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Rheumatoid Arthritis

Rheumatoid arthritis (RA) affects 0.5%-1% of the adult population. The symptoms of RA (joint pain, stiffness, tenderness, swelling and effusion; malaise, fever, weight loss, fatigue) and associated comorbid conditions (e.g. extra-articular autoimmune disease, depression, cardiovascular disease, serious infections) and side effects of standard drug therapy with disease modifying anti rheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs (NSAID), and possibly corticosteroids, lead to reduced quality of life, work disability and considerable societal and personal costs as well as increased risks for hospitalization and mortality.1 For patients with early RA, immediate treatment with DMARDs is usually recommended, in order to retard or stop disease progression. Nonetheless, some patients do not tolerate DMARDs or have preferences against DMARD therapy.(1)

In Anthroposophic Medicine (AM), a treatment program for RA without DMARDs has been developed, including biographical and nutrition counselling, special AM medications, AM art or eurythmy therapy, and AM-extended physical therapy and nursing techniques. The aim is to retard disease progression and relieve symptoms, if possible without DMARDs. Corticosteroids are used if needed, with the long-term aim to reduce the dose or even stop the medication.(1)

This program has been evaluated in a small pilot study(2) and in a prospective 4-year non-randomized comparative study of 251 patients with early RA, funded by the German Ministry for Education and Research.1 The latter was the first controlled study of a complementary or integrative intervention for RA with a follow-up beyond 12 months, the first with radiological progression as outcome, with a focus on early RA, and with a CAM intervention implemented without the use of DMARDs. Also, the authors could identify only four other treatment studies of DMARD-naïve patients with early RA in which radiological progression was measured after 48 months or later. Other strengths include a rigorous adherence to RA diagnostic criteria with independent assessor technique and blinded rating of radiological findings by two different assessors.(1)

The study comprised two patient groups (A- and C-patients); C-patients, without specific therapy preferences received conventional drug therapy with DMARDs while A-patients, with preference against DMARDs, received the AM treatment program described above, without DMARDs in 94% of cases. Both groups had standard physical therapy and used corticosteroids and NSAIDs as needed, with significantly fewer A-patients using corticosteroids and NSAIDs.(1) Both treatment regimens were associated with marked reduction in symptoms and systemic inflammation and only slight radiological progression after 4 years; these results did not differ significantly between the groups. The incidence of adverse drug reactions was significantly lower among A-patients (50% of patients) than C-patients (70%).

Study results suggest that for most patients preferring anthroposophic treatment, satisfactory results can be achieved without use of DMARDs and with less use of corticosteroids and NSAIDs than in conventional care.(1)

April 2018

Dr. med. Harald J. Hamre
IFAEMM Freiburg at the Witten/Herdecke University
http://ifaemm.de/index.html
ESCAMP - European Scientific Cooperative on Anthroposophic Medicinal Products
http://www.escamp.org

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References

(1) Hamre HJ, Pham VN, Kern C, Rau R, Klasen J, Schendel U, Gerlach L, Drabik A, Simon L. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs vs. conventional therapy including DMARDs for patients without preference. Patient Preference and Adherence 2018; 12: 375-97.DOI: https://doi.org/10.2147/PPA.S145221

(2) Simon L, Schietzel T, Gärtner C, Kümmell HC, Schulte M. Ein anthroposophisches Therapiekonzept für entzündlich-rheumatische Erkrankungen. Ergebnisse einer zweijährigen Pilotstudie. [An anthroposophic therapy concept for inflammatory rheumatoid disorders. Results of a two-year pilot study]. Forsch Komplementärmed 1997; 4: 17-27. DOI: https://doi.org/10.1159/000210288