Rheumatoid arthritis alternative therapy

Remedies that fail to survive stringent examination are by no means limited to Chinese or other traditional sources. The United States has a long history of unorthodox medications, many of them based on plant extracts. Cancer and rheumatoid arthritis seem to attract especial attention, perhaps because orthodox therapies frequently offer little relief from these afflictions. In controlled testing, many widely touted novel medications perform no better than placebos. Proponents of such alternative treatments have often complained that their medications were unfairly denounced and that they were victimized by the medical establishment. 

Feverfew may be considered as an alternative migraine prophylaxis regimen in patients failing to respond to conventional therapy. It has not been shown to be effective for rheumatoid arthritis. There is insufficient evidence to support its use in other conditions. 

Corticotropin (corticotrophin adrenocorticotrophin ACTH) is a straight-chain polypeptide with39 amino acid residues, and its function is to control the activity of the adrenal cortex, particularly the production of corticosteroids. Secretion of the hormone is controlled by corticotropin-releasing hormone (CRH) from the hypothalamus. ACTH was formerly used as an alternative to corticosteroid therapy in rheumatoid arthritis, but its value was limited by variable therapeutic response. ACTH may be used to test adrenocortical function. It has mainly been replaced for this purpose by the synthetic analoguetetracosactide (tetracosactrin) (Figure 7.10), which contains the first 24 amino acid residues of ACTH, and is preferred because of its shorter duration of action and lower allergenicity. 

Corticosteroids have been used in 60-70% of rheumatoid arthritis patients. Their effects are prompt and dramatic, and they are capable of slowing the appearance of new bone erosions. Corticosteroids may be administered for certain serious extra-articular manifestations such as pericarditis or eye involvement or during periods of exacerbation. When prednisone is required for long-term therapy, the dosage should not exceed 7.5 mg daily, and gradual reduction of the dose should be encouraged. Alternate-day corticosteroid therapy is usually unsuccessful in rheumatoid arthritis. 

When a drug has been titrated to the maximum dose that can be tolerated and the level of disease control is still unacceptable, therapy may be switched to an alternative agent or another drug may be added in. Other treatments available for managing rheumatoid arthritis include ... 

Since 1983 phenylbutazone and oxyphenbutazone have been removed from the market in many countries or have been hmited to specific indications. In 1985, Ciba-Geigy decided to stop sales of systemic dosage forms of oxyphenbutazone worldwide and to reduce the indications for phenylbutazone (SEDA-9, 85) (SEDA-10, 78). Nevertheless, phenylbutazone is still to be found in many places. Phenylbutazone and its congeners are now used only for ankylosing spondyhtis and sometimes for acute gout, psoriatic arthritis, and active rheumatoid arthritis in patients who have not responded to other therapy, including other NSAIDs. For other indications, less toxic alternatives suffice (1,2). 

Sulfasalazine, commonly used in the treatment of inflammatory bowel disease and rheumatoid arthritis, is selectively used as an alternative treatment, particularly in patients with concurrent psoriatic arthritis. Sulfasalazine is an anti-inflammatory agent that inhibits 5-lipoxygenase. When used as a single agent in the treatment of psoriasis, it is not as effective as is therapy with methotrexate, PUVA, or acitretin. One possible advantage of sulfasalazine therapy compared with other systemic treatments is its relatively high margin of safety. The usual dose of oral sulfasalazine is 3 to 4 g/day for 8 weeks. ... 

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