Naturheilkunde und Komplementärmedizin bei rheumatischen Erkrankungen

Zusammenfassung

Naturheilkunde und Komplementärmedizin werden von Patienten mit rheumatischen Erkrankungen häufig nachgefragt und in Anspruch genommen. Durch die wachsende wissenschaftliche Evidenz können Naturheilverfahren zunehmend besser gewichtet und im Konzept der integrativen Rheumatologie sinnvoll in die medizinische Versorgung implementiert werden. In der Therapie der rheumatoiden Arthritis und der Spondylarthropathien sind insbesondere das modifizierte Fasten, Verfahren der Mind-Body Medizin, systemische Thermotherapien, spezifische Nahrungsmittel und Supplementierungen, probiotische Therapie und die Ayurveda Medizin geeignet die konventionelle Therapie zu ergänzen. Für die Behandlung der Arthrosen sind v. a. die Verfahren der Blutegeltherapie und der Akupunktur in ihrer Wirksamkeit gut belegt. Darüber hinaus sind Schröpfen, Ayurveda Medizin, systemische Thermotherapie, Hydrotherapie, spezifische externe Auflagen und Mind-Body Techniken wie Tai-Chi in der Therapie bewährt. Für die Therapie der Fibromyalgie wird eine multimodale Komplexbehandlung unter Einbezug der systemischen Thermotherapie und der mit guter Evidenz belegten Mind-Body-Techniken Tai-Chi und Yoga als intensivierter Therapieansatz erfolgreich eingesetzt. Schwerpunkt der Naturheilkunde bilden die Konzepte der Salutogenese, Selbstwirksamkeit und des gesundheitsfördernden Lebensstils. Weitere klinische Forschung und zugrundeliegende Forschungsförderung sind notwendig. In der medizinischen Versorgung erscheint vor dem Hintergrund der Inanspruchnahme eine bessere Implementierung der Naturheilkunde und seriösen Komplementärmedizin im Konzept der integrativen Rheumatologie in ausgewiesenen Zentren angemessen.

Abstract

Patients with rheumatic diseases frequently use treatment methods such as naturopathy and complementary medicine. With the growing body of scientific evidence, the value of these methods can better appraised and the methods can be implemented into medical care as part of the concept of integrative rheumatology. The most promising treatment methods for rheumatoid arthritis and spondylarthropathy consist of modified fasting, relaxation techniques of mind-body medicine, whole-body thermal therapy, specific foods and supplements, probiotics and the whole-system approach of ayurvedic medicine. The effectiveness of leech therapy and acupuncture in the symptomatic treatment of osteoarthritis has been shown in clinical trials. Further treatment options for osteoarthritis consist of cupping, ayurvedic medicine, systemic thermotherapies, hydrotherapy and various external local packs and mind-body techniques such as Tai-Chi und yoga. For the treatment of fibromyalgia, a complex multimodal treatment approach has been successfully used, including systemic thermotherapy and the well-evidenced mind-body techniques of Tai-Chi and yoga. The principal focus of naturopathy is set on the concept of salutogenesis, the enhancement of self-efficacy and the promotion of a health-promoting lifestyle modification. Further clinical research and research support in the field of integrative rheumatology are needed. On the background of the high demand and usage of naturopathy and evidence-based complementary medicine, a better implementation of high-quality integrative rheumatology in selected centres might be an appropriate approach.

