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There are more than 100 kinds of arthritis, the Like OA, RA affects the joints, but in addition it can
most common of which are osteoarthritis (OA) and also result in inflammation of the tendons, lungs, and
rheumatoid arthritis (RA). Of the two, osteoarthritis is blood vessels. Over the years, there has been
the most common form, affecting approximately three speculation as to its causes, but as yet its cause
million Canadians, mostly over the age of 45. While remains unknown.
both forms involve the typical joint pain associated
Conventional treatment for rheumatoid arthritis
with arthritis, they are in fact completely different
employs the use of pain killers, anti-inflammatory
diseases.
medications (which includes the COX-2 inhibitors
Osteoarthritis is commonly caused by hard such as Vioxx and Celebrex), and a category of
repetitive activity, and joint injury. The condition is medications known as disease modifying anti-
normally limited to the joint capsule, and is the result rheumatic drugs, or DMARDS (which includes
of the gradual deterioration of the cartilage that lines medications such as methotrexate). Reports over the
the bone surfaces. As it wears away, the synovial last year have resulted in several of the commonly-
lining in the joint capsule becomes inflamed. When used COX-2 inhibitors being pulled off the market.
severe, the bone ends will touch, and begin to wear
In addition to these conventional treatments,
away, resulting in joint deformity.
more and more patients are seeking out different
On the other hand, in rheumatoid arthritis, the treatment options, and in many cases seeing multiple
inflammation is the result of an autoimmune illness. practitioners for the same condition. One of the most
Autoimmune conditions result when the body highly sought treatment options is traditional Chinese
recognizes some of its own cells as being harmful and medicine (TCM).
many of those studies very little information is arthritis participated in the trial over a 12-18 month
i
provided regarding outcome measures. Still, there period. Nine of the patients went through the whole
are many studies that are noteworthy, and they do program, all experienced marked improvement and
point to the efficacy of TCM in arthritis. one went into complete remission on a dose of 390
mg/day. ESR (erythrocyte sedimentation rate) went
In their paper “Arthritis and Acupuncture: The from 55 mm/hour to 22 mm/hour on a dose of 480
Evidence for Effectiveness”, which was published by ii
mg/day. Fuelled by the results of this small trial,
the British Acupuncture Council in October 1998, researchers are currently conducting a much larger,
authors Saunders, Gould, and MacPherson reviewed double- blind, controlled study to confirm the benefits
a total of 18 papers, and regarding rheumatoid of lei gong teng extracts.
arthritis, they reached this conclusion:
“Acupuncture has been shown to give some pain relief Clinical Experience
in rheumatoid arthritis and an anti-inflammatory
response may also be present. Treatment early in the In my own experience, I have found arthritis to be
disease is preferable but age and duration of the
one of the most commonly-encountered clinical
disease should not be seen as barriers to treatment.”
conditions, and one that responds very favourably to
There are also countless studies regarding the treatment. Based upon my own clinical experience
efficacy of Chinese herbal medicines. Some of these using acupuncture, I have devised a treatment
studies examined the effects of a single herb, while protocol that divides the treatment into different
others examined the effects of herbal formulas. In one phases (Table 1). I recommend treatment initially at 2-
such study, a team of researchers from the University 3 times per week for several weeks. Depending on a
of Texas and the National Institutes of Health patient’s reaction to treatment, this will be reduced to
analyzed the effect of the herb Tripterygium wilfordii 1-2 treatments per week (perhaps for several weeks
Hook F, or lei gong teng as it is known in Chinese. or more), then 1 per week, then every 2 weeks, then
Thirteen patients with long-standing rheumatoid 3, and eventually tapering to a maintenance schedule
of one treatment per month (plus or minus).
Like the above acupuncture protocol, herbal every year they have had the condition. Therefore, if a
therapy is also of longer duration, and patients can patient has had RA for 10 years, they can reasonably
expect approximately one month of herbal therapy for
expect to be taking herbal medicines for at least 10 diagnosed several years earlier, and was prescribed
months. methotrexate, (a disease modifying anti-rheumatic
drug “DMARD”). Her pain was considerable and joint
deformity in the metacarpophalangeal (MCP) joints as
Case Example: Rheumatoid Arthritis
well as the thumbs of both her hands was evident.
(62-year-old Female Accountant) Her right hand was somewhat more painful, but both
were at times “intolerable”. Her hands were especially
The case history of a 62-year-old female stiff in the morning, and could remain so for several
accountant is summarized in Table 2. hours or more. She was an accountant, and the pain
made doing her job “impossible at times”.
Table 2. Case History - Rheumatoid Arthritis of the
Hands The TCM diagnosis confirmed that she was
suffering from “Bi Zheng” due to “Wind-Cold-Damp”
(considered to be the main etiological factors in
Chief Complaint Joint pain of hands arthritic conditions). In accordance with the
discussion presented above, the recommendation for
MD Diagnosis Rheumatoid arthritis this patient was a comprehensive treatment of
acupuncture and herbal medicine (Table 3). The
Treatment anti-inflammatory medication - acupuncture treatment focussed on invigorating
Methotrexate (DMARD) circulation and stopping the pain, while the herbal
medicine treatment focussed on resolving the Wind-
Cold-Damp condition, clearing the stagnation of
Phlegm and blood, tonifying the Kidneys,
A 62-year-old female sought help for her joint strengthening qi, and clearing heat-toxins.
pain due to rheumatoid arthritis. She had been
Diagnosis:
TCM Disease: Bi Zheng
TCM Pattern: Wind-Cold-Damp Bone Bi
Acupuncture: Initial treatment frequency of weekly acupuncture, gradually decreased over
the course of one year
Herbal Medicine: Herbal formula was modified periodically, with focus on
Clearing Wind-Cold-Damp
Clearing stagnation of Phlegm
Invigorating Blood
Strengthening Kidneys
Boosting Qi
Clearing Heat-Toxins
Other Recommendations: The patient was also encouraged to participate in stress-reducing
activities such as meditation, and to ensure she was getting adequate rest.
