According to Neha Shah, MD, to achieve the best patient outcomes, “every rheumatologist can and should try to be an integrative and complementary rheumatologist.” In this video, Dr Shah explains the benefits you may see by integrating complementary medicine and herbs into the management of your patients with rheumatic diseases. It was a topic she presented about during ACR Convergence.

Video Transcript:

Neha Shah:  Hello. I’m Neha Shah from Stanford University. I’m an assistant professor in rheumatology and immunology, as well as the Rheumatology Fellowship Program director.

At the ACR, I gave a talk focusing on complementary medicine and herbs. The focus of this talk was some basic take-home points that the practicing rheumatologist could take back to their practice Monday morning.

The first point was that complementary medicine is something that patients are looking for and many are using right now, with or without the advice of the rheumatologist. Becoming familiar with some of the complementary modalities out there, herbal and botanical medicine, Ayurveda, traditional Chinese medicine, acupuncture is certainly helpful. That doesn’t necessarily mean one needs to go out and become certified in acupuncture or become a yoga instructor, but to be familiar with these modalities, and the safety, and their use in our patient population.

Complementary medicine can be used to align both physician and patient goals. It gives a sense of power and control back to patients, when often this is something they feel they have lost when they’ve been given their rheumatic diagnosis.

For the average rheumatologist, an easy way to focus on complementary medicine is to really think of it as a lifestyle change or lifestyle medicine, focusing on sleep quality and quantity, food and diet, stress levels, toxins like tobacco and alcohol, relationships — if patients have supportive people in their lives — as well as exercise.

The amount of data in these particular areas is growing in rheumatology. We also already have data for heart disease, strokes, diabetes, obesity, all of the comorbidities that affect our patient population.

Initiating lifestyle medicine in our practices should certainly be something that shouldn’t seem out of the box or shouldn’t seem like it doesn’t have enough evidence backing it.

The last point I wanted to make was the use of herbs and botanicals.

From the Ayurvedic tradition, turmeric and ginger are two of the most common herbs that are used to help treat inflammation. These herbs and spices work through various different mechanisms that have been elucidated both in animal and human studies. They can be incorporated into a patient’s diet.

Certainly, there are some contraindications. The Natural Medicines database is a great resource for physicians to use to make sure that, if their patients come to them and want to use certain herbal supplements, that there aren’t any specific contraindications such as bleeding risk or liver disease.

My take-home is that every rheumatologist can and should try to be an integrative and complementary rheumatologist. This is how we will get the best outcomes for our patients.

Neha Shah, MD, is a clinical assistant professor in the Division of Immunology & Rheumatology at Stanford University. There, she also serves as the program director for the Adult Rheumatology Fellowship.

Additional Resources:

1. Shah N. Complementary medicine & herbs for the rheumatology patient. Session presented at: American College of Rheumatology Convergence 2020; November 5-9, 2020; Virtual. 
2. Natural Medicines. TRC. Accessed November 17, 2020. https://naturalmedicines.therapeuticresearch.com/