Schlüsselwörter

Naturheilkunde - Komplementärmedizin - rheumatische Erkrankungen

Key words

naturopathy - complementary medicine - rheumatic disease

• Literatur

• 1 Dobos G, Deuse U, Michalsen A. Chronische Erkrankungen integrativ. München: Elsevier; 2007
• 2 Hildebrandt G. Therapeutische Physiologie. In: Gutenbrunner-C H-G. (ed.). Handbuch der Balneologie und der medizinischen Klimatologie. Springer; Berlin, Heidelberg: 1998: 5-83
• 3 Benson HMS. The Wellness book. Mind-Body Medicine. New York: Fireside; 1999
• 4 Kabat-Zinn J. The full catstrophe living. New York: Delacorte Press; 1999
• 5 Ornish D, Scherwitz LW, Billings JH et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA: the journal of the American Medical Association 1998; 280: 2001-2007
• 6 Antonovsky A. The life cycle, mental health and the sense of coherence. The Israel journal of psychiatry and related sciences 1985; 22: 273-280
• 7 Michalsen A. Wissenschaftlicher Wirksamkeitsnachweis. Dobos G, Paul A. (eds.). München: Elsevier; 2011
• 8 McLean MH, Dieguez Jr. D, Miller LM et al. Does the microbiota play a role in the pathogenesis of autoimmune diseases?. Gut 2015; 64: 332-341
• 9 Scher JU, Abramson SB. The microbiome and rheumatoid arthritis. Nature reviews Rheumatology 2011; 7: 569-578
• 10 Taneja V. Arthritis susceptibility and the gut microbiome. FEBS letters 2014; 588: 4244-4249
• 11 Yeoh N, Burton JP, Suppiah P et al. The role of the microbiome in rheumatic diseases. Current rheumatology reports 2013; 15: 314
• 12 Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A et al. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition 2014; 30: 430-435
• 13 Kessler C, Michalsen A. The role of whole medical systems in global medicine. Forsch Komplementmed 2012; 19: 65-66
• 14 Witt CM, Michalsen A, Roll S et al. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee–study protocol for a randomized controlled trial. Trials 2013; 14: 149
• 15 Kjeldsen-Kragh J, Haugen M, Borchgrevink CF et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991; 338: 899-902
• 16 Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scandinavian journal of rheumatology 2001; 30: 1-10
• 17 Kjeldsen-Kragh J. Rheumatoid arthritis treated with vegetarian diets. The American journal of clinical nutrition 1999; 70: 594S-600S
• 18 Fontana L, Partridge L, Longo VD. Extending healthy life span-from yeast to humans. Science 2010; 328: 321-326
• 19 Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell metabolism 2014; 19: 181-192
• 20 Mattson MP. Energy intake, meal frequency, and health: a neurobiological perspective. Annual review of nutrition 2005; 25: 237-260
• 21 Lord GM, Matarese G, Howard JK et al. Leptin modulates the T-cell immune response and reverses starvation- induced immunosuppression. Nature 1998; 394: 897-901
• 22 Michalsen A, Li C. Fasting therapy for treating and preventing disease – current state of evidence. Forsch Komplementmed 2013; 20: 444-453
• 23 Al-Okbi SY. Nutraceuticals of anti-inflammatory activity as complementary therapy for rheumatoid arthritis. Toxicology and industrial health 2014; 30: 738-749
• 24 Anand R, Kaithwas G. Anti-inflammatory potential of alpha-linolenic acid mediated through selective COX inhibition: computational and experimental data. Inflammation 2014; 37: 1297-1306
• 25 Ramadan G, Al-Kahtani MA, El-Sayed WM. Anti-inflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis. Inflammation 2011; 34: 291-301
• 26 Ramadan G, El-Menshawy O. Protective effects of ginger-turmeric rhizomes mixture on joint inflammation, atherogenesis, kidney dysfunction and other complications in a rat model of human rheumatoid arthritis. International journal of rheumatic diseases 2013; 16: 219-229
• 27 Riegsecker S, Wiczynski D, Kaplan MJ et al. Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis. Life sciences 2013; 93: 307-312
• 28 Roy S, Sannigrahi S, Vaddepalli RP et al. A novel combination of methotrexate and epigallocatechin attenuates the overexpression of pro-inflammatory cartilage cytokines and modulates antioxidant status in adjuvant arthritic rats. Inflammation 2012; 35: 1435-1447
• 29 Shukla M, Gupta K, Rasheed Z et al. Consumption of hydrolyzable tannins-rich pomegranate extract suppresses inflammation and joint damage in rheumatoid arthritis. Nutrition 2008; 24: 733-743
