Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Complementary or alternative therapies for osteoarthritis

Abstract

Complementary or alternative therapies for osteoarthritis are commonly used and therefore it is important that health-care providers and patients are aware of the evidence for or against these approaches. In this article, the best available evidence is reviewed. The results suggest that, for several treatments, the risk–benefit profile is encouraging: acupuncture, several herbal medicines and capsaicin cream. For other therapies the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, yoga, imagery and therapeutic touch. Many other treatments have not been scientifically tested. It is concluded that some complementary or alternative therapies have generated sufficiently promising results to warrant further investigation in large-scale, definitive, randomized clinical trials.

Key Points

  • Complementary or alternative medicine is commonly used by patients with osteoarthritis

  • The risk–benefit profile is encouraging for acupuncture, several herbal remedies and capsaicin cream

  • For other treatments the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, imagery and therapeutic touch

  • Most complementary or alternative medicine interventions recommended for osteoarthritis have not been studied in clinical trials

  • Some complementary or alternative medicines seem to merit further study

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Ernst E et al. (1995) Complementary medicine—a definition. Br J Gen Pract 45: 506

    PubMed Central  Google Scholar 

  2. 2

    Barnes PM et al. (2004) Complementary and alternative medicine use among adults: United States, 2002. Advance data from vital and health statistics; no 343. Hyattsville: US Department of Health and Human Services, CDC, National Center for Health Statistics

    Google Scholar 

  3. 3

    Ernst E et al. (2001) The desktop guide to complementary and alternative medicine. Edinburgh: Mosby

    Google Scholar 

  4. 4

    Rhee SM et al. (2004) Use of complementary and alternative medicines by ambulatory patients. Arch Intern Med 164: 1004–1009

    Article  Google Scholar 

  5. 5

    Harrison RA et al. (2004) Are those in need taking dietary supplements? A survey of 21,923 adults. Br J Nutr 91: 617–623

    CAS  Article  Google Scholar 

  6. 6

    Richardson J (2004) What patients expect from complementary therapy: a qualitative study. Am J Pub Health 94: 1049–1053

    Article  Google Scholar 

  7. 7

    Giveon SM et al. (2004) Are people who use “natural drugs” aware of their potentially harmful side effects and reporting to family physician? Patient Educ Couns 53: 5–11

    Article  Google Scholar 

  8. 8

    Ernst E and White AR (Eds; 1999). Acupuncture—A Scientific Appraisal. Oxford: Butterworth Heinemann

    Google Scholar 

  9. 9

    Ezzo J et al. (2001) Acupuncture for osteoarthritis of the knee. Arthritis Rheum 44: 849–855

    Article  Google Scholar 

  10. 10

    Berman BM et al. (2004) Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Ann Intern Med 141: 901–910

    Article  Google Scholar 

  11. 11

    Vas J et al. (2004) Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 329: 1216

    Article  Google Scholar 

  12. 12

    Tukmachi E et al. (2004) The effect of acupuncture on the symptoms of knee osteoarthritis—an open randomised controlled study. Acupunct Med 22: 14–22

    Article  Google Scholar 

  13. 13

    Witt C et al. (2005) Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 366: 136–143

    CAS  Article  Google Scholar 

  14. 14

    Ernst E and White A (1997) Life-threatening adverse reactions after acupuncture? A systematic review. Pain 71: 123–126

    CAS  Article  Google Scholar 

  15. 15

    Melchart D et al. (2004) Prospective investigation of adverse effects of acupuncture in 97,733 patients. Arch Intern Med 164: 104–105

    Article  Google Scholar 

  16. 16

    Little CV et al. (2000) Herbal therapy for treating rheumatoid arthritis. The Cochrane Database of Systematic Reviews, Issue 4, Art. No CD002947

    Google Scholar 

  17. 17

    Ernst E (2003) Avocado–soybean unsaponifiables (ASU) for osteoarthritis—a systematic review. Clin Rheumatol 22: 285–288

    CAS  Article  Google Scholar 

  18. 18

    Gagnier JJ et al. (2004) Harpagophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med 4: 13

