Major Finding: There is some consistent suggestion of a benefit of fish body oil in RA and capsaicin gel in OA, but there is no such support for the use of any oral or topical complementary or alternative medicine in fibromyalgia.
Data Source: Complementary and alternative medicine symposium held at the British Society for Rheumatology annual meeting.
Disclosures: Dr. MacFarlane had no disclosures or conflicts of interest. The research was funded by Arthritis Research UK.
BIRMINGHAM, ENGLAND — The use of complementary or alternative medicines in rheumatoid arthritis, osteoarthritis, and fibromyalgia is not supported by credible evidence, according to an expert review of available data.
The review, which was commissioned by Arthritis Research UK for patients, shows that, although there is some consistent suggestion of a benefit for fish body oil in RA and capsaicin gel in OA, there is no such support for the use of any oral or topical complementary or alternative medicines (CAMs) in fibromyalgia.
“Complementary medicines are popular, but considering particularly those taken orally or applied topically, we have relatively little information for most compounds on efficacy,” Dr. Gary J. MacFarlane said.
“Both positive and negative conclusions are based upon relatively little amounts of evidence,” added Dr. MacFarlane, professor of epidemiology at the University of Aberdeen (Scotland) and head of the Arthritis Research UK working group on complementary and alternative medicines.
The working group looked at the available evidence on 41 CAMs for which there was some evidence from randomized controlled trials. There were a further 38 compounds commonly used by patients for which no suitable trial evidence could be found.
The aim of the review was to determine both the efficacy and safety of the compounds to give patients some idea of which CAMs worked and which probably did not, Dr. MacFarlane said. If a rigid Cochrane Review had been performed, he conceded, the majority of studies that were assessed would probably have been excluded.
“However, patients were saying to us, actually we want you to say something, not just that there is not enough evidence,” Dr. MacFarlane explained.
Efficacy was graded on a 1- to 5-level scale, with level 1 signifying that there is no overall evidence that the compound worked, and level 5 meaning that there was some consistent evidence across several studies.
The only compounds at level 5 were fish body oil for RA and capsaicin gel for OA. Glucosamine sulfate for OA was graded at level 3, meaning that there was some promising evidence, despite its not being recommended for the treatment of OA in the 2008 OA clinical guidelines of the U.K. National Institute for Health and Clinical Excellence. Out of four CAMs used for fibromyalgia, none was graded higher than a level 2.
Dr. MacFarlane said that in his view, “fibromyalgia is a condition that really doesn't have any very effective therapy.” Although there have been a small number of positive CAM studies in fibromyalgia, he added, their lack of replication means that further, higher-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.
The working group's findings on the use of CAM in fibromyalgia have recently been published (Rheumatology 2010;49:1063-8), and publications on OA and RA will follow in the coming months.