Kikuchi Motoo, Matsuura Kentaro, Matsumoto Yoshifuji, Inagaki Toshiaki, Ueda Ryuzo
Department of Medicine, Fujita Health University, Nanakuri Sanatorium, Tsu, Mie, Japan.
Geriatr Gerontol Int. 2009 Mar;9(1):29-40. doi: 10.1111/j.1447-0594.2008.00503.x.
A variety of complementary and alternative medicine (CAM) treatments are provided to the elderly. We investigated the efficacy and safety of CAM substances that are available to patients with osteoarthritis (OA) and rheumatoid arthritis (RA), both in Japan and overseas.
Information on CAM products was collected from the World Wide Web, using the keywords "arthritis" and "supplement" in five languages (Japanese, English, French, Italian and German) using a popular search engine for each of the languages. References to published work on the products were researched using PubMed with the keywords of "arthritis", "anti-inflammatory" and "analgesics". Such published work was classified according to the evidence levels established by the Cochrane Library.
Two-hundred and sixty CAM products for OA or RA were available in Japan, of which 41 CAM products had been tested in randomized controlled trials (RCT); there was no scientific evidence for the remaining 219 CAM products. Most of the previous RCT suggested that CAM was effective in OA or RA. Herein, we confirmed the significant OA relieving effects of chondroitin sulfate through a meta-analysis. Effectiveness was assessed using subjective scores, not disease-specific immunological or serological markers for assessment. Toxicological investigations had only been performed for a few CAM products.
Some CAM products that are effective against RA may be used together with biological therapy. However, some of the CAM products available in Japan should be tested using objective markers. Some CAM products for OA could be used for the relief of pain.
为老年人提供了多种补充和替代医学（CAM）疗法。我们调查了在日本和海外骨关节炎（OA）和类风湿关节炎（RA）患者可用的CAM物质的疗效和安全性。
使用流行的搜索引擎，用五种语言（日语、英语、法语、意大利语和德语）通过关键词“关节炎”和“补充剂”从万维网上收集有关CAM产品的信息。使用PubMed以“关节炎”、“抗炎”和“镇痛药”为关键词对已发表的关于这些产品的研究进行检索。此类已发表的研究根据Cochrane图书馆制定的证据水平进行分类。
在日本有260种用于OA或RA的CAM产品，其中41种CAM产品已在随机对照试验（RCT）中进行了测试；其余219种CAM产品没有科学证据。以前的大多数RCT表明CAM对OA或RA有效。在此，我们通过荟萃分析证实了硫酸软骨素对OA有显著的缓解作用。疗效是使用主观评分评估的，而不是使用疾病特异性免疫或血清学标志物进行评估。仅对少数CAM产品进行了毒理学研究。
一些对RA有效的CAM产品可与生物疗法联合使用。然而，日本现有的一些CAM产品应使用客观标志物进行测试。一些用于OA的CAM产品可用于缓解疼痛。
