CAM Therapies to Try for Juvenile Arthritis

By Mary Anne Dunkin 

When your child is in pain or her medications aren’t working as well or as quickly as you’d like, it’s natural to seek solutions elsewhere. In fact, nearly 75 percent of parents of kids with arthritis turn to complementary and alternative medicine therapies (CAM) to help their child find relief.  

For some children, CAM therapies improve pain and mobility and promote feelings of well-being.  But for others, they bring disappointment, drain their parents’ bank accounts or even do harm—particularly if they are used in place of the child’s prescribed treatment, says Austin Dalrymple, DO, a pediatric rheumatologist and assistant professor of medicine at Saint Louis University School of Medicine. 

If you are considering a complementary therapy for your child, it’s important to understand that it should be used alongside any treatment prescribed by your child’s doctor, not instead of it, says Dr. Dalrymple.   

It’s also important to understand that while there is evidence that some complementary treatments relieve symptoms, they do not alter the course of the disease. Furthermore, few studies show that complementary therapies are effective for kids with juvenile arthritis (JA), says Dr. Dalrymple. Most studies showing the benefits of CAM therapies are done on adults with osteoarthritis and rheumatoid arthritis, but they don’t necessarily apply to children with arthritis. 

Still, many doctors say complementary therapies may be worth trying – but only if you proceed with caution. That means always telling your child’s doctor about which complementary therapies you want to try or are already using, says Monica Friedman, chief of pediatric rheumatology at Arnold Palmer Medical Center in Orlando.  

“Go to your child’s doctor with any questions you may have,” says Dr. Friedman. “Some supplements can affect the liver, while some may affect growth. Just knowing the combination of medications and supplements or other CAM therapies is important for your child’s safety.” 

If you’re interested in CAM therapies for your child, here’s what you need to know about the most popular ones for JA.   

Exercise

Several studies, including a 2013 Swedish study published in the online journal Pediatric Rheumatology, show that regular exercise is safe and beneficial for kids with arthritis. The 2013 study found that exercising three times a week for 12 weeks with free weights, core exercises and jumping rope can improve both physical and mental health in children with arthritis without increasing pain scores. When choosing an exercise plan for your child, it’s important to discuss it with your child’s doctor. Based on your child’s specific needs, he or she may need to avoid certain high-impact activities.   

Yoga 

This ancient practice combines physical stretching exercises with mindfulness-based therapy. A 2017 study in the Journal of Alternative and Complementary Medicine found that yoga improved physical and psychosocial symptoms in adults with rheumatoid arthritis (RA).  A separate 2013 study published in the Clinical Journal of Pain found that young women with RA who participated in a six-week Iyengar yoga program experienced improvements in quality of life, pain disability and mood that continued at the two-month follow-up.  

While published research on the benefits of yoga for juvenile arthritis is lacking, Dr. Dalrymple encourages activities that promote a mind-body balance. However, he cautions that yoga is probably not appropriate for children with hypermobility.  

Massage 

Massage may relax muscles, lessen pain and improve circulation. Though there is limited research on the benefits of massage for kids with arthritis, past studies suggest it may have some benefits for pediatric pain. Two decades ago, a study from the University of Miami School of Medicine found that a daily 15-minute massage from a parent for 30 days decreased anxiety levels, blood levels of the stress hormone cortisol, pain and morning stiffness in children with juvenile idiopathic arthritis (JIA). A 2008 study following 57 pediatric chronic pain patients also found that massage therapy significantly improved levels of distress, pain, discomfort, tension and mood. If you are interested in learning massage to help your child, speak with your child’s physical therapist or a massage therapist. Older children can also learn self-massage.  

Acupuncture 

A 2008 review of acupuncture in children from the National Center for Complementary Medicine, National Institutes of Health, found that acupuncture is generally safe in children, but that trials of acupuncture for musculoskeletal pain in children have been inconclusive. However, testing the effects of acupuncture can be difficult, says Dr. Friedman, noting she practices acupuncture on her own pediatric patients with arthritis and other pain syndromes and has seen positive results.    

Foods and supplements 

Some children see benefits from certain foods or supplements. Blueberries and turmeric are two that are worth trying, says Dr. Dalrymple, but not necessarily together.  

• Blueberries.  In a 2015 Japanese study of 201 children who were taking etanercept, those who drank 50 ml of blueberry juice (about 1 ½ ounces) daily with their treatment had “clinically meaningful improvement” compared to those drinking no juice or a placebo juice.  Inflammatory cytokine levels and many symptoms and side effects were significantly reduced or absent as well.  
• Turmeric. Although it has not been studied specifically in children, Dr. Dalrymple says he has had patients report good benefits from turmeric – a yellow-colored powder ground from the root of the turmeric plant. Studies show that turmeric has an anti-inflammatory effect and inhibits inflammatory cytokines and enzymes, including cyclooxygenase-2 (COX-2), the target of celecoxib (Celebrex). 
• Fish oil.  Several studies of adults with RA or OA suggest that fish oil supplements may improve pain and function, but evidence for its effectiveness for juvenile arthritis is lacking. “There’s some evidence fish oil may be helpful for children with arthritis, and little evidence that it’s harmful,” says Dr. Dalrymple. “If a parent asked me about it, I’d say it’s worth a try.”  

Always talk to your child’s doctor before trying a new supplement. He or she can help you decide which brand to choose and how much to give to your child, as well as help determine if there are any possible medication interactions.  

Elimination diets 

Some people claim that certain foods worsen arthritis symptoms, but for the most part, research fails to show the benefits of eliminating specific foods or nutrients from the diet.  For that reason, most pediatric rheumatologists advise against elimination diets. One possible exception – at least for some people – is gluten. “When you have a gluten intolerance, fixing that will help with the arthritis,” says Dr. Friedman. Otherwise, there is “not really anything to back-up a gluten-free diet,” she says.  

Cognitive Behavioral Therapy (CBT) 

CBT is a form of psychotherapy that helps people change unhelpful thinking and behavior patterns to achieve lasting improvement in mood and function. While more research is needed to determine its effectiveness, it is commonly used in people with chronic disease. At least one small study published in 2015 in Pediatric Rheumatology Online Journal evaluated its usefulness for pain in JIA. While a preliminary analysis showed no benefits against pain, those participating in six group sessions of CBT experienced better quality of life, reduction in pain catastrophizing and an improvement in adaptive pain cognitions (the beliefs around controlling pain and self-efficacy). Ask your child’s doctor or consult a pediatric psychologist or therapist for more information about how CBT may help.