Since I dedicated an entire issue of JAMA on Nov. 11, 1998 to the theme of Complementary and Alternative Medicine in an effort to move CAM into the mainstream, I keep hoping that some of the numerous CAM offerings will make it out of the realm of anecdotal and placebo-healer-effect, and successfully through randomized controlled clinical trials.
So I got excited when I saw the BMJ Evidence Centre via McMaster feature the article, entitled “Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review,” published in Rheumatology in September 2011.
The authors critically evaluated the evidence regarding complementary and alternative medicine taken orally or applied topically (excluding fish oil) in the treatment of rheumatoid arthritis (RA).
They studied randomized controlled trials (RCTs) of RA using CAMs, in comparison with other treatments or placebo, published in English up to August 2010.
The RCTs 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 other treatments, and reported side effects. The methodological quality of the primary studies was determined using the Jadad scoring system.
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 medicine compared to standard treatment.
However, two studies conducted on borage seed oil and three on thunder god vine have been positive and may warrant further investigation.
The authors concluded that the major limitation in reviewing the evidence for CAMs is the paucity of RCTs in the field.
Nonetheless, the available evidence does not support CAM use currently in the management of rheumatoid arthritis.
An ideal disease example to study — important, common, highly symptomatic, even deforming and debilitating, although usually nonfatal.
Well, maybe the thunder god vine will be the breakthrough CAM has been looking for.
More RCTs, please.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.
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