    Article  Google Scholar 

  19. 19

    Altman RD and Marcussen KC (2001) Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 44: 2531–2538

    CAS  Article  Google Scholar 

  20. 20

    Wigler I et al. (2003) The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 11: 783–789

    CAS  Article  Google Scholar 

  21. 21

    Long L et al. (2001) Herbal medicines for the treatment of osteoarthritis: a systematic review. Rheumatology 40: 779–773

    CAS  Article  Google Scholar 

  22. 22

    Jung YB et al. (2001) Effect of SKI306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study. Am J Chin Med 29: 485–491

    CAS  Article  Google Scholar 

  23. 23

    Biegert C et al. (2004) Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind trials. J Rheumatol 31: 2121–2130

    CAS  PubMed  Google Scholar 

  24. 24

    Mills SY et al. (1996) Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 35: 874–878

    CAS  Article  Google Scholar 

  25. 25

    Ferraz MB et al. (1991) Tipi. A popular analgesic tea: a double-blind cross-over trial in osteoarthritis. Clin Exp Rheumatol 9: 205–212

    CAS  PubMed  Google Scholar 

  26. 26

    Kulkarni RR et al. (1991) Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 33: 91–95

    CAS  Article  Google Scholar 

  27. 27

    Ryttig K et al. (1991) Gitadyl versus ibuprofen in patients with osteoarthritis. The result of a double-blind, randomized cross-over study. Ugeskr Laeger 153: 2298–2299

    CAS  PubMed  Google Scholar 

  28. 28

    Biswas NR et al. (1998) Treatment of osteoarthritis, rheumatoid arthritis and non-specific arthritis with a herbal drug: a double-blind, active drug controlled parallel study. JK Pract 5: 129–132

    Google Scholar 

  29. 29

    Randall C et al. (2000) Randomized controlled trial of nettle sting for treatment of base-of-thumb pain. J R Soc Med 93: 305–309

    CAS  Article  Google Scholar 

  30. 30

    Kimmatkar N et al. (2003) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial. Phytomedicine 10: 3–7

    CAS  Article  Google Scholar 

  31. 31

    Rein E et al. (2004) A herbal remedy, Hyben Vital (stand. powder of a subspecies of Rosa canina fruits), reduces pain and improves general wellbeing in patients with osteoarthritis—a double-blind, placebo-controlled, randomised trial. Phytomedicine 11: 383–391

    CAS  Article  Google Scholar 

  32. 32

    Teekachunhatean S et al. (2004) Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial [ISRCTN70292892]. BMC Complement Altern Med 4: 19

    Article  Google Scholar 

  33. 33

    Ernst E (2000) Risks associated with complementary therapies. In Meyler's Side Effects of Drugs, edn 14, 1649–1681 (Eds Dukes MNG and Aronson JK) Amsterdam: Elsevier

    Google Scholar 

  34. 34

    Long L (2001) Homeopathic remedies for the treatment of osteoarthritis: a systematic review. Br Homeopath J 90: 37–43

    CAS  Article  Google Scholar 

  35. 35

    Shang A et al. (2005) Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 366: 726–732

    Article  Google Scholar 

  36. 36

    Hulme JM et al. (2002) Electromagnetic fields for the treatment of osteoarthritis. The Cochrane Database of Systematic Reviews, Issue 1, Art. No CD003523.

    Google Scholar 

  37. 37

    Battisti E et al. (2004) Efficacy and safety of a musically modulated electromagnetic field (TAMMEF) in patients affected by knee osteoarthritis. Clin Exp Rheumatol 22: 568–572

    CAS  PubMed  Google Scholar 

  38. 38

    Nicolakis P et al. (2002) Pulsed magnetic field therapy for osteoarthritis of the knee—a double-blind sham-controlled trial. Wien Klin Wochenschr 114: 678–684

    PubMed  Google Scholar 

  39. 39

    Hinman MR et al. (2002) Effects of static magnets on chronic knee pain and physical function: a double-blind study. Altern Ther Health Med 8: 50–55

    PubMed  Google Scholar 

  40. 40

    Harlow T et al. (2004) Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee. BMJ 329: 1450–1454