• 30 Singh S, Nair V, Gupta YK. Linseed oil: an investigation of its antiarthritic activity in experimental models. Phytotherapy research: PTR 2012; 26: 246-252
• 31 Wu D, Wang J, Pae M et al. Green tea EGCG, T cells, and T cell-mediated autoimmune diseases. Molecular aspects of medicine 2012; 33: 107-118
• 32 Guillot X, Tordi N, Mourot L et al. Cryotherapy in inflammatory rheumatic diseases: a systematic review. Expert review of clinical immunology 2014; 10: 281-294
• 33 Hirvonen HE, Mikkelsson MK, Kautiainen H et al. Effectiveness of different cryotherapies on pain and disease activity in active rheumatoid arthritis. A randomised single blinded controlled trial. Clinical and experimental rheumatology 2006; 24: 295-301
• 34 Lange U, Uhlemann C, Muller-Ladner U. Serial whole-body cryotherapy in the criostream for inflammatory rheumatic diseases. A pilot study. Med Klin (Munich) 2008; 103: 383-388
• 35 Lv QW, Zhang W, Shi Q et al. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Annals of the rheumatic diseases 2014;
• 36 Goldbach-Mansky R, Wilson M, Fleischmann R et al. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial. Annals of internal medicine 2009; 151: 229-240 W49-W51
• 37 Tao X, Younger J, Fan FZ et al. Benefit of an extract of Tripterygium Wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study. Arthritis and rheumatism 2002; 46: 1735-1743
• 38 Furst DE, Venkatraman MM, McGann M et al. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 2011; 17: 185-192
• 39 Cramer H, Lauche R, Langhorst J et al. Yoga for rheumatic diseases: a systematic review. Rheumatology (Oxford) 2013; 52: 2025-2030
• 40 Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 1985; 8: 163-190
• 41 Pradhan EK, Baumgarten M, Langenberg P et al. Effect of Mindfulness-Based Stress Reduction in rheumatoid arthritis patients. Arthritis and rheumatism 2007; 57: 1134-1142
• 42 Falkenbach A, Toennemann J, Mur E. Retained and discontinued conventional and unconventional measures by patients with Bechterew disease for modifying the course of illness. Zeitschrift fur Rheumatologie 2002; 61: 271-278
• 43 Michalsen A, Klotz S, Ludtke R et al. Effectiveness of leech therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of internal medicine 2003; 139: 724-730
• 44 Lauche R, Cramer H, Langhorst J et al. A systematic review and meta-analysis of medical leech therapy for osteoarthritis of the knee. The Clinical journal of pain 2014; 30: 63-72
• 45 Teut M, Kaiser S, Ortiz M et al. Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial. BMC complementary and alternative medicine 2012; 12: 184
• 46 Berman BM, Langevin HM, Witt CM et al. Acupuncture for chronic low back pain. The New England journal of medicine 2010; 363: 454-461
• 47 Witt CM, Jena S, Brinkhaus B et al. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Arthritis and rheumatism 2006; 54: 3485-3493
• 48 Witt C, Brinkhaus B, Jena S et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005; 366: 136-143
• 49 Vickers AJ, Cronin AM, Maschino AC et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine 2012; 172: 1444-1453
• 50 Kessler CS, Pinders L, Michalsen A et al. Ayurvedic interventions for osteoarthritis: a systematic review and meta-analysis. Rheumatology international 2015; 35: 211-232
• 51 Christensen R, Bartels EM, Altman RD et al. Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? – a meta-analysis of randomized controlled trials. Osteoarthritis and cartilage/OARS, Osteoarthritis Research Society 2008; 16: 965-972
• 52 Wang C, Schmid CH, Rones R et al. A randomized trial of Tai-Chi for fibromyalgia. The New England journal of medicine 2010; 363: 743-754
• 53 Langhorst J, Klose P, Dobos GJ et al. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology international 2013; 33: 193-207
• 54 Michalsen A, Li C, Kaiser K et al. In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy. Evidence-based complementary and alternative medicine: eCAM 2013; 2013: 908610
• 55 Brockow T, Wagner A, Franke A et al. A randomized controlled trial on the effectiveness of mild water-filtered near infrared whole-body hyperthermia as an adjunct to a standard multimodal rehabilitation in the treatment of fibromyalgia. The Clinical journal of pain 2007; 23: 67-75
• 56 Huber R, Michalsen A. Checkliste Komplementärmedizn. Stuttgart: Haug; 2014