Studie på Reumatologi og andre muskel- og skjelettplager

Reumatology and other musculoskeletal complaints␣ summary of publications110117

Her følger en oversikt over forskning på Reumatologi og andre muskel- og skjelettplager. Oversikten er på engelsk, og er laget på bakgrunn av World Homeopathy Awareness Week som i 2011 har muskel- og skjelettplager som tema!

Prevalence studies

Branco JC, Bannwarth B, Failde I, Carbonell JA, Blotman F, Spaeth M, Saraiva F, Nacci F, Thomas E, Caubère JP, Le Lay K, Taieb C, Matucci-Cerinic M. Prevalence of fibromyalgia: A survey in five European countries. Semin Arthritis Rheum 2010; 39: 448-453. Survey to estimate prevalence of fibromyalgia in 5 countries (France, Germany, Italy, Portugal and Spain). Estimated overall prevalence 2.9 to 4.7 %. FM appears to be a common condition.

Tobón GJ, Youinou P, Saraux A. The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis. Journal of Autoimmunity 2010; 35: 10-14. Incidence of RA is estimated at 0.5-1.1 %.

Shapira Y, Agmon-Levin N, Shoenfeld Y. Geoepidemiology of autoimmune rheumatic diseases. Rheumatology 2010; 6; 468-476. The global burden of autoimmune and inflammatory rheumatic diseases is substantial. Rheumatic diseases is relatively evenly distributed globally. AIRDs are widespread.

Visser GJ, Peters L, Rasker JJ. Rheumatologists and their patients who seek alternative care: an agreement to disagree. Br J Rheumatol 1992; 31(7): 485-90. 43% of patients consulting with over 100 rheumatologists had visited an alternative practitioner

Homeopathy studies

Anderson K. A complex homeopathic preparation for the treatment of osteoarthritis. Explore 2006; 2(3): 234.

592 patients with stage I og II osteoarthritis seen by 127 physicians Physicians decided whether to use Cox-2 inhibitors Celebrex or Vioxx, or Zeel Efficacy of treatment evaluated by physician and patient Physician assessed:

Cardinal symptoms: – Initial pain with movement – Pain continuing during movement or weight-bearing exercise – Pain when fatigues – Joint stiffness/tension

Evaluated: – Onset of symptomatic improvement – Overall results of therapy (very good, good, fair, no success, worse) Assessed at entry, 4 weeks, 6-10 weeks Entry: Cardinal symptoms moderabely severe 4 weeks: Significant improvements in all symptoms under both treatment regimens, somewhat more in the Cox-2 inhibitor group 6 weeks: Homeopathic medication and Cox-2 inhibitors equally effective Tolerability: Zeel scored significantly higher (p<0.0001) than Cox-2 inhibitors ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣-2 inhibitors 74% Undesired effects of Cox-2 inhibitors: edema, diarrhea/vomiting/dizziness, gastric complaints

Andrade LEC, Ferraz MB, Atra E, Castro A, Silva MSM. A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand J Rheumatol 1991; 20: 204-208.

44 patients with active RA (hom 23, placebo 21) 6 month double-blind trial homeopathy vs placebo All patients interviewed by homeopathic physician Constitutional medication + local medication prescribed alternately during the day Potencies: C5 go C30 Most common Rx: Rhs-t, Puls, Lach, Hydr, Thuj, Nat-m, Calc-p, Calc, Lyc, Ars, Arg-n, Apis, Led, Med, Cham, Caust, Nux-v, Ign, Sep, Staph, Sulph ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣

Not intention-to-treat analysis, but only patients who completed trial 5 hom and 5 placebo D-O, due to lack of efficacy 1 hom D-O due to psychosis Completed hom 17, placebo 16

Treatments equally effective in most assessments Statistically significant improvements in 3 of 5 and 2 of 5 results assessed in homeopathic and placebo tretaed groups No statistically significant difference between groups Adverse effects scarcely and comparably reported in both groups, no change in therapy required

Hom ␣ change between start and end of trial

Improvement in 3 clinical parameters

15-meter walking time -2.4 (12%) (p<0.05) Ritchie articular index -5.4 (23%) (p<0.05) Functional class -0.38 (16%) (p<0.05) Prednisone daily dose -2.20 (45%) (p<0.05)

Placebo ␣ change between start and end of trial

Improvement in 1 clinical parameter

Ritchie articular index -4.3 (25%) (p<0.05) Prednisone daily dose -1.94 (55%) (p<0.05) NSAID daily dose -3.31 (37%) (p<0.05)

No difference: Morning stiffness, Grip strenght, ESR mm/1st hour, Seromucoids

Physician assessment Hom (n=17)

Conclusion: No statistically significant evidence that homeopathic therapy was superior to placebo. Moderate improvement in both groups.

Improved Unchanged Worse No statistically significant differences between groups

10 (59%) 4 (23%) 3 (18%)

Placebo (n=16) 7 (44%) 5 (31%) 4 (25%)

Bell IR, Lewis DA, Brooks AJ, Schwartz GE, Lewis SE, Walsh BT, Baldwin CM. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology, 2004 a. Doi: 10.1093/rheumatology/keh111

Over 50 patients diagnosed with fibromyalgia Homeopathy versus placebo, 4 months Clear effect seen in the homeopathy group Significant improvement in the number of painful points and degree of pain. Homeopathy patients experienced improvement in quality of life, general state of health and mood. ␣␣␣ ␣␣␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣ ␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣ ␣␣␣ ␣␣␣␣ ␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣ ␣␣␣ treatment.