    Article  Google Scholar 

  41. 41

    Wolsko PM et al. (2004) Double-blind placebo-controlled trial of static magnets for the treatment of osteoarthritis of the knee: results of a pilot study. Altern Ther Health Med 10: 36–43

    PubMed  Google Scholar 

  42. 42

    Richy F et al. (2003) Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 163: 1514–1522

    CAS  Article  Google Scholar 

  43. 43

    McAlindon TE et al. (2000) Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 283: 1469–1475

    CAS  Article  Google Scholar 

  44. 44

    Towheed TE et al. (2005) Glucosamine therapy for treating osteoarthritis. The Cochrane Database of Systematic Reviews, Issue 2, Art. No CD002946

    Google Scholar 

  45. 45

    Morreale P et al. (1996) Comparison of the anti-inflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol 23: 1385–1391

    CAS  PubMed  Google Scholar 

  46. 46

    Leeb BF et al. (2000) A meta-analysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol 27: 205–211

    CAS  PubMed  Google Scholar 

  47. 47

    Häuselmann HJ (2001) Nutripharmaceuticals for osteoarthritis. Best Pract Res Clin Rheumatol 15: 595–607

    Article  Google Scholar 

  48. 48

    Uebelhart D et al. (2004) Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage 12: 269–276

    Article  Google Scholar 

  49. 49

    Mathieu P (2002) Radiological progression of internal femoro-tibial osteoarthritis in gonarthrosis. Chondro-protective effect of chondroitin sulfates ACS4–ACS6. Presse Med 31: 1386–1390

    PubMed  Google Scholar 

  50. 50

    Rai J et al. (2004) Efficacy of chondroitin sulfate and glucosamine sulfate in the progression of symptomatic knee osteoarthritis: a randomized, placebo-controlled, double-blind study. Bull Postgrad Inst Med Educ Res Chandigarh 38: 18–22

    Google Scholar 

  51. 51

    Michel BA et al. (2005) Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial. Arthritis Rheum 52: 779–786

    CAS  Article  Google Scholar 

  52. 52

    Cohen M et al. (2003) A randomized, double-blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. J Rheumatol 30: 523–528

    CAS  PubMed  Google Scholar 

  53. 53

    Cohen M et al. (2003) A randomized, double-blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee [erratum]. J Rheumatol 30: 2512

    Google Scholar 

  54. 54

    Song R et al. (2003) Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol 30: 2039–2044

    PubMed  Google Scholar 

  55. 55

    Hartman CA et al. (2000) Effects of t'ai chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc 48: 1553–1559

    CAS  Article  Google Scholar 

  56. 56

    Michalsen A et al. (2003) Effectiveness of leech therapy in osteoarthritis of the knee. Ann Intern Med 139: 724–730

    Article  Google Scholar 

  57. 57

    McCaffrey R and Freeman E (2003) Effect of music on chronic osteoarthritis pain in older people. J Adv Nurs 44: 517–524

    Article  Google Scholar 

  58. 58

    Garpike MS et al. (1994) Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol 21: 2341–2343

    Google Scholar 

  59. 59

    Baird CL and Sands L (2004) A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manage Nurs 5: 97–104

    Article  Google Scholar 

  60. 60

    Eckes Peck SD (1997) The effectiveness of therapeutic touch for decreasing pain in elders with degenerative arthritis. J Holist Nurs 15: 176–198

    CAS  Article  Google Scholar 

  61. 61

    Klassen KP et al. (2005) For randomized controlled trials, the quality of reports of complementary and alternative medicine was as good as reports of conventional medicine. J Clin Epidemiol 58: 763–768

    Article  Google Scholar 

  62. 62

    Lawson ML et al. (2005) Systematic reviews involving complementary and alternative medicine interventions had higher quality of reporting than conventional medicine reviews. J Clin Epidemiol 58: 777–784

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Edzard Ernst.

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ernst, E. Complementary or alternative therapies for osteoarthritis. Nat Rev Rheumatol 2, 74–80 (2006). https://doi.org/10.1038/ncprheum0093

Download citation

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing