Homeopathy for Rheumatological Diseases: A Systematic Review

Abstract

Homeopathy has mainly been used to treat several diseases. On the other hand, it has been used in a few rheumatic disorders. The aim of this article is to review the use of homeopathy in rheumatic diseases (RDs). PubMed and Embase databases were examined for literature on homeopathy and RDs between 1966 and April 2023. There are 15 articles found with 811 patients. The diseases treated were osteoarthritis (n = 3), followed by rheumatoid arthritis (n = 3), ankylosing spondylitis (n = 1), hyperuricemia (n = 1), and tendinopathy (n = 1). Age varied from 31 to 87 years old, and male gender ranged from 56.7% to 100%. Homeopathy changed from a fixed medicine to an individualized homeopathy. Most studies (9/15) demonstrated improvements after homeopathy. Side effects were not seen or minimal and were comparable to placebo groups. In conclusion, this review shows homeopathy is a promising and safe therapy for RD treatment. However, the data needs to be reproduced in future more extensive studies, including other rheumatic conditions.

Introduction

In the second part of the eighteenth century, the German physician Samuel Christian Hahnemann (1755-1843) invented homeopathy. Although homeopathy has experienced fluctuations in popularity over the past 2 centuries, its usage has increased in recent years because of the worldwide interest in alternative and complementary medicine.¹ Recent research highlights the prevalence of homeopathy usage during a 12-month period in 11 nations (Australia, UK, Japan, USA, Israel, Singapore, Switzerland, Canada, Norway, South Korea, and Germany). The authors noted that a tiny but significant percentage of these general populations utilize homeopathy annually, including the use of over-the-counter homeopathic medications and homeopathy consultations.²

The rheumatic diseases (RDs) field is also a reality. Studies demonstrated that many patients utilize complementary and alternative medicine (CAM), such as homeopathy. For example, a large study using a questionnaire with 800 RD patients used homeopathy for 15% of these patients.³ It is, therefore, reasonable to evaluate the use of homeopathy in people with RD.

The aim of this investigation was to systematically review the articles that used homeopathy to treat RDs.

Methods

Literature review: The following MeSH entry phrases were used to conduct a systematic search of papers published in Scielo, EMBASE, and PubMed/MEDLINE between 1966 and August 2022: “homeopathy” OR “homeopathic” AND “rheumatic” OR “rheumatologic” OR “systemic lupus erythematosus” OR “lupus” OR “fibromyalgia” OR “rheumatoid arthritis” OR “spondyloarthritis” OR “Sjögren’s syndrome” OR “myositis” OR “systemic sclerosis” OR “vasculitis” OR “Takayasu disease” OR “Wegener’s disease” OR “granulomatosis with polyangiitis” OR “Kawasaki’s disease” OR “polyarteritis nodosa” OR “Livedoid vasculitis” OR “Churg-Strauss” OR “eosinophilic granulomatosis with polyangiitis” OR “osteoarthritis” OR “gout.” The search collected only articles in the English language. To find further papers, the reference lists of the chosen papers were examined. Inclusion criteria were all articles with patients with RDs who received homeopathy as therapy. Exclusion criteria were in vitro and animal studies and review articles.

The initial literature search was carried out by the first and second authors, who both independently chose the research abstracts. The full-text publications chosen by abstracts were then independently reviewed by the same reviewers in a second step. Again, the authors adhered to PRISMA standards.⁴ Lastly, a standardized form was created to capture data from pertinent studies, including the year of publication, authors’ names, the number of investigated patients, demographic information, the length of the illness, study follow-up, homeopathy description, outcomes, and side effects. See an AMSTAR results as appendix 1.

Results

Figure 1 shows the PRISMA flowchart of the articles included in this manuscript.

Figure 1.

The rheumatological diseases where homeopathy was helpful and its various beneficial effects. Those various conditions and their beneficial effects are summarized.

Table 1 summarizes the search results on homeopathy treatment in RD.^5-19 There are 15 articles in this field, including 1459 patients. The countries that produced these articles were the UK (n = 6), followed by Germany (n = 2), India (n = 2), Scotland (n = 2), Brazil (n = 1), Poland (n = 1), Scotland (n = 1), and the United States (n = 1). Most studies had a double-blinded randomized controlled design trial as the study design (n = 7), followed by double-blinded (n = 1), open prospective trial (n = 3), randomized controlled trial (n = 2), double-blinded (n = 1) and randomized cross-over trial (n = 1). The diseases treated were rheumatoid arthritis (n = 5), followed by osteoarthritis (n = 4), fibromyalgia (n = 3), ankylosing spondylitis (n = 1), hyperuricemia (n = 1) and tendinopathy (n= 1). Age varied from 18 to 87 years old, and female gender ranged from 0 to 95.7%. Disease duration ranged from weeks to 25 years. The study follow-up ranged from 4 to 48 weeks. Homeopathy varied from a fixed medicine such as Traumeel, composed of several substances, as an individualized homeopathy (see Table 1).

Table 1.

Studies of Homeopathy in Rheumatic Diseases

Author, Reference	Study Design	Country	Disease	N	Age % F/M	Disease Duration	Follow-up	Homeopathy Regimen
								Outcome
								Side Effects
Brien et al., 20115	Double-blind, randomized, placebo-controlled trial	United Kingdom	RA	83	63.3 65% F	10.99 years	24 weeks	Regimen:
								Outcome: A homeopathic consultation significantly improved DAS-28, swollen joint count, current pain, weekly pain, weekly patient global assessment, and negative mood. But the homeopathic remedy is the same
								Side effects No significant differences were identified between groups. Four serious adverse events were reported, all unrelated to the study medication.
Fisher et al., 20016	Double-blind randomized controlled	United Kingdom	RA	112	54 79% F	9 years	24 weeks	Regimen: NSAIDS + individualized prescription vs. NSAIDS+ placebo
								Outcome: No effect of homeopathy over the placebo
								Side effects ND
Andrade et al., 19917	Randomized, double-blinded controlled trial	Brazil	RA	44	52.8 87% F	8.8 years	24 weeks	Regimen : Rhus toxicodendron, Calcarea carbônica, Pulsatilla nigricans, L ycopodium clavatum, Causticum Lachesis trigonocephalum, Arsenic album, Nux vomica, Hydrastis canadenses, Argentum nitricum, Ignatia amara, Thuja occidentalis, Apis mellifica, Sepia succus, Natrum muriaticum, Ledum palustre, Staphisagria, Calcarea phosphorica, Medorrhinum, Sulphur
								Outcome: Homeopathy improved in 59% vs. 44% placebo. It was unchanged in 23% vs. 31% in homeopathic vs. placebo, respectively.
								Side effects were scarce and comparable in both groups: headache, heartburn, anorexia, and dizziness.
Gibson et al., 19808	Double-blind trial	Scotland	RA	23	54 (32-76) 69.6% F	7.2 (1-25) years	12 weeks	Regimen : Arnica, Nux vômica, A. album, Opium, B. alba, Pulsatilla, C. carbonica, Rhododendron, Causticum, R. toxicodendron, Ignatia, Ruta, Lachesis, Sepia, Lycopodium, Sulphu, Morgan, Sycotic co, N. muriaticum, Thuja
								Outcome : After homeopathy, there was an improvement: Subjective pain Articular index Stiffness Grip strength
								Side effects None
Gibson et al., 19789	Double-blind randomized controlled	Scotland	RA	195	49.7 + 11.6 79.6% F	8.8 years	48 weeks	Regimen : Individualized prescription vs. salicylate and placebo
								Outcome : Better relief in the homeopathic group compared to the allopathic and placebo. High incidence of drop-out.
								Side effects None
