Editing Rheumatoid arthritis (section)

===Alternative medicine===
In general, there is not enough evidence to support any complementary health approaches for RA, with safety concerns for some of them. Some mind and body practices and dietary supplements may help people with symptoms and therefore may be beneficial additions to conventional treatments, but there is not enough evidence to draw conclusions.<ref name=NCCIH>{{cite web|title=Rheumatoid Arthritis and Complementary Health Approaches|url=http://nccih.nih.gov/health/RA/getthefacts.htm|publisher=National Center for Complementary and Integrative Health|access-date=July 1, 2015|url-status=live|archive-url=https://web.archive.org/web/20150705082102/https://nccih.nih.gov/health/RA/getthefacts.htm|archive-date=July 5, 2015|date=January 2006}}</ref> A [[systematic review]] of [[complementary and alternative medicine|CAM]] modalities (excluding fish oil) found that " The available evidence does not support their current use in the management of RA."<ref name=Macfarlane>{{cite journal | vauthors = Macfarlane GJ, El-Metwally A, De Silva V, Ernst E, Dowds GL, Moots RJ | title = Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review | journal = Rheumatology | volume = 50 | issue = 9 | pages = 1672–1683 | date = September 2011 | pmid = 21652584 | doi = 10.1093/rheumatology/ker119 | collaboration = Arthritis Research UK Working Group on Complementary Alternative Medicines | doi-access = free }}</ref> Studies showing beneficial effects in RA on a wide variety of CAM modalities are often affected by [[publication bias]] and are generally not high quality evidence such as [[randomized controlled trial]]s (RCTs).<ref name=Ef2010>{{cite journal | vauthors = Efthimiou P, Kukar M | s2cid = 21179821 | title = Complementary and alternative medicine use in rheumatoid arthritis: proposed mechanism of action and efficacy of commonly used modalities | journal = Rheumatology International | volume = 30 | issue = 5 | pages = 571–586 | date = March 2010 | pmid = 19876631 | doi = 10.1007/s00296-009-1206-y }}</ref>

A 2005 Cochrane review states that [[low level laser therapy]] can be tried to improve pain and morning stiffness due to rheumatoid arthritis as there are few side-effects.<ref>{{cite journal | vauthors = Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K, Morin M, Shea B, Tugwell P | title = Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD002049 | date = October 2005 | pmid = 16235295 | doi = 10.1002/14651858.CD002049.pub2 | pmc = 8406947 }}</ref>

There is limited evidence that [[tai chi]] might improve the range of motion of a joint in persons with rheumatoid arthritis.<ref>{{cite journal | vauthors = Mudano AS, Tugwell P, Wells GA, Singh JA | title = Tai Chi for rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | volume = 9 | pages = CD004849 | date = September 2019 | issue = 9 | pmid = 31553478 | pmc = 6759565 | doi = 10.1002/14651858.CD004849.pub2 }}</ref><ref>{{cite journal | vauthors = Lee MS, Pittler MH, Ernst E | title = Tai chi for rheumatoid arthritis: systematic review | journal = Rheumatology | volume = 46 | issue = 11 | pages = 1648–1651 | date = November 2007 | pmid = 17634188 | doi = 10.1093/rheumatology/kem151 | doi-access = free }}</ref> The evidence for acupuncture is inconclusive<ref>{{cite journal | vauthors = Lee MS, Shin BC, Ernst E | title = Acupuncture for rheumatoid arthritis: a systematic review | journal = Rheumatology | volume = 47 | issue = 12 | pages = 1747–1753 | date = December 2008 | pmid = 18710899 | doi = 10.1093/rheumatology/ken330 | doi-access = free }}</ref> with it appearing to be equivalent to sham acupuncture.<ref>{{cite journal | vauthors = Macfarlane GJ, Paudyal P, Doherty M, Ernst E, Lewith G, MacPherson H, Sim J, Jones GT | title = A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis | journal = Rheumatology | volume = 51 | issue = 9 | pages = 1707–1713 | date = September 2012 | pmid = 22661556 | doi = 10.1093/rheumatology/kes133 | collaboration = Arthritis Research UK Working Group on Complementary Alternative Therapies for the Management of the Rheumatic Diseases | doi-access = free }}</ref>

A Cochrane review in 2002 showed some benefits of the electrical stimulation as a rehabilitation intervention to improve the power of the hand grip and help to resist fatigue.<ref>{{cite journal | vauthors = Brosseau LU, Pelland LU, Casimiro LY, Robinson VI, Tugwell PE, Wells GE | title = Electrical stimulation for the treatment of rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003687 | date = 2002 | volume = 2010 | pmid = 12076504 | doi = 10.1002/14651858.CD003687 | pmc = 8725644 }}</ref> D‐penicillamine may provide similar benefits as DMARDs but it is also highly toxic.<ref>{{cite journal | vauthors = Suarez-Almazor ME, Spooner C, Belseck E | title = Penicillamine for treating rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD001460 | date = 2000-10-23 | volume = 2011 | pmid = 11034719 | doi = 10.1002/14651858.cd001460 | pmc = 8407185 }}</ref> Low-quality evidence suggests the use of therapeutic ultrasound on arthritic hands.<ref name=":6">{{cite journal | vauthors = Casimiro L, Brosseau L, Robinson V, Milne S, Judd M, Well G, Tugwell P, Shea B | title = Therapeutic ultrasound for the treatment of rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD003787 | date = 2002-07-22 | pmid = 12137714 | doi = 10.1002/14651858.cd003787 }}</ref> Potential benefits include increased grip strength, reduced morning stiffness and number of swollen joints.<ref name=":6" /> There is tentative evidence of benefit of [[transcutaneous electrical nerve stimulation]] (TENS) in RA.<ref name=":7">{{cite journal | vauthors = Johnson MI, Walsh DM | title = Pain: continued uncertainty of TENS' effectiveness for pain relief | journal = Nature Reviews. Rheumatology | volume = 6 | issue = 6 | pages = 314–316 | date = June 2010 | pmid = 20520646 | doi = 10.1002/14651858.cd004377 | pmc = 8826159 }}</ref> Acupuncture‐like TENS (AL-TENS) may decrease pain intensity and improve muscle power scores.<ref name=":7" />

Low-quality evidence suggests people with active RA may benefit from assistive technology.<ref name=":8">{{cite journal | vauthors = Tuntland H, Kjeken I, Nordheim LV, Falzon L, Jamtvedt G, Hagen KB | title = Assistive technology for rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD006729 | date = October 2009 | volume = 2009 | pmid = 19821383 | doi = 10.1002/14651858.cd006729.pub2 | pmc = 7389411 }}</ref> This may include less discomfort and difficulty such as when using an eye drop device.<ref name=":8" /> Balance training is of unclear benefits.<ref>{{cite journal | vauthors = Silva KN, Mizusaki Imoto A, Almeida GJ, Atallah AN, Peccin MS, Fernandes Moça Trevisani V | title = Balance training (proprioceptive training) for patients with rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD007648 | date = May 2010 | pmid = 20464755 | doi = 10.1002/14651858.cd007648.pub2 }}</ref>