Bell IR, Lewis DA, Lewis SE, Schwartz GE, Brooks AJ, Scott A, Baldwin CM. EEG Alpha sensitization in individualized homeopathic treatment of fibromyalgia. Intern J Neuroscience, 2004 b, 114, 1195-1220. Bell IR, Lewis DA, Schwartz GE, Lewis SE, Capsi O, Scott A, Brooks AJ, Baldwin CM. Electroencephalographic cordance patterns distinguish exceptional clinical responders with fibromyalgia to individualized homeopathic medicines. The Journal of Alternative and Complementary Medicine, 2004 c, 10(2), 285-299.

M␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣halography (EEG) Significant differences were found between patients receiving homeopathic medicine and those receiving placebo. Patterns improved significantly in homeopathy patients after 3 and 6 months.

Brien S, Lachance L, Prescott P, McDermott C, Lewith G. Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology Advance Access 2010. Doi:10.1093/rheumatology/keq234.

83 patients diagnosed with rheumatoid arthritis (RA)

Double-blind, randomized placebo-controlled trial

Randomized to: – Homeopathic consultation + individualised remedy: 16 – Homeopathic consultation + complex remedy: 14 – Homeopathic consultation + placebo: 16 – No homeopathic consultation + complex remedy: 15 – No homeopathic consultation + placebo: 16

56 completed treatment

Result

Homeopathic consultation significantly improved

– DAS-28 (p=0.005, effect size 0.70) – Swollen joint count (p=0.003, ES 0.83) – Current pain (p=0.038, ES 0.48) – Weekly pain (p=0.045, ES 0.30) – Weekly patient GA (p=0.036, ES 0.31) (GA: patient monthly golbal assessment) – Negative mood (p=0.015, ES 0.90)

No effect of complex remedy NOTE: Insufficient number of participantstodraw other conclusions

Contrast 1: Consultation vs non-consultation groups – Consultation + complex remedy AND consultation + placebo – No consultation + complex remedy AND No consultation + placebo Those receiving individualised homeopathy were excluded, due to no comparison available

Contrast 2: Effect of complex treatment – Consultation + complex remedy AND No consultation + complex remedy – Consultation + placebo AND No consultation + placebo

Contrast 3: Individualised vs complex remedy – Consultation + individualised remedy – Consultation + complex remedy

Contrast 4: Individualised remedy vs placebo – Consultation + individualised remedy – Consultation + placebo

All individualised remedies prescribed in LM potencies Homeopathic consultations: Visits 2-6 (1st 1hour, f.u. 30 min), non-medical homeopaths with 15 years of experience Complex remedy: Rheumaselect: Thus-t D4, Bryonia cretica D4, Nux-v D4, Berg D4, Led D4

Critique Each group had 14-16 participants (ITT analysis). “No study has previously determined the effect size (ES) of the consultation or how relative this effect is to the specific treatment effect.” Hence, the authors made an estimate to carry out a power calculation. “Under-recruitment resulted in lower patient numbers than those required …”

“There were two major limitations to this study; it was underpowered for dichotomous outcomes due to under-recruitment and a slightly higher rate of attrition than anticipated (27% compared with 20%).

However, it was adequately powered for continuous variables and comparisons using Contrasts 1 and ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣

This means that the study had: – Sufficient number of participants to compare the effect of having a consultation with not having a consultation – Sufficient number of participants to compare the effect of a complex remedy with placebo. – I NSUFFI CI ENT number of participants to compare individualized homeopathy with a complex remedy. – I NSUFFI CI ENT number of participants to compare individualized homeopathy with placebo.

Fisher P, Greenwood A, Huskisson EC et a␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣366

Randomized double-blind placebo controlled trial Rhus-t C6 for 30 patients with symptoms fitting the Rhus-t picture Reduction in the number of tender points (p<0.005), pain and improved sleep (p=0.0052) in patients receiving a homeopathic medicine, compared to those who received placebo.

Fisher PA, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology 2001; 40: 1052-1055.

112 patients diagnosed with RA, 58 completed Stable doses of single NSAID min 3 months or single disease-modifying anti-rheumatic druges (DMARDs) with or without NSAID min 6 months 6 months Blinded RCT, cross-over

Medication: – One HMP at the time, out of 42 HMPs (59 preparations in C6 and/or C30 potency) – Placebo

HMPs: Ant-c C6, Apis C6/30, Arn C6/30, Ars C6/30, Aur C30, Bell-p 6C, Berb C6, Bry C6/30, Calc C6/30, Calc-fl C6/30, Calc-p C6, Caul C6, Caust C6/30, Cim C6/30, Dulc C6/30, Ign C6, Kalm C6/30, Kali-bi C6/30, Kali-c C30, Kali-p C6, Lach C30, Led C6/30, Lyc C30, Mag-p C6, Med C30, Nat-m C30, Nat-s C30, Nux-v C6/30, Op C30, Psor C30, Puls C6/30, Rhod C6, Rhus-t C6/30, Ruta C6/30, Sep C30, Sil C6/30, Staph C30, Tub C30, Viol-o C6, Zinc C6.

C6: 1 pillule 2x daily. C30: 2 pillules 2x weekly.

Homeopath blinded Physiotherapist observer blinded

Main outcome: VAS pain, Ritchie articular index, duration of morning stiffness, erythrocyte sedimentation rate (ESR)

Results

Withdrawal: 54 – Changed conventional medication: 31 – Serious intercurrent illness or surgery: 10 – Failed ot attend: 12 – Withdrawal of consent: 3

Over 6 months: Significant decreases in – Mean pain scores (down 18%) (p<0.01) – Articular indices (down 24%) (p<0.01) – ESR (down 11%) (p<0.01) – Morning stiffness showed non-significant 43% rise (75 to 107 min)

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ Articular index, ESR and morning stiffness similar (n.s.) No evidence that active homeopathy improves RA symptoms over 3 months

Most frequent prescriptions: – Sulphur C30 (n=50) – Rhus-t C6 (n=43) – Rhus-t C30 (n=21) –

23 remained on the same HMPs throughout the trial, Rhus-t n=6, Sulph n=4

Freye E, Latasch L. Analgesic therapy of rheumatoid arthritis – Part II: A study of combined allopathic and homeopathic therapy. Biomed Ther 2000; 18(2): 193-196.