Janczewska et al., 202310	Prospective controlled trial	Poland	OA	90	31-87 70% F	ND	ND	Regimen : Traumeel* ointment compared to magnetic stimulation plus light radiation (LED)
								Outcome : Traumeel* ointment, compared to magnetic stimulation plus LED, was better.
								Side effects ND
Koley et al., 201511	Prospective, placebo-controlled randomized, double-blind, parallel-arm,	India	OA	60	56.4 ± 12.1 83% F	ND	12 weeks	Regimen : Bryonia alba, Rhus toxicodendron, Calcarea carbônica, Arnica montana and Natrum muriaticum
								Outcome : Over the course of two weeks, both groups saw statistically significant reductions in 3 visual analog scales (measuring pain, stiffness, and loss of function) and Osteoarthritis Research Society International ratings. However, there were no significant differences across groups.
								Side effects None
Van Haselen et al., 200012	Randomized controlled trial	United Kingdom	OA	172	65.3 ± 8.8 77% F	5 (1.9-12.5) years	4 weeks	Regimen : Local application of a homeopathic gel vs. piroxicam gel
								Outcome : Equivalence of homeopathic and allopathic gel
								Side effects In 28 patients: 12 in homeopathy (5 withdrawn) and 16 in piroxicam (9 withdrawn).
Shipley et al., 198313	Double-blind randomized controlled	United Kingdom	OA	36	18-85 ND	ND	6 weeks	Regimen : Rhus Toxicodendron 6x vs. placebo and fenoprofen
								Outcome : No effect of homeopathy vs. placebo; fenoprofen is better than homeopathy vs. placebo
								Side effects ND
Relton et al., 200914	Non-blinded randomized (open) controlled;	United Kingdom	FM	47	43.9 ± 8.9 95.7% F	6.3 ± 5.1 years	22 weeks	Regimen : Individualized homeopathy vs. placebo
								Outcome : Better reduction of symptoms in patients treated with homeopathy vs. control; no adverse effects
								Side effects None
Bell et al., 200415	Double-blind randomized controlled	United States	FM	62	49 ± 10 94% F	14.8 ± 14 years	16 weeks	Regimen: Individualized homeopathy vs. placebo
								Outcome: Significantly better outcomes of the homeopathy group vs. the placebo
								Side effects ND
Fisher et al., 198916	Double-blind randomized controlled cross-over	United Kingdom	FM	24	ND	ND	ND	Regimen : Arnica, Rhus tox, Bryonia 6c vs. placebo
								Outcome : Trend to a better improvement in the homeopathic group, not statistically significant
								Side effects ND
Nayak et al., 202017	Open randomized trial	India	Hyperuricemia	50	45.7 y 43.3% F	15 months	24 weeks	Regimen: Urtica urens mother tincture (UUMT), Individualized homeopathy (IH), and combined (UUMT +IH), together with lifestyle changes
								Outcome: At 3 months, reduction in serum uric acid was higher in UUMT, although at 6 months, it lost this statistical difference. No difference in Gout Assessment Questionnaire version 2 in the 3 groups. Few differences were seen in MYMOP scores at 3 months preferring IH (symptom 2, P = .001 and well-being score, P = .002), and also at 6 months preferring UUMT + IH over others (symptom 1, P < .001).
								Side effects None
Schneider et a. 200518	Nonrandomized, controlled study	Germany	Tendinopathy	357	47.8 51.6% M	Weeks to months	4 weeks	Regimen: Traumeel S ointment* compared to gel diclofenac
								Outcome : Homeopathic therapy was non-inferior to diclofenac on all variables (all pain-related variables, motility-related variables, and summary scores for all clinical variables).
								Side effects None
Schirmer et al., 200019	Prospective double-blind, randomized trial	Germany	AS	104	47.04 ± 8.94 100% M	17.5 years	24 weeks	Regimen : Formica rufa D6 and reinjection of the patient’s blood
								Outcome : No significant differences were seen
								Side effects ND

