Memorandum submitted by the Arthritis
Research Campaign (HO 28)
1.0 Brief introduction to the organisation
and the submitter
1.1 The mission of the Arthritis Research
Campaign is to improve the lives of people with arthritis by:
funding high quality research into the cause, treatment and cure
of arthritic conditions, translating the outcomes of research
to benefit patients, educating health professionals and providing
information to the general public. The charity was founded in
1936 and is the fourth largest medical research charity in
the UK and the only charity in the UK solely dedicated to investigating
arthritis in all its forms. The charity invests an average of
£30 million pounds every year in research, education
1.2 The Arthritis Research Campaign does
not receive any government or statutory funding and is therefore
totally dependent on voluntary donations. Fundraising in the community
is organised through a combination of voluntary fundraising branches,
paid staff and charity shops. The charity has no conflict of interests
1.3 Professor Alan Silman, the Medical Director
of Arthritis Research Campaign, makes this submission on behalf
of the charity. In addition to his remit of developing and directing
the research strategy for the Arthritis Research Campaign, he
covers the charity's educational role which ranges from patient
information to ensuring training for all health professionals.
Prior to joining the charity in 2007 he was the director
of the Epidemiology Unit in Manchester and had research interests
in several areas of rheumatology. He has published over 500 original
articles and several books, including being one of the five joint
editors of the major international reference work "Rheumatology".
He serves on several national and international committees which
include, among others, membership of the Expert Advisory Group
to the MHRA and Chair of the Op Telic Health Review Board, the
MoD committee responsible for overseeing research on the health
of servicemen and women in Iraq and Afghanistan.
2.0 Factual information
2.1 Some facts on arthritis: more
than six million people in the UK have painful osteoarthritis
in one or both knees. Prevalence increases with age with one in
five adults aged 50-59 to almost one in every two adults
aged 80+ having painful osteoarthritis in one or both knees. 
It is thought that over 10 million people in the UK have
a form of arthritis. The Arthritis Research Campaign is currently
re-evaluating the prevalence of arthritis in the UK and hopes
to publish the results by the end of 2009. In terms of the cost
of arthritis, research has shown that 10 million working
days were lost in 2006-07 due to musculoskeletal conditions,
second only to stress, depression and anxiety.  The cost to
the UK of musculoskeletal conditions is £5.7billion annually
 and arthritis is the most common condition for which people
receive Disability Living Allowance.
2.2 Arthritis and alternative treatments:
over 60% of people with arthritis or other aches and pains use
some form of complementary and alternative medicine and
claim different things work for them. Under this broad heading
are included care from alternative practitioners such as chiropractic
and osteopathy as well as the use of over the counter herbal and
other ingested agents. Overall 46% of the UK population use complementary
medicines at some point in their lives spending over £450 million
per year.  People with arthritis and musculoskeletal conditions,
whose symptoms are often chronic, are particularly attracted to
try such medicines and therefore need guidance to help them decide
if such treatments may or may not be suitable for their arthritis
and associated rheumatic conditions.
2.3 An evidence-based approach to homeopathy:
in February 2009, the Arthritis Research Campaign published the
first evidence-based report on the use of homeopathy and complementary
medicines in arthritis using evidence from randomised controlled
trials. A second report is underway on the use of complementary
practitioners. A section within this report, written by the Arthritis
Research Campaign in conjunction with national experts, is dedicated
to homeopathy, which is defined by the Society of Homeopaths in
England as "treating like with like" and based on an
observation that symptoms of an illness are identical to those
experienced by a healthy person treated for that illness. Homeopathic
remedies are produced by a sequence of dilutions of an active
substance causing similar symptoms in the belief that this will
reduce the likelihood of harm.  The report is a summary of
existing published studies which indicates whether or not there
is scientific evidence to support the clinical effectiveness and
safety of certain named products for people with arthritis. The
report also considered issues such as biological plausibility
and ease of obtaining the treatments.
2.4 A simple way of communicating the
information to the general public: the Arthritis Research
Campaign score medicines according to their effectiveness with
one indicating that there is no evidence that the compound works
and five indicating that the compound is effective. It also grades
the medicines according to safety, providing traffic light classifications
2.4.1 Based on the evidence available from
clinical trials with other supporting information, the Arthritis
Research Campaign categorised each medicine into one of five categories:
1. There is, overall, no evidence to suggest
that the compound works or only a little evidence which is outweighed
by much stronger evidence that it does not work.
2. There is only a little evidence to suggest
the compound might work. The evidence from studies in this category
often come from only a single study which has reported positive
results and there are therefore important doubts about whether
3. There is some promising evidence to suggest
that the compound works. The evidence will be from more than one
study. However there may also be some studies showing that it
does not work. For a compound in this category however we are
still uncertain whether it works or not.
