Most of Dr. Randy Horwitz’s patients come to him after their rheumatologists have prescribed medications or biologics. “Typically, they’ll ask their physicians, ‘What can I be doing to help with my condition?’ said Dr. Horwitz, medical director of the Arizona Center for Integrative Medicine and a University of Arizona College of Medicine associate professor.

The doctors generally tell his patients that they needn’t take anything else beyond the medications. “My take-home message would be that there is much that patients can do to help improve their own health,” Dr. Horwitz said. “As a foundation, a good diet and exercise program is essential. Weight control and physical activity provide more benefits than most people realize.”

And, as Dr. Horwitz explained in the two-hour workshop titled “Complementary and Alternative Therapies in Rheumatic Disease,” which he led with Nisha Manek at the 2016 ACR Annual Meeting in Washington, D.C., there are a variety of “integrative” medical approaches that can also be beneficial to patients.

Early on, Dr. Horwitz defined “integrative medicine” as “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.” Although it overlaps with complementary and alternative medicine, integrative medicine is distinct from CAM.

Dr. Horwitz discussed anti-inflammatory herbs and botanicals that can be helpful to patients with rheumatic diseases. In particular, he singled out fish oil and turmeric, the spice that lends mustard its yellow color and one of the most potent natural anti-inflammatories. For those taking fish oil, he advised freezing the capsules to prevent “fish burp.” Fish oil, he said, has been shown in 13 randomized and controlled studies, to improve some clinical symptoms.

“These are compounds that we use extensively in our clinic,” he said of turmeric and fish oil. “Patients can speak with their healthcare providers regarding the safety and effectiveness of these compounds in their particular cases.”

Mind-body therapies, he added, can also be an immense help.

“While mind-body interventions cannot typically change pain or painful stimuli, they can effectively alter the threshold for pain and reduce the patient’s focus on pain,” Dr. Horwitz said.

In the workshop, Dr. Horwitz cited a colleague’s notion of a sliding scale of evidence for the kinds of interventions he was discussing. “The greater the potential a treatment has to cause harm, the stricter the standards of evidence it should be held to, in terms of efficacy,” he said.

About some of the treatments, though, there isn’t much if any good data. There are few controlled studies about chiropractic manipulation, he said, and limited data in peer-reviewed journals. And physical therapy was shown in one study to be no more effective than a sham therapy when it came to reducing the pain of and improving function in those with hip osteoarthritis, he said.