A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis.
OBJECTIVE
To critically review the evidence on the effectiveness of complementary therapies for patients with RA.


METHODS
Randomized controlled trials, published in English up to May 2011, were identified using systematic searches of bibliographic databases and 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 identified studies was determined using the Jadad scoring system. All outcomes were considered but with a focus on patient global assessment and pain reporting.


RESULTS
Eleven eligible trials were identified covering seven therapies. Three trials that compared acupuncture with sham acupuncture reported no significant difference in pain reduction between the groups but one out of two reported an improvement in patient global assessment. Except for reduction in physician's global assessment of treatment and disease activity reported in one trial, no other comparative benefit of acupuncture was seen. There were two studies on meditation and one each on autogenic training, healing therapy, progressive muscle relaxation, static magnets and tai chi. None of these trials reported positive comparative effects on pain but some positive effects on patient global assessment were noted at individual time points in the healing therapy and magnet therapy studies. A small number of other outcomes showed comparative improvement in individual trials. There were no reports of major adverse events.


CONCLUSIONS
The very limited evidence available indicates that for none of the practitioner-based complementary therapies considered here is there good evidence of efficacy or effectiveness in the management of RA.
Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, UK. g.j.macfarlane@abdn.ac.uk
Gary J
GJ
Macfarlane
Priya
P
Paudyal
Michael
M
Doherty
Edzard
E
Ernst
George
G
Lewith
Hugh
H
MacPherson
Julius
J
Sim
Gareth T
GT
Jones
D015670:Acupuncture Therapy; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D000529:Complementary Therapies; D019317:Evidence-Based Medicine; D006801:Humans; D055909:Magnetic Field Therapy; D019122:Meditation; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D026302:Tai Ji; D016896:Treatment Outcome