4. There is some consistency to the evidence,
which will come from more than one study, to suggest that the
compound works. Although there are still doubts from the evidence
that it works, on balance we feel that it is more likely to be
effective than not.
5. There is consistent evidence across several
studies to suggest that this compound is effective.
2.4.2 The research also included a categorisation
of all compounds according to their safety profile. For many compounds
it was not easy to do this because there was relatively little
information available on safety. Where information was available,
it was categorised, assuming that it is taken within the range
of recommended doses. Compounds which are safe at the recommended
doses may have serious adverse effects when taken at higher doses.
Again, it should be emphasised that most conventional medicines
have adverse effects, some serious. However, there is generally
greater information available on conventional drugs in order to
determine the frequency and range of such adverse effects. The
categorisation used was:
Traffic light at Green
Compounds with reported adverse effects which
are mainly minor symptoms and infrequent. A classification of
Green does not mean that the compound has no reported adverse
effects and patients should check in the product information leaflet
what these are.
Traffic light at Amber
Compounds with adverse effects reported as common
(even if they are mainly minor symptoms) or with more serious
Traffic light at Red
Compounds with serious adverse effects reported.
Patients should carefully consider these before deciding whether
to take these medicines.
There were some compounds on which there was
very little information on adverse effects and it was therefore
not possible to classify them. Such examples are therefore indicated
by traffic light at Amber together with "No information"
2.5 Conclusion from the review of the
evidence: homeopathic remedies are widely available over-the-counter
in pharmacies and health food shops throughout the UK. The mechanism
of action of these remedies is not clear. There is no evident
safety risk with the use of these remedies, and interactions with
other drugs are unlikely. Even though isolated reports have suggested
positive effects of homeopathy in the treatment of fibromyalgia,
evidence is still not conclusive. Trials which investigated the
role of these remedies in osteoarthritis and rheumatoid arthritis
yielded inconsistent results.
2.6 Relationship to Conventional Medicine:
The Arthritis Research Campaign review also made clear that the
effectiveness of homeopathic and other complementary medicines
needs to be evaluated in part against that of conventional remedies
for the same condition. Furthermore, as many patients take both
kinds of treatment there is a need to consider interactions both
in terms of effectiveness and safety.
3.1 That the Committee welcomes an evidence-based
approach to homeopathy, (as well as other non conventional therapies
available over the counter), that can be communicated directly
with lay audiences, and that the Committee actively encourages
further evidence-based assessments of homeopathic remedies in
arthritis as well as other diseases, so that more information
is available to assess any real benefits from homeopathy. This
is particularly important in chronic, progressive diseases.
3.2 That the Committee considers the straightforward
1-5 categorisation process for efficacy and the traffic light
system for safety used in the Arthritis Research Campaign's review
described above, for all areas of homeopathy, so that patients
can make better informed decisions.
3.3 That the Committee agrees that the efficacy
and safety of homeopathic and other complementary medicines available
over the counter need be evaluated against the conventional remedies
for the same condition as well as potential interactions of other
remedies that could be taken at the same time.
Please find attached a pdf of the report, Complementary
and alternative medicines for the treatment of Rheumatoid Arthritis,
Osteoarthritis and Fibromyalgia, 2009. The report was written
national experts in conjunction with the Arthritis Research Campaign.
1. Peat G, Duncan R, Thomas E. Data from CAS-K
study. Personal communication 2008
2. Health and Safety Executive. Estimated days
(full-day equivalent) off work and associated average days lost
per (fulltime equivalent) worker and per case due to a self-reported
work-related illness or workplace injury. http://www.hse.gov.uk/statistics/tables/0607/swit1.htm
[Date accessed: 13-5-2008]
3. Health and Safety Executive. Musculoskeletal
disordersWhy tackle them?
[Date accessed: 1-7-2008].
4. Department for work and pensions. Disability
Living Allowancecases in payment Caseload (Thousands):
Main Disabling Condition by Gender of claimant.
ccsex_nov07.html [Date accessed: 1-5-2008].
5. Arthritis Research Campaign website (accessed
6. Thomas K J, Coleman P. Use of complementary
or alternative medicine in a general population in Great Britain.
Results from the National Omnibus Survey. J Public Health 2004;26:152-7
7. Complementary and alternative medicines for
the treatment of Rheumatoid Arthritis, Osteoarthritis and Fibromyalgia,
37 Disability Living Allowance (DLA) is a benefit for
people who are so disabled, they have personal care needs, mobility
needs or both. Claimants must be under 65. Back