
authors.initials: E
authors.lastname: Ernst
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Dowds
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Moots
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D000529:Complementary Therapies / Q000379:methods*; D006801:Humans; D010938:Plant Oils / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D029757:Tripterygium; D017965:gamma-Linolenic Acid / Q000627:therapeutic use
chemical_list: D010938:Plant Oils; D017965:gamma-Linolenic Acid; C079363:borage oil