How would you counsel a patient who is interested in using supplements (such as fish oil or turmeric) as an adjunct to treatment of inflammatory arthritis?

Drs. @Dr. First Last and @Dr. First Last expertly raise the key difficulty rheumatologists face with herbal medications: imparting a healthy respect for the potential risk:benefit (and limited data) about these agents against allowing patients to erroneously characterize their physician as close-minded (and thus risking biasing them against all the physicians' management advice).

Adding to this, patients may not appreciate disease indication often significantly affects the amount of published data, safety profile, and potential utility of herbal medications. For example, many erroneously think that just because an agent is used for "arthritis", its parameters must be the same for both osteoarthritis and autoimmune arthritis.

I often find it h...

First, remember that many patients, especially those interested in “natural approaches" will do this regardless of our disapprobation. I would encourage them to bring in the bottles so that you can review them together. If there is nothing amiss, I see no reason not to take these IN ADDITION TO standard therapy. If this is intended to be INSTEAD OF standard therapy, I would caution the patient that these are unproven and may allow the disease to continue and cause physical damage, loss of function, and ultimate adverse outcome that might be avoidable if standard of care had been used. Any criticism or belittling will lead the patient to quit the practice in which case both patient and clinician lose. If the patient insists, proper documenta...

What is commonly forgotten in the use of supplements is that they are drugs. For example, turmeric can interact with methotrexate to increase levels and alter intestinal transport. This underscores what Dr. @Dr. First Last noted in his write up. Equally important, we have very little data on the effects of these supplements in a randomized, controlled, placebo trial; most of the trials published on supplements use very small patient populations and are frequently unblinded. When I speak to my patients about using supplements for inflammatory arthritis, I like to emphasize to them that I am drawing on the medical literature to provide them with recommendations. With such little guidance on their use, I am frequently left explaining to them t...