Complementary and Alternative Medicine Use in Rheumatoid Arthritis: Considerations for the Pharmacological Management of Elderly Patients.

Complementary and alternative medicines (CAMs) are widely used by patients with rheumatoid arthritis (RA); however, a significant proportion of these patients do not inform their physicians. This has many potential implications in a group of predominantly elderly patients with altered pharmacokinetics, comorbidities and polypharmacy of potentially toxic drugs. CAM usage may affect compliance and pharmacokinetics of conventional therapy for RA and comorbidities; therefore, physicians should engage patients in dialogues regarding CAM usage. This review introduces common CAMs used by RA patients, such as herbal remedies, supplements, and fish and plant oils, and their potential impact on conventional therapy. Efficacy of these treatments are not reviewed in detail but references for reviews and trials are provided for further reading. Fish oils and vitamin D supplementation may generally be recommended, while thunder god vine should be avoided. Patients should also be made aware of the risks of contamination and adulteration of less reputable sources of CAMs, and directed to evidence-based sources of information. Physicians should acknowledge the limitations of scientific evidence and not be prejudiced or dogmatic; however, they should remain resolute against therapies that are known to be ineffective or unsafe.