Indian frankincense (olibanum), the homeopathic preparationsTraumeel S and Zeel (used in combination with the local anesthetic ropivacaine to block pain), and high doses of vitamins C and E. Thirtypatientswith longhistoriesof rheumaticdiseasewere closely monitored as they underwent therapy that combined several different means of administering Traumeel S and Zeel with ropivacaine or vitamins C and E. Patient assessments of severity of pain during movement, degree of restriction of movement, and general level of well-being were recorded before and after each treatment. Over the course of treatment, gradual improvement was noted and standardallopathictherapywasreduced or eliminated. Although the therapy described in this article cannot completely cure rheumatoid arthritis, it offers a valuable alternative approach that is freeof adverseeffects. In addition, a better understanding of the mechanisms of rheumatic pain and inflammation may lead to better therapies with fewer adverse effects.

Gibson RG, Gibson SL, MacNeill AD, Watson Buchanan W. Homoeopathic therapy in rheumatoid arthritis. Evaluation by double-blind clinical therapeutic trial. Br J Clin Pharm 1980; 9: 453-459.

Randomized double-blind placebo-controlled trial

46 patients with RA randomized to: – Homeopathy: 23, orthodox first-line anti-inflammatory treatment + homeopathy – Placebo: 23, orthodox first-line anti-inflammatory treatment + placebo

2 physicians prescribed for patients Individualised homeopathy group divided into two groups:

– Good prescribing symptoms – Poor prescribing symptoms

Results Significant improvement in homeopathy group compared to placebo (p=0.001) Homeopathy: Significant improvement subjective pain, articular index, stiffness, grip strength Placebo: No significant change Most obvious changes in pain and stiffness

No side effects from homeopathy One third of patients on gold and levamisole treatment dropped out due to side-effects

Most commonly used: Arn, Ars, Bry, Calc, Caust, Ign, Lach, Lyc, Morgan, Nat-m, Nux-v, Op, Puls, Rhod, Rhus-t, Ruta, Sep, Sulph, Syc-co, Thuj

Gibson RG, Gibson SLM, MacNeill AD, Gray GH, Dick WC, Watson Buchanan W. Salicylates and homoeopathy in rheumatoid arthritis: Preliminary observations. Br J Clin Pharm 1978; 6: 391-395.

95 patients with RA (4 months to 10 years) – High dose salicylate: 41 patients – Homeopathy: 54 patients, but allowed to continue previous orthodox therapy

Addition: – Placebo: 100 patients

Homeopathy individualised

Results Average duration of disease prior to trial: salicylate 5 years, homeopathy 8.8 years (p<0.05) Drop-out salicylates: 35, 16 due to toxic effects, 19 due to no relief Drop-out homeopathy: 14, none due to toxic effects

At 1 year: – Salicylate: 6 of 41 patients still on therapy and doing well – Homeopathy: 23 (42.6%) solely on homeopathy and better than 1 year before – Homeopathy: 13 (24%) on homeopathy + orthodox therapy (most often aspirin or

indomethacin), but at doselevelssignificantlylower thanwhenenteringthetrial – Homeopathy: 4 (7.4% ) completed, but not helped

Homeopathy: Improvement 42.6%, Toxiceffects0% Salicylate: Improvement 14.6%, Toxiceffects39% Placebo: Improvement 0%, Toxiceffects0%

Homeopathy did better than salicylate Homeopathy alone or homeopathy plusorthodox treatment improved

– Pain (p=0.05/p<0.05) – Joint stiffness(p<0.05/p=0.05)

No side effects of homeopathy

200 different HMPs were used throughout the trial, most commonly: Bry, Calc, Lyc, Nat-m, Puls, Rhus-t

Gottwald R, Weiser M. Treatment of rheumatic diseases with a homeopathic preparation. Biomed Ther 2000; 18(2): 211-216.

In a drug-monitoring study of the combination injectable homeopathic preparation Discus compositum, 402 patientswere treated for the indications osteochondrosis, neuralgic-rheumatic diseases(spinal column), chronicarthritis, chronicarthrosis, and other diagnoses. The study’s specific diseases were chr onic in many cases and most had existed fr om sever al months to mor e than 2 years. The duration of treatment ranged from 2 weeksto2 monthsin 70% of the patients with a 2-4 week treatment being the most typical, with 36%. The majority of patients (77%) experienced improvement during the first 4 weeksof treatment. The best results were obtained from the indication neuralgic-rheumaticdiseases(spinal column), where in approximately 1/3 of the patients, an improvement of symptoms was obtained within the first week of treatment. The investigators assessed the efficacy of the treatment as verygood; good; and moderatein 20%, 54%, and 18% of patients, respectively. The tolerability assessment of the remedy was positive: excellent and good in 63% and 32% of patients, respectively.

Haila S, Koskinen A, Tenovuo J. Effects of homeopathic treatment on salivary flow rate and subjective symptoms in patients with oral dryness: a randomized trial. Homeopathy 2005; 94: 175- 181.

