A recent review article appearing in Medscape (Evidence for the Efficacy of Complementary and Alternative Medicines in the Management of Osteoarthritis. Vijitha De Silva; Ashraf El-Metwally; Edzard Ernst; George Lewith; Gary J. Macfarlane) shed light on a rapidly growing but mysterious - at least to traditional practitioners- method of medical treatment. That is the field of complementary, better known as, alternative therapies.

In our practice, most patients will readily talk about alternative therapies they are trying or hope to try in the future. Often, they ask my opinion and ask about which types of alternative therapies I would recommend.

One of the biggest shortfalls of treatment today in rheumatology is the lack of effective treatment modalities for osteoarthritis. All therapies currently considered "conventional" are designed to alleviate symptoms. They do absolutely nothing to control the progression of disease.

Osteoarthritis is not a benign disease in that it is a key cause of disability in adults and a leading cause of missed days from work.

So... one argument raised by many patients is this... 'Why should I take a chemical pain killer with all the potential side effects when I can take an alternative therapy that does the same thing without the side effects?" And I have no good response to that question other than, "You have a good point."

Nonetheless, it is nice to have a review article that has examined the therapies and provides some evidence, albeit sparse, that some therapies work while others are still, in the drawing board phase.

The article mentioned above exhaustively examined numerous studies. They concluded that capsaicin gel and S-adenosyl methionine (SAMe) had credible data supporting their use in osteoarthritis.

They also felt there was sufficient evidence to possibly support the use of frankincense, MSM, and rose hips.

Unfortunately, there was not enough clinical trial data to advocate the following: ASU, CMO, green-lipped mussel, pine bark extracts, SKI 306XI, vitamin B complex, ginger and homeopathy.

One flaw is that there are few well-controlled studies looking at these types of therapies. The major reason is that it is extremely difficult to secure funding to look at therapies that are not produced by a pharmaceutical or biotech company. As the director of a leading arthritis research center, I can vouch for the difficulty in obtaining any type of grant that is not tied to a drug in development.

One key point, the authors made in the above referenced review is that there were very few side effects associated with these alternative therapies. These included heartburn, gastrointestinal upset, and heartburn.

There is a dilemma here because many alternative therapies have, over time, proved their worth. These include chiropractic, acupuncture, massage therapy, hypnotherapy, and the like.

On the other hand, there are alternative therapies where the evidence is lacking. For every treatment that eventually proves its worth, there are probably ten that are bogus. But how do you tell?

In all honesty, you can't. And that is why you have to rely on your doctor as well as your own response to the treatment. Remember... the placebo response for arthritis remedies can approach forty per cent. That isn't all bad if the aim is to get symptom relief. Nonetheless, if it is a treatment with potential harm associated with it, be very wary.