Juvenile rheumatoid arthritis affects nearly every aspect of a child’s life, including relationships, school activities, diet, exercise and sports.

With more than 50,000 children in the United States dealing with symptoms of JRA and side effects of medications, an increasing number of children, parents and health professionals are exploring alternative treatments. The various options in this branch of medicine, known as Complementary and Alternative Medicine or CAM, can help children reduce symptoms of JRA, cope with side effects of medications and improve their quality of life.

While CAM therapies, including supplementation, massage and acupuncture, have been around for decades (in some cases, centuries), CAM is a new addition to the treatment of JRA. This section of kidswitharthritis will help explain many CAM treatments that JRA patients, health professionals, conventional and alternative practitioners are looking into.

What is CAM?

Complementary refers to non-medical treatments, used along with conventional medicine. An example is aromatherapy used to calm a person down during use of conventional medicine. Another example is application of heat and cold, along with medication, to reduce inflammation. Alternative Medicine is used in place of conventional medicine. An example is a special diet to replace medication.

Complementary and Alternative Medicine is not part of conventional medicine that is practiced by M.D.’s, by D.O’s (doctors of osteopathy) and R.N.’s. However, some M.D.’s and D.O.’s also practice CAM.

The National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, is a Federal Government agency for scientific research on CAM.  NCCAM's mission is “to explore complementary and alternative healing practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals.” NCCAM explains that scientific evidence exists for some CAM therapies, but that there are still questions about the safety and effectiveness of various treatments.

Diet

Food and the need for a nutrient filled diet are significant issues in the life of a child with JRA.
There is little evidence showing that any specific diet – or so-called miracle cures – benefit people with rheumatoid arthritis. Vegetarian and vegan diets in particular are not advisable as they are often deficient in nutrients and calories: and JRA patients need all of the nutrients they can get. It is wise to avoid saturated fats (meats and butter) and hydrogenated or trans fatty acids (processed vegetable oils that form the basis of some margarines) as limited research explains that these can add to joint and tissue inflammation.

However, omega-3 fatty acids are therapeutic for JRA patients, as these elements are said to reduce inflammation and help prevent risk factors associated with chronic diseases, including arthritis. Some people even believe that omega-3’s can control arthritis. A good way to absorb large amounts of omega-3’s is to take fish oil or flax seed oil, while recommended foods include whole grains, fresh fruits and vegetables, fish and olive oil. (Please see Diet & Nutrition for more information).

Food allergies, also addressed by CAM, are of interest to some JRA patients as some children have allergies or sensitivities to certain foods, including wheat, corn, milk, beef and food additives. If you think that your child has a food allergy, it is advisable to consult with an allergist before removing specific foods from the diet.

Supplements and Herbs

In addition to fish oils, plant oils containing gamma-linolenic acid (GLA), omega 6 fatty acids, may reduce rheumatoid arthritis symptoms, including morning stiffness. Other suggested supplements, including vitamins C, D, E, B6 and B12, and calcium, magnesium, selenium, zinc and copper can be found in over-the-counter vitamin pills. Children taking methotrexate may have folic acid deficiency, and are sometimes advised to take this supplement. Joint support formulas containing glucosamine, chondroitin and MSM are often recommended for people with osteoarthritis, while some people with rheumatoid arthritis believe them to be helpful. However, it is unclear if these supplements are appropriate for children whose bones are still growing.

Some alternative practitioners suggest eating probiotic foods such as yogurt and taking probiotic supplements to promote the production of helpful intestinal bacteria.

A variety of herbs are available, many with unpronounceable names, and some with questionable aspects. However, four well-known, safe herbs are bromelain, ginger, Aloe Vera and turmeric. Bromelain, a pineapple derivative, is known for anti-inflammatory effects. Ginger root is a spicy addition to foods. Ginger, also in capsules and liquids, has antioxidant and anti-inflammatory effects, while ginger tea can soothe an upset stomach. Aloe Vera in liquid form is a mildly flavored drink that heals the lining of the intestine and soothes an upset stomach.

The spice turmeric, used to flavor foods, is known for antioxidant and anti-inflammatory effects. It is believed to be such a powerful treatment that doctors and researchers are investigating its effects to treat several different diseases. According to Bharat B. Aggarwal, M.D., professor of cancer medicine, Dept. of Experimental Therapeutics, University of Texas, the active component of turmeric is an excellent blocker of TNF, or tumor necrosis factor, which contributes to cancers and arthritis.

Some herbs that researchers advise avoiding include: arnica, aconite, autumn crocus, echinacea (which is believed to stimulate the immune system), 5-HTP, GBL, chaparral and kombucha.

If you would like to treat the symptoms of JRA with herbs, please consult a registered dietician who is knowledgeable about herbs. It is also advised that you check with your pediatric rheumatologist about any unusual supplement, as some can interfere with medications.

Massage and acupuncture

Massage therapy can ease pain and stiffness by easing muscle pain and spasms, increasing the body’s production of pain-killing endorphins and improving sleep.

Acupuncture, originally from China, employs needles to stimulate specific points throughout the body. In treatment, extremely thin needles are inserted through the skin to various depths at strategic points on your body. Acupuncture is said to reduce pain and nausea and to increase energy, among other effects. This is accomplished through a harmonious balance between the complementary extremes (yin and yang) of the life force known as chi. Acupuncture practitioners believe that when needles are inserted into various points of the body, your energy flow is rebalanced.

The Western explanation is that needles inserted into the skin stimulate nerves, muscles and connective tissue. This stimulation appears to boost activity of your body's natural painkillers and increase blood flow. While adults with rheumatoid arthritis have experienced decreased pain after receiving acupuncture treatments, there is no such research with children.

Additional treatments

In the Treatment section of kidswitharthritis, we describe the application of warm and cold packs, the use of wax baths and deep microwave hyperthermia, explaining that many parents claim they reduce their children’s swelling, pain and fever.

Thermotherapy, meaning application of heat, is used to reduce the pain and inflammation of arthritis by increasing blood flow, maximizing the patient's tolerance for pain, and enhancing flexibility. It includes heating pads, hot water bottles, paraffin wax baths, and therapeutic heat wraps.

In hot wax bath therapy, paraffin wax is heated in a special container. The child’s joint is coated by being repeatedly dipped in the hot wax bath, then wrapped in a terry towel to provide insulation, to transfer the energy released from the solidification of the wax to the underlying tissues of the limb.

Cryotherapy is the application of cold to help reduce the pain of arthritis by numbing the nerves surrounding the joint. Cryotherapy reduces inflammation of arthritis and minimizes muscle spasticity. Home methods include using gel packs and homemade cold packs.

Deep microwave hyperthermia heats the target organ and spares the adjacent tissues. In experiments in Israel, patients experienced reduced pain and knee circumference and increased range of motion, for six weeks following treatment, with no observable adverse reactions.

While a TENS unit is not specifically cited as an alternative or complimentary remedy, it is a non-medical device that sends electrical impulses to certain parts of the body to block pain signals. (See Treatment section of kidswitharthritis for more information.)

Choosing treatments

Choosing which CAM treatments to use to minimize JRA symptoms can be confusing. However, the NCCAM Clearinghouse provides information on CAM, including publications and searches of Federal databases of scientific and medical literature. Publications include "Selecting a CAM Practitioner" and "Are You Considering Using CAM?" The Clearinghouse does not provide medical advice, treatment recommendations or referrals to practitioners.

Complementary and Alternative Medicine is yet another option that can help JRA patients improve their health, and find comfort and help to diminish symptoms.