Many people who have chronic inflammatory disease and rheumatoid arthritis seek additional help with painful symptoms.
Fatigue, swelling and agony of the joints that may come with the disorder, which is caused by the immune system itself of a person who attacks the joints, cannot be completely banished.
While there are medications that help delay joint damage and relieve symptoms, they often come with side effects such as nausea, anemia, high blood sugar levels, bone loss and an increased risk of infection.
To avoid these possible risks, some patients seek alternative therapies to supplement the prescription medications they are already taking.
"More than 50 percent of the patients I see will have tried or wanted to try them," said Dr. Dana DiRenzo, a medical instructor in the rheumatology division of Johns Hopkins University.
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Although there are no large clinical trials that have studied these therapies, some, such as omega-3 fatty acids, are backed by smaller studies, DiRenzo said.
Often, patients expect complementary and alternative therapies to allow them to reduce the amount of medication they take, said Dr. Wei Wei Chi, a rheumatologist and assistant professor at Mount Sinai Medical Center.
"Patients like to be able to take care of their own health and this is a way to do it," Chi said.
Because it is not possible to predict in advance which one will be the most useful for a particular person, Dr. Elizabeth Volkmann encourages patients interested in alternative therapies to try multiple options.
"My approach is to tell patients to make a combination," said Volkmann, an assistant professor of medicine in the rheumatology division at the University of California, Los Angeles.
"Very often patients feel they have to choose," he added. "I don't think so. Just be sure to tell your doctor, whatever you are using, so you can check your kidney and liver function."
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The following is a list of therapies for which there is evidence of efficacy in patients with rheumatoid arthritis:
A 2018 review article recommended the Mediterranean diet and fish oil for patients with RA. DiRenzo said that any diet that eliminates foods that could have inflammatory effects can help.
"Basically, you want to avoid processed foods high in enriched flour," he explained. “You want to include a good amount of vegetables and lean meats and olive oil. The Mediterranean diet fits that bill. "
Another possible addition: antioxidant-rich foods, such as blueberries, DiRenzo said.
DiRenzo recommends a yoga program designed for those suffering from arthritis.
"Yoga is good for strengthening the core, improving overall mobility and also reducing stress," he said. "There are many studies that come out now to see how stress affects disease activity." Doing an exercise that is good for the joints and that reduces stress is a victory for everyone. ”
A small randomized control trial of 2019 supports DiRenzo. That trial found that yoga improved inflammation markers in patients with RA.
Recent data have suggested that problems with the microbiome may be involved in the development of RA, said Armin Alaedini, an assistant professor in the department of medicine and the Institute of Human Nutrition at Columbia University Medical Center.
"Therefore, certain probiotics and prebiotics can have a beneficial effect on RA, in part by acting on the immune system to reduce inflammation," Alaedini said in an email. "This is an exciting area and more research is needed to better understand the mechanisms and possible therapeutic opportunities."
These are among the best studied anti-inflammatories. Several review articles that combine data from small clinical trials found that these supplements can relieve pain in patients with RA.
DiRenzo said that Omega-3 supplements have the additional benefit of being heart-healthy, warning patients to keep their doctors informed if they choose to use Omega-3 since this supplement can dilute the blood, which could be A problem if you are already taking anticoagulants.
GLA is another fatty acid with anti-inflammatory properties. It is found in evening primrose oil, black current seed and borage oil. A small 18-month clinical trial in 2014 found that the supplement improved symptoms and allowed some patients to reduce their medication doses.
This spice also has anti-inflammatory properties. DiRenzo said that in some small studies it has been associated with pain relief.
"It has few side effects, but in large quantities it can cause gastrointestinal upset," he said.
On the positive side, it can be used in the kitchen.
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Linda Carroll is a regular contributor to NBCNews.com and Today.com. She is also co-author of Out of the clouds: the unlikely rider and The unwanted colt that conquered the sport of the kings.