Problem 5: Use of Alternative Therapy for RA Flashcards
Compare and contrast the clinical evidence for the use of complementary therapy in RA?
In general, there is not enough scientific evidence to prove that any complementary health approaches are beneficial for RA, and there are safety concerns about some of them.
Most of the herbal medicinal products used orally have a broad mechanism of action, as shown by in vitro studies. Herbal medicinal products may be more or less involved in the inhibition of cyclo-oxygenase-1 or 2, lipoxygenase and enzymes that participate in cartilage destruction, such as elastase and hyaluronidase. The active principles may also inhibit the release of pro-inflammatory cytokines and stimulate the production of cytokines that inactivate enzymes, such as metalloproteinases.
There are a wide range of symptom relief /control areas that herbal medicines are used for but not many show significant benefit in randomised controlled placebo tests; pain is shown to be reduced by Gamma linolenic acid (GLA).
Construct appropriate advice which should be given to Mrs Li regarding the use of complementary therapy?
Broad mechanism of action, poorly understood how they work in the body, range of side effects and some safety concerns with some of them too.
GLA, Tripterygium wilfordii Hook F and phytodolor are the three that show some evidence of minor effect compared to placebo but adequate dose and the duration of treatment are unknown
The current available evidence for herbal treatment of RA is generally sparse and reliant on small sample sizes and is therefore insufficient for any reliable assessment of efficacy to be made. The variability between studies indicates a need to establish efficacy, optimum dosage and duration of treatment for these interventions.