In autoimmune conditions such as RA, one has to The patient reported noticeable decrease in pain
be careful not to stimulate the immune system too after every acupuncture treatment. Sometimes it
much, but the main concern in the case of this patient would last for a few days, sometimes longer. She
was her use of methotrexate. This drug has some found that the stress of caring for her ailing husband
hepatotoxic effects (toxic for the liver), and some directly influenced her level of pain, as well as too
studies suggest that the use of certain herbal much use of her hands (in the course of doing her
medicinals can add to the hepatotoxic effects. For job).
example, echinacea (not a TCM herb) is commonly
used to boost the immune system during bouts of She was treated weekly for 3 months, and then
common cold. Studies have also shown that using it bi-weekly for 3 months, then she began coming less
with methotrexate can add to hepatotoxicity if used for regularly because she moved. The patient was
more than 8 weeks. Dang gui (Angelica) is a treated for about a year, after which the pain, redness,
commonly used TCM herb to invigorate circulation, and swelling of her joints was significantly reduced.
but it also can increase the hepatotoxic effects of Her treatment frequency and progress is summarized
methotrexate. Understanding the possible herb-drug in Table 4.
interactions, an herbal formula was utilized, the main
focus of which was to address the phlegm and blood
stagnation.
1 - 12 Weekly Decrease in pain after every Joints red and swollen, pain
treatment. reduced on palpation.
At the last examination, she was more able to majority of respondents had expressed “total”, or “a
carry out her daily activities, but was still taking the lot” of confidence in their CAM provider, more than
methotrexate, as she felt “afraid to stop”. She has half of those who had used CAM in 2006 did so
since moved again, and it is not known how her without discussing their use with their doctor. The
condition is now. reasons for patients not having a discussion with their
doctor about their use of complementary therapies
Interdisciplinary Communication – varied. Many (61%) thought it was not important for
their doctor to know about it, while 56% of
the only way forward
respondents said that their doctor had never asked
about these therapies. Thirty-one percent of
Complementary and Alternative (CAM) therapies respondents felt that it was none of their doctor’s
are more popular than ever. A 2006 study conducted business, and 11 percent were concerned that the
by the Fraser Institute showed that more than 80% of iv
doctor would disapprove or not understand.
British Columbians have used at least one alternative
therapy at sometime in their lives, and of the therapies Studies like the Fraser Institute Study illustrate
most commonly utilized, almost one in five had used the reality of practicing medicine in modern times:
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acupuncture. Unfortunately, despite the fact that the patients are commonly seeing multiple practitioners
for the same condition, and often not informing their When the steroid levels administered for treating
practitioners of other treatments they might be inflammation are high enough to cause some side
receiving. This is especially true for chronic and effects, elevation of the drug level by herb action
v
enduring conditions like arthritis, and represents a could increase the side effects. At the same time,
potentially hazardous situation. As the above Case due to this very interaction, conventional steroid
Example illustrated, some understanding of potential therapy could be reduced. This has been exactly the
herb-drug interactions is imperative in order to case in Japan, where an herbal formula called Chai
mediate the risks of herb-drug complications. This fact Ling Tang (Bupleurum and Hoelen Combination) has
requires and demands more open communication been used in cases of rheumatoid arthritis and found
between different disciplines of heath service that the result is a reduction in the dose of steroids by
providers (interdisciplinary communication). up to two-thirds. It was also shown to be helpful in
vi
reducing arthritic inflammation.
In modern clinical practice, the prudent
practitioner will make himself aware of the potential Studies such as this would indicate that there can
risks and benefits of such therapies as herbal be a positive effect for the use of herbs in combination
medicine. As an example, certain herbs have shown with corticosteroids, but it also presents a potential
an effect in enhancing the circulating levels of problem: if a medical doctor is administering high
corticosteroids by slowing their metabolism. This (rather than low) doses of steroids to a patient who is
action will not only increase the amount of natural also taking herbal medicine, the effects can be
vii
corticosteroids (hormones produced by the adrenal adverse . Other examples of potentially negative
cortex), but also any steroids administered as drugs. drug-herb interactions are summarized in Table 5.
Radix Ligustici Wallichii chuan xiong may interfere with Anti-Coagulating drugs
Radix Saviae Miltiorrhizae dan shen may interfere with Anti-Coagulating drugs
Radix Angelicae Sinensis dang gui may interfere with Anti-Coagulating drugs
Ligustri Lucidi nu zhen zi lowers plasma glucose levels. Combining this herb with anti-
diabetic medication such as insulin or sulfonylureas may result
in hypoglycaemia
Ginseng ren shen may reduce fasting blood glucose levels. Hypoglycemia may
occur when this herb is combined with drugs for diabetes
mellitus.
Finally, immunostimulants such as echinacea and such as corticosteroids (prednisone, etc.) and
zinc should not be given with immunosuppressants cyclosporine, and are contraindicated in patients