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Complementary and alternative remedies for rheumatic disorders

Richard S Panush, MD, MACP, MACR
Section Editor
Daniel E Furst, MD
Deputy Editor
Paul L Romain, MD


An overview of the role of complementary and alternative (CAM) remedies for rheumatic disorders is presented in this topic review. The uses of these remedies for specific disorders are addressed separately in reviews of the treatment of individual conditions (see appropriate topic reviews). In addition, the use of herbal medicines and dietary supplements, acupuncture, and spinal manipulation are discussed in detail elsewhere. (See "Overview of herbal medicine and dietary supplements" and "Acupuncture" and "Spinal manipulation in the treatment of musculoskeletal pain".)


It was not long ago that today’s “complementary and alternative medicine (CAM)” was simply called “quackery.” These therapies were considered by authorities in rheumatology as worthless—nonsensical, illogical, and with no value. Advocates of these therapies were passionate but unscientific, reflecting Lewis Carroll’s remark from The Hunting of The Snark—“What I tell you three times is true”—and Galen’s “All who drink of this remedy are cured, except those who die; thus, it is effective for all but the incurable.” A number of reports, reviews, and commentaries sought to place these therapies in perspective [1-26], and many ridiculed this “quackery,” even though most such remedies had never been rigorously examined and became increasingly appealing to many patients. Occasionally, there would be scientific study of an unconventional therapy or other attention to one of these in a scholarly journal. Public attitudes changed. CAM began to become acceptable, the tipping point probably being the establishment of the Office of Alternative Medicine at the National Institutes of Health (NIH) in 1992 (despite considerable opposition from the scientific community), first called the National Center for Complementary and Alternative Medicine, now renamed the National Center for Complementary and Integrative Health.

Terms were sought to substitute for the pejorative “quackery.” At different times “dubious,” “unconventional,” “unproven,” “questionable,” “nonstandard,” and “irregular” therapies were favored to describe what is now “complementary and alternative medicine.” “Complementary” and “alternative” have been generally adopted and used, but not always rigorously or appropriately [9,11,14-16,25,26]. Many today call this “integrative” medicine, to reflect inclusion into conventional practice of evidence-based therapies, regardless of origin [9,14,24]. There is also taxonomy for CAM [27-30]. The American College of Rheumatology (ACR) established a committee in 1993 to address pertinent issues originally surrounding the terminology, use, and efficacy of these remedies. At that time, the committee deliberately selected the term “questionable,” following the approaches of other similar groups in the scientific community. This permitted the avoidance of terms that might inappropriately euphemize the value of “questionable” remedies. However, to conform to subsequent trends, the ACR later adopted the terms “complementary” and “alternative.”

In the author’s view, there are three types of therapies:

Genuine, defined as those proven acceptably safe and effective


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