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣n ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣

28 patients with xerostomia (oral dryness due to lack of saliva), randomized to: – Homeopathy (n=15) – Placebo (n=13)

Treatment 6 weeks Oral dryness: measurement of unstimulated and wax-stimulated salivary flow rates and VAS

Results No baseline differences

Salivary flow rate slightly higher with homeopathy than placebo Improved VAS dryness while eating (p=0.02) Improved VAS need to sip liquid to aid swallowing (p=0.03) Notable decrease in complaints of dryness while eating (p<0.0001) Notable decrease in need to sip liquid to aid swallowing (p<0.0001) VAS score need to drink during night (p=0.03)

VAS amount of salivation (p=0.01) Need to drink (p=0.0011) Amount of salivation (p<0.0001) Placebo group: No improvement during experimental period No consistent changes in salivary immunoglobulin (IgA, IgG) levels Slight increasing trend (p=0.06) in salivary IgG in homeopathy gorup

12 week open follow-up period where both groups received indiviudalised homeopathy Symptoms improved in both groups Xerostomia (VAS) continued to decline in homeopathy group:

– Dryness while eating (p=0.002) – Need to sip liquid while swallowing (p=0.006) – Need to drink at night (p=0.012) – Quantity of salivation (p=.001)

Improvement in former placebo (now verum) group: – Dryness while eating (p=0.047) – Feeling of salivation (p=0.047)

Remedies prescribed: Ars, Calc, Ign, Iod, Kali-c, Lyc, Mag-c, Merc, Nat-m, Nux-v, Ph-ac, Phos, Puls, Sep, Sil, Spong, Staph, Sulph, Thuj D12 3granules daily, or D30 4granules 2x weekly, or D200 5granules weekly

Jonas WB, Linde K, Ramirez G. Homeopathy and rheumatic disease. Rheumatic Disease Clinics of North America 2000; 26(1): 117-123.

Systematic review on all published reports of placebo-controlled RCTs of homeopathy on arthritis (Jonas et al. 2000). Three trials on rheumatoid arthritis and one each on OA, fibromyalgia and myalgia ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ Overall, homeopathic remedies are more effective than placebo in studies of rheumatic syndromes. However, there are too few studies to make definitive conclusions about the efficacy of any one type of homeopathic treatment of any one condition.

Current medical treatments do not consistently halt the long-term progression of these (rheumatic) diseases, and surgery may still be needed to restore mechanical function in large joints (7). Ref: Fisher P, Greenwood A, Huskisson EC, et al. Effect of homeopathic treatment on fibrositis (primary fibromyalgia). BMJ 1989; 299: 365-366.

Patients with rheumatic syndromes often seek alternative therapies, with homeopathy being one of the most frequent.

Survey comparing conditions treated in homeopathy compared with primary care practice: arthritis and MS syndromes more frequently treated in practices using homeopathy (12). Jacobs J, Chapman EH, Crothers D. Patient characteristics and practice patterns of physicians using homeopathy. Arch Fam Med 1998; 7: 537-540.

All published controlled clinical trials of homeopathy on arthritis and MS disease

Studies categorised into: classical/single remedy and nonclassical/complex homeopathy. Nonrandomized and case series not included

6 controlled trials with a total ot 392 patients RA n=226, OA n=36, fibromyalgia n=30, myalgia n=60

5 trials with quality score of 60% of the maximum or more Low quality for myalgia

All 6: Combined OR 2.19 with 95% CIs of 1.55 to 3.11 (fixed or random effects model). 5 high quality: OR 2.11 with 95% CI, 1.32-3.35 (p=0.002)

1 study on complex nonclassical homeopathy (n=176): OR 2.18 with 95% CI, 1.19-4.02 (p<0.01) 2 studies individualised hom (n=90) OR 2.04 with 95% CI. 0.66-6.34, fixed eff model (p=0.218)

All studies statistically but not clinically homogenous with regard to: – Patient selection – Treatment strategies – Outcomes

No comparison of complex vs classical homeopathy, or homeopathy vs conventional treatment

Overall, it appears that homeopathic remedies work better than a placebo in studies of rheumatic syndromes, but there are too few studies to make definitive conclusions about the efficacy of any one type of homeopathic treatmen on any one condition.

RA is most studies, total 266 patients in 3 studies. ORs around 2.0 in favor of homeopathy

Kozlovskaya LV, Mukhin NA, Rameev VV, Sarkisova IA, Epstein OI. Potentiated antibodies to tumor necrosis factor-alpha in the therapy of patients with rheumatoid arthritis. Bull Exp Biol Med 2003; (Suppl. 1): 152-154.

12 patients with rheumatoid arthritis Artrofoon: Purified antiboties to tumor necrosis factor-alpha Results

Effective in 8 of 12 patients (66% )

Improvement first 10 days: – Severity of pain 30.4% – Swelling of joints 22.5% – Morning stiffness 30% – Volume of movements in the joints 20%

Improvement after 1 month: – Pain (Ritchie index) 62% – Swelling 57% – M or n i n g st i f f n ess 6 5 % – Functional activity in joints36%

Result evaluated by patients and physicians: – Excellent: 1 (8.3% ) – Good:5(41.7%) – Satisfactory: 2 (16.7%)

– Unsatisfactory: 4 (33.3%) Positive result in 8 (66.7%)

Reduced severity of arthralgia (indexes of Li and Ritchie) Reduced morning stiffness Decreased erythrocyte sedimentation rate Decreased contents of rheumatoid factor

Decreased contens of C-reactive protein

Well tolerable

No ulcerogenic and neprhotoxic effects

Long L, Ernst E. Homeopathic remedies for the treatment of osteoarthritis: a systematic review. Br Hom J 2001; 90: 37-43.

Systematic review of RCTs of homeopathic treatment of patients with osteoarthritis Search yielded 4 trials ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ homeopathic treatment, do now allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis. The clinical evidence appears promising, however, and more research into this area seems warranted.

Search of Medline, Embase, AMED, Biosis, CIRARL and Cochane Library to August 2000 Search words:

–

Osteoarthritis, osteoarthrosis, degenerative joint disease, degenerative arthritis, degenerative arthrosis, gonarthrosis, coxarthrosis homeop* and homoeop* MeSH terms homeopathy, homeopathy and alternative medicine

– Manual search for additional trials using bibliographies of identified through searches and through scanning own files. Experts and manufacturers in the field were contacted to provide published and unpublished material. All articles (or abstracts if only available as abstracts) were read in full and, if additional information was required, authors were contacted wherever possible.

All studies were of high methodological quality, although none were free from flaws Two of these trials present positive evidence for the effectiveness of combination homeopathic preparations in comparison to conventional medications (Nahler et al. 1998, Shealey et al. 1998) A topically applied homeopathic gel was at least as effective as a conventional NSAID gel (Shipey and Berry 1983) A single orally administered homeopathic remedy, Rhus toxicodendron, was significantly inferior to a conventional medication (Van Haselen and Fisher 2000)

There appears to be a positive trend towards the effectiveness of combination homeopathic preparations for the treatment of patients with OA. However, the small number of trials performed to date preclude firm conclusions as to the effectiveness of combination homeopathic remedies for this indication.

␣␣␣␣␣␣␣ ␣␣␣ ␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣ ␣␣␣ ␣␣␣ ␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ ␣␣␣ ␣␣␣␣ ␣␣ ␣␣␣␣␣␣ ␣␣␣␣␣␣␣ 105-115.

12 month period 155 patients with rheumatic disease

Summary of positive results

Clinical practice report of patientswith a variety of rheumatic complaints, with positive reports on patientsdiagnosed with rheumatic polyarthritis, osteoarthrosis(hip or knee) or spinal problems.

Rheumatic polyarthritis: 3/4 of 23 patients felt homeopathy helped significantly Osteoarthritis of hip: 6 out of 6 did well with homeopathy Osteoarthritis of knee: 16 or 20 had useful improvement with homeopathy Pain from cervical or thoracolumbar or sacral region: 2/3 improved, half considerably by combination treatment including constitutional homeopathy

Cervical spondylitis/spondylosis: 75% had worthwhile improvement

Inflammatory polyarthritis(rheumatoid type) Over threequartersof 23patientsfeld homepathy had helped them to a significant degree. Most had reduced conventional treatmeyt by half and experienced improvement in general health and well-being.

Osteoarthritisof thehip

14 patients, 8 had successful operations and did not need homeopathic treatment 6 had no operation, all 6 did sufficiently well with homeopathy not to be considered for operation, 4 were able to reduce analgesic therapy by half or more

Osteoarthritisof theknee 20 patients, 16 had useful improvement with homeopathy, 4 did not

Osteoarthritis of the elbow 2 patients, neither improved under homeopathy

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣

73 patients, 30 with pain from cervical spine, 43 from thoracolumbar or sacral region Twothirdshad improvement, half considerableimprovement, by the use of a combination of sensible physical regime, adoption of suitable ancillary measures, encouragement, constitutional remedy or less frequently symptom-prescribing

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ Women who menopausally had subliminal surges of ovarian hormone production, homeopathy was almost always clearly indicated and very helpful

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣

75% had a worthwhile improvement as judged by patient and doctor, 15% unchanged, 10% deteriorated

Ankylosing spondylitis 2 patients, one responded partially to homeopathy, the other not

Psoriasis with arthropathy Homeopathy did not help

Primary hyperuricaemia (gout)

3 patients, can not truly assess the value of homeopathy as course varies unpredictably

Infective arthropathy 1 patient, homeopathy of no real value as patient relapsed

Connective tissue disease 2 patients, both improved, but both also on conventional treatment

Shoulder joint pain ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ bursitis, frozen shoulder) 1 improved, 4 no benefit from homeopathy

Chronic muscular and ligamentous 2 patients, 1 not improved, other not reported

Psychological disease masqurating as rheumatism 2 patients, 1 slow improvement, 1 no change

Osteoarthritis of the hip

Nahlaer G, Metelmann H, Sperber H. Treating osteoarthritis of the knee with a homeopathic preparation: results of a randomized, controlled, clinical trial in comparison th hyaluronic acid. Biomed Ther 1998; 16(2): 186-191.

From Long and Ernst 2001 Nahler G, Metelmann H, Sperber H. Treating osteoarthritis of the knee with a homoeopathic preparation. Biomedical Therapy 1998; XVI: 186-191. Multicentre randomised, single-blind, clinical equivalence study Compared Zeel (Rhus-t, Arn, Dulc, Sang, Sulph) with hyaluronic acid (Hyalart) 121 patients with primary knee OA admitted by 12 orthopaedic physicianc 10 injections of Zeel or 5 injections of Hyalart Treatment duration 5 weeks No difference between treatments for reduction of pain during movement (p=0.04298) No difference in therapeutic efficacy for pain during the night (p=0.3077) No difference in duration of morning stiffness (p=0.9211) No difference in final assessments by physician and patient Increased functional ability observed and associated with pain reduction with both treatments Trend in favour to Zeel with respect to tolerance: fewer Zeel patients (n=6) with undesirable adverse effects compared to Hyalart (n=13), but final assessment of tolerance (VAS) indicated very good tolerance of both treatments with no between group differences Criticism: Not double-blinded (only single blinded), compliance not mentioned

Noskov SM, Snigireva AV, Dolgova LN, Somova MA, Polyakov DP. The use of homeopathic preparation Vozraston in the therapy of patients with rheumatoid arthritis. Bull Exp Biol Med 2003; (Suppl. 1): 94-95.

34 patients with rheumatoid arthritis – Homeopathy: 16, Vozraston in addition to standard therapy – Control: 18, standard therapy (methotrexate or Delagil, and NSAIDs)

Vozraston: Ambr C50, Aur-I C30, Caust C200

Results No changes in clinical and psychoemotional parameteres were revealed Vozraston reduced pain syndrome and increased tone of the sympathetic nervous system Decrease in integral objective index, joint index and index of Ritchie (all p<0.01) in both groups No difference in patients after the therapy Reactive anxiety and depression unchanged Homeopathy group: Pain syndrome (VAS) decreased (p<0.01) and lower than in control (p<0.05) Results indicate that Vozraston reduced pain syndrome in patients with RA

Petrov VI, Babaeva AR, Cherevkova EV, Epstein OI, Sergeeva SA. Efficiency of potentiated antibodies to tumor necrosis factor-alpha (Artrofoon) in the therapy of patients with rheumatoid arthritis. Bull Exp Biol Med 2003; 135(Suppl. 1): 155-158.

30 patients with rheumatoid arthritis, most with stage 2-3 RA (narrowing of joint space, usuras)

– Artrofoon: 15, Artrofoon 2tbl 4x/day for 6 months

– Control: 15, diclofenac 100mg daily Artrofoon: ultralow doses of antibodies against tumor necrosis factor-alpha

Results No baseline differences Reduction in (n=number of patients with positive changes):

– Pain syndrome (p<0.01) (n=13) – Duration of morning stiffness (p<0.01) (n=14) – Ritchie index (p<0.05) (n=12) – Index of swelling (p<0.05) (n=11) – Diameter of damaged joints(p<0.05) (n=) – Articular score (abs. number) (n.s.) (n=11) – Li functional index (n.s.) (n=7) – Number of swollen joints (abs. number) (n.s.) (n=9) – Leucocytes, ESR, Albumins, Globulins and RF (n.s.) (n=2, 6, 2, 2, 1) – CRP (p<0.05) (n=12)

C-reactive protein (CRP) concentration: considerably changed Erythrocyte sedimentation rate (ESR): tendency to decrease Plasma globulin content: tendency to decrease Rheumatoid factor (RF): unchanged

Out of 15 patients, severity of joint pain decreased in – 2 (13.3%) for 1 month – 9 (60%) for 3 months – 13 (86.7%) for 6 months

Other clinical signs of disease underwent similar changes

Considered therapy as: – Good 10 (66.7%) – Satisfactory 5 (33.3%)

Physician evaluation of effects of Atrofoon: – Good 9 (60%) – Satisfactory 6 (40%)

Positive changes were observed only by the 3rd month of therapy and became most pronounced after 5-6 months

No side effects

Pinto S, Rao AV, Rao A. Lipid peroxidation, erythrocyte antioxidants and plasma antioxidants in osteoarthritis before and after homeopathic treatment. Homeopathy 2008; 97: 185-189.

81 patients with osteoarthritis, 53 normal 47 patients considered for the follow-up studies OA patients: Mean duration of OA 4.14 years (+/- 0.656)

OA is an inflammatory disorder of the joint, which includes progressive focal degradation of the articular cartilage, associated with chronic pain and loss of knee function. Underlying mechanism of cartilage matrix degradation in OA is poorly understood but the reactive oxygen species (ROS) are implicated as causative factors.

Oxidative stress in osteoarthritis Aim: Assess the role of homeopathy in modulating free radical toxicity in OA Measuring parameters of oxidant stress & antioxidant defenses in blood before/after homeopathy

Erythrocyte lipid peroxidation (LP) Erytrocyte antioxidants viz. Glutathione (GSH) Glutathione reductase (RG) Superoxide dismutase (SOD) Catalase (CT)

Plasma antioxidants viz. Plasma ceruloplasmin Plasma glutathione-S-transferase (GST) Plasma vitamin C Plasma total antioxidant activity (AOA)

Classical homeopathy, single individualised remedy in response to changing symptoms Patients suffered from: stiffness, swelling and/or pain in knee joints

Results

Erythrocyte LP (0 hour, p<0.001; 2 hours, p<0.01; and susceptibility to LP, p<0.05) and SOD (p<0.05) were significantly lower in OA patients when compared to controls. Treatment reduced LP and susceptibility to LP Follow-up patients: erythrocyte LP (0 hour, p<0.01; 2 hours, p<0.01; and susceptibility to LP, p<0.01) and SOD (p<0.01) were significantly lower in OA patients when compared to pretreatment values. Plasma vitamin C attained normal range

AOA activity after treatment not significantly different from before treatment

Conclusion: Oxidative stress increased in OA as indicated by increased LP, SOD, decreased vitamin C and AOA. Homeopathic treatment ␣ LP decreased in erythrocytes which shows reduced oxidative stress. This is further evidenced by returning of plasma vita min C and erythrocyte SOD to noamal levels, but oxidant stress has not been completely overcome as plasma AOA remained low after treatment.

Prescriptions: Mean of 2.4 medications per patients ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ Most frequent: Calc-fl (65%), Rhus-t (43%), Puls (25%), Nat-m(19%), Bry(17%), Thuj(15%) Most often in C30: Rhus-t, Nat-m, Bry Most often in D6: Calc-fl, Thuj

After 3 months of homeopathic treatment 85% of follow-up patients had improved with decrease in pain, stiffness and swelling of the joints.

TBARS levels decreased significantly, which suggests it resulted in antioxidant mechanisms or effect. Homeopathy had some effect in reducing oxidative stress.

Relton C, Smith C, Raw J, Walters C, Adebajo AO, Thomas KJ, Young TA. Healthcare provided by a homeopath as an adjunct to usual care for fibromyalgia (FMS): results of a pilot randomised controlled trial. Homeopathy, 2009, 98, 77-82. 47 patients diagnosed with fibromayalgia, conventional care alone og CC (n=24) + homeopathy (n=23). Follow-up at 22 weeks

Significant improvement in patients treated with homeopathy (p<0.01): in function, pain, fatigue and tiredness in the homeopathy group. No side-effects of homeopathic treatment were noted.

Shealy CN, Thomlinson RP, Cox RH, Borgmeyer RN. Osteoarthritic pain: a comparison of homeopathy and acetaminophen. American Journal of Pain Management 1998; 8: 89␣91.

From Long and Ernst 2001 Shealey CN, Thomlinson RP, Cox RH, Borgmeyer V. Osteoathritic pain: a comparison of homeopathy and acetaminophen. American Journal of Pain Management 1998; 8: 89-91. Double-blind, placebo-controlled RCT 65 patients with knee OA 43: Liquid homeopathic preparation (Rhus-t D12, Caust D12, Lac vaccinum D30) and plaecbo 22: Liquid placebo and paracetamol capsules (2600mg) 10 drops sublingually 4x daily for 1 month I mpr ovements in pain obser ved in both gr oups, with a gr eater per centage (55% ) of those taking homeopathicpreparationachievingclinicallyusefulpainreductionof40% orgreater,compared tothosetakingparacetamol (38%), but differencenot statistically significant. Homeopathy at least aseffectiveasparacetamol, with theadvantageof fewer adverseeffects Criticism: No power calculation performed, compliance not addressed, primary outcome measures ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣verage daily pain using VAS, no independent assessment by a physician, no mention of adverse reactions, withdrawals or droputs

Shipley M, Berry H, Broster G, Jenkins M, Clover A, Williams I. Controlled trial of homoeopathic treatment of osteoarthritis. The Lancet 1983, January 15: 97-98.

Double-blind, placebo-controlled cross-over study to compare Rhus-t D6 with fenoprofen Osteoarthritis of the hip and knee Effects of Rhus-t D6 and placebo did not differ significantly Patient preference was for fenoprofen

Side-effects seen more frequently with fenoprofen Fenoprofen causes a relatively high incidence of minor side-effects

From Long and Ernst 2001 Shipley M, Berry H. Controlled trial of homoeopathic treament of osteoarthritis. Lancet 1983; i: 97- 99. Double-blind, placebo-controlled crossover study 36 knee and/or hip OA patients Placebo capsules and placebo drops Fenoprofen capsules (300mg) or placebo drops 3x/day Placebo capsules or Rhus-t D6 drops 3x/day Inclusion criteria for patients with symptoms appropriate for Rhus-t were applied All patients received the three treatment regimens Each treatment regimen lasted 2 weeks No wash-out period between treatments No significant difference between Rhus-t and placebo Fenoprofen produced highly significant pain relief compared to Rhus-t and placebo Criticism: Short duration, small sample size, naïve symptomatic basis of the remedy prescription. In long-term chronic illnessess such as OA, it may be preferable to treat homeopathically with a constitutional remedy over a long period of time, and for the prescribed remedy to change according to changes in clinical features. Hence, trials of the treatment of chronic conditions such as OA using a single homeopathic remedy over a short duration do not represent an adequate test of efficacy.

Van Haselen RA, Fisher PA. A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee. Rheumatology 2000; 39: 714-719.

Conclusion: The homeopathic gel was at least as effective and as well tolerated as the NSAID gel. The homeopathic gel supplemented by simple analgesics if required may provide a useful treatment option for patients with osteoarthritis.

From Long and Ernst 2001 Van Haselen RA, Fisher PAG. A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee. Rheumatology 2000; 39: 714-719. Randomised, double-blind controlled trial 184 patients suffering from osteoarthritis of the knee Homeopathic gel SRL (Symph, Rhus-t, Led) n=86 NSAID gel (0.5% piroxicam) n=86 Topically 3x/day for 4 weeks SRL: Mean pain reduction 16.5 mm (s.d. 24.6) VAS Piroxicam: Mean pain reduction 8.1 mm (s.d. 25.7) VAS Difference 8.4 mm (95% CI 0.8-15.9) Difference between groups adjusted for pain at baseline 6.8 (95% CI -0.2- -13.8) Differencebetweenthetwogroupsfor pain(VAS) favouringhomeopathy No significant difference found for single-joint Ritchie index (p=0.78) Criticism: no power calculation performed, sample size based on previously reported comparative trial of piroxicam gel and ibuprofen. However, the obtained sample size of 184 patients gives this study sufficient power to detect a difference in pain (VAS) between the two treatments, providing evidence that SRL gel is at least as effective as piroxicam gel. Main danger of underpowered equivalence study: potential for showing equivalence by default. For this reaason, the results from the Ritchie index are less ocnvincing (and they were not positive). Imperfect masking, inappropriate choice of Ritchie score as a non-validated primary outcome measure for OA. Concomitant use of NSAIDs and analgesics during the trial.

␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ among general practitioners or ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ unlikely to represent common homeopathic practice, where treatment tends ot be individualised. None ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣dual remedy selection and the possibility of changing the medicine during the treatment are integral to the treatment regime. The trials perfomed to date do not accurately reflect the routine practice of homeopathy.

Van Wassenhoven M. Retrospective study of rheumatological patients in a private homoeopathic medical practice. Br Hom J 1996; 85: 198-204.

Retrospective study of rheumatological patients seen in a private homeopathic practice 3555 patient files, 99 patients with primary diagnosis rheumatic disease

Ostaoarthritis deformans n=36 Ankylosing spondylitis (Bekhterev) n=28 Psoriatic arthritis n=4 Rheumatoid arthritis n=9 Calcifying periarthritis of shoulder n=2 Sarcoidosis n=1 Atypical + fibromyalgia n=10 Inflammatory arthritis of knee n=1 Gout n=2 ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ ␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ Chondrocalcinosis HLA n=1

All diagnoses made by specialists

Results 43 patients were able to discontinue all conventional medication Most treatment failures were in-patients with relatively brief follow-up

Recovery n=27 (independence from all medical treatment) Recovery, few relapses n=17 Improvement n=42 (general well-being, physical improvement, laboratory results returning to normal, but further (also homeopathic) treatment is needed) Aggravation n=4 (aggravation with no subsequent improvement) Failure n=9 (no reaction)

Poorer results (failure) in patients followed up for less tan 2 years

System similitude level n=67 Clinical similitude level n=36 (symptom improvement, but no global improvement) Isopathy n=49 Sequential nosodes n=78 Gluconicum (trace elements) n=42

Most frequent remedies prescribed: Ars (n=8), Bry (n=2), Graph (n=2), Kali-c (n=2), Lyc (n=12), Merc (n=3), Nat-c (n=3), Nat-m (n=5), Nux-v (n=9), Phos (n=7), Plat (n=3), Puls (n=6), Sep (n=11), Sil (n=3), Sulph (n=4), Thuj (n=2). The remaining only once. Total 38 remedies.

Visser GJ, Peters L, Rasker JJ. Rheumatologists and their patients who seek alternative care: an agreement to disagree. Br J Rheumatol 1992; 31(7): 485-90.

Alternative treatment, such as homoeopathy, acupuncture and spiritual healing, are popular among patients with rheumatic diseases. Rheumatologists are therefore likely to be confronted with patients who make use of less orthodox health care. Patients’ and rheumatologists’ views on the subject and on the rheumatologists’ role, however, have not yet been assessed. A questionnaire on alternative medicine was sent to all 101 practising Dutch rheumatologists(responserate: 70%). After the results had been analysed 17 rheumatologists, seven rejecting alternative medicine and ten accepting it, handed out a questionnaire to a sample of their patients: 1466 patient questionnaires were distributed (responserate: 80%). Of the respondents 43% had visited an alternative practitioner at least once for their rheumatism and 26% in the year before the survey was held. Hand healers, homoeopathsand acupuncturistswere most often visited. Rheumatologists, on their part, were not too enthusiastic about these visits. Only patients’ visits to spa treatment centres were welcomed by a majority of them; visits of their patients to manipulative therapists, acupuncturists and homoeopaths were judged positively by a large minority, whereas other therapies were strongly disapproved. Nevertheless, most patients informed their rheumatologist about their visiting an alternative practitioner. A surprisingly low percentage of these patients noticed that the rheumatologist did not sympathize with it. Although many patientspaid a visit to an alternative practitioner because regular care did not really help them, their satisfaction with the alternative treatment turnedout tobelessthantheir satisfactionwiththerheumatologists’ help.

Wiesenauer M, Gaus W. Wirksamkeitsnachweis eines Homöopathikums bei chronischer Polyarthritis. Eine randomisierte Doppelblindstudie bei nieder-gelassenen Ärzten. (A randomized double-blind trial on the efficacy of a homeopathic drug for rheumatoid arthritis.) (German) Aktuelle Rheumatologie 1991; 16: 1␣9.

Six general practitioners treated 111 patients with rheumatoid arthritis with the homeopathic preparation ‘Rheumaselect‘ or placebo over 12 weeks in a randomized, double blind, controlled trial. Outcome criteria were pain at night, resting, and movement, inflammatory signs, morning stiffness, fatigue, patient’s assessment of pain, functional index according to Lee, and the overall assessment of the therapy by the treating physician and by the patient. A remarkable improvement of these criteria was found in both groups, but the improvement was more marked with verum than with placebo. In the protocol was defined, that the consumption of antirheumatic and analgetic drugs and the assessment of pain by the patient were combined to a single outcome variable for the statistical test. The result is a significant efficiency of the homeopathic drug.

References

Anderson K. A complex homeopathic preparation for the treatment of osteoarthritis. Explore 2006; 2(3): 234.

Andrade LEC, Ferraz MB, Atra E, Castro A, Silva MSM. A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand J Rheumatol 1991; 20: 204-208.

Fisher PA, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology 2001; 40: 1052-1055.

Freye E, Latasch L. Analgesic therapy of rheumatoid arthritis – Part II: A study of combined allopathic and homeopathic therapy. Biomed Ther 2000; 18(2): 193-196.

Gibson RG, Gibson SL, MacNeill AD, Watson Buchanan W. Homoeopathic therapy in rheumatoid arthritis. Evaluation by double-blind clinical therapeutic trial. Br J Clin Pharm 1980; 9: 453-459.

Gibson RG, Gibson SLM, MacNeill AD, Gray GH, Dick WC, Watson Buchanan W. Salicylates and homoeopathy in rheumatoid arthritis: Preliminary observations. Br J Clin Pharm 1978; 6: 391-395.

Gibson RG, Gibson SLM, MacNeill AD, Buchanan WW. The place for non-pharmaceutical therapy in chronic rheumatoid arthritis. A critical study of homoeopathy. Brit Hom J 1980; 69(3): 121-133.

Gottwald R, Weiser M. Treatment of rheumatic diseases with a homeopathic preparation. Biomed Ther 2000; 18(2): 211-216.