AS, ankylosing spondylitis; MYMOP2, Measure Yourself Medical Outcome Profile version 2.; ND, not described; OA, osteoarthritis; RA, rheumatoid arthritis.

*Traumeel composition: Arnica montana D3, Calendula officinalis, Achillea millefolium, Chamomilla recutita, Symphytum officinale D4, Atropa belladonna D1, Aconitum napellus D1, Bellis perennis, Hypericum perforatum, Echinacea angustifolia, Echinacea purpurea, Hamamelis irginica, Mercurius solubilis D6, and Hepar sulfuris D6.

Most studies (9/15) demonstrated improvements after homeopathy,^{7-11,14,15,17,18} 5/15 articles did not show any significant difference;^{6,12,13,16,19} and one showed that the homeopathic consultation was therapeutical and beneficial but not related to the homeopathic preparation.⁵

Side effects were not seen in 6/15 studies and not described in 6/15; they were mild and similar to the control group.

Discussion

This is the first study to review the therapeutic effects of homeopathy in RDs systematically.

Homeopathy has 2 central tenets: the “similars” principle and the dilutions.¹ According to the similars principle, a medicine that causes the same symptoms and signs in a healthy person can be administered to a patient who has a certain pattern of symptoms in order to cure them. As a result of this idea, therapy in homeopathic medicine is individualized. Depending on the distinct pattern of sickness symptoms in each individual, various drugs may be administered to 2 or more people with the same clinical diagnosis. The second homeopathic principle is that if remedies are diluted, shaken or agitated, between successive dilutions, they maintain biological activity. These serially agitated dilutions are reported to generate effects even after being diluted beyond the number of Avogadro and leaving no original molecules of the beginning substance.¹ This principle has frequently caused scientists to dismiss homeopathy without considering the evidence for its effectiveness in clinical studies. Most physicians and patients, on the other hand, are more concerned with whether there is clinical proof supporting homeopathic therapy of specific ailments and are less interested in the processes. As a result, the authors decided to use systematic review methods to examine controlled clinical evidence on homeopathy in rheumatic illnesses.

Homotoxicology was developed by the German physician Hans Reckeweg and is strongly influenced by homoeopathy.^{20 ,},²¹ In a recent review, the author reviewed the randomized trials in this field. They included 7 articles in their review and found that quality Jadad scores were regarding study methodologies, and the outcomes were positive in most studies.^20,21 Despite a rising interest in understanding the underlying mechanisms of RDs and arthritis, medical treatment for these conditions remains symptomatic. In addition, current medical therapies may not always stop the long-term development of these disorders, and surgery may still be required for restoring mechanical function in big joints. As a result, individuals suffering from RDs frequently look for alternative therapy, with homeopathy, along with acupuncture, being among the most prominent. On the basis of self-reported efficacy, homeopathy scored higher for osteoarthritis, but satisfaction was lower for connective tissue diseases and rheumatoid arthritis. Case histories and retrospective studies indicate that homeopathic therapies for ankylosing spondylitis, rheumatoid arthritis, and osteoarthritis can result in clinical improvement or recovery, as shown in the present review.

This systematic review showed that most studies that evaluated homeopathy in RD showed at least 1 benefit, with mild or absent adverse effects. Those various conditions and their beneficial effects are summarized in Figure 2.

Figure 2.

Summary the positive impacts of homeopathy on various rheumatic diseases. A detailed insights into various homeopathic remedies and their positive impacts on different rheumatic conditions. It compiles evidence from numerous studies, most of which have reported at least 1 beneficial effect for each condition treated with homeopathy, typically with minimal or no side effects.

This study’s strengths are (1) the inclusion of studies with patients with international criteria for RDs and (2) the inclusion of all kinds of study designs for using homeopathy in RDs, except reviews, animal studies, and in vitro studies. In this way, the authors believe all published homeopathy cases in rheumatic patients were collected.

Some limitations were observed in this study. For instance, the number of participants was low. Second, a few RDs were evaluated: osteoarthritis, rheumatoid arthritis, fibromyalgia, hyperuricemia, ankylosing spondylitis, and tendinopathy. Therefore, future investigations must involve bigger patient samples and other RDs, enabling a better understanding of the course of homeopathy in rheumatic conditions. No assessment on bias risk and meta-analysis was performed since there are several different RDs included herein in this analysis.

A few articles in the literature evaluate the effects of homeopathy in rheumatological diseases, and 6 RD were assessed. Nevertheless, most reports analyzed studies demonstrated that homeopathy use is efficacious in treating signs and symptoms of RD with no or minimal adverse events. However, more studies are waiting to confirm the present data.

AMSTAR 2 Results
Printer Friendly Version
Article Name: HOMEOPATHY FOR RHEUMATOLOGICAL DISEASES: A SYSTEMATIC REVIEW
You are currently logged on as Guest. You need to be logged on as a member to submit your score.Log On HOMEOPATHY FOR RHEUMATOLOGICAL DISEASES: A SYSTEMATIC REVIEW is a Critially Low quality review
1. Did the research questions and inclusion criteria for the review include the components of PICO?	NoYesYesYes
2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?	YesYesYes
3. Did the review authors explain their selection of the study designs for inclusion in the review?	No
4. Did the review authors use a comprehensive literature search strategy?	YesYesYes
5. Did the review authors perform study selection in duplicate?	YesYes
6. Did the review authors perform data extraction in duplicate?	YesYes
7. Did the review authors provide a list of excluded studies and justify the exclusions?	Partial YesYes
8. Did the review authors describe the included studies in adequate detail?	Partial YesYesYesYes
9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
RCT	No
NRSI	No
10. Did the review authors report on the sources of funding for the studies included in the review?	No
11. If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
RCT	0
NRSI	0
12. If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?	0
13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?	No
14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?	No
15. If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?	0
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?	YesYes
To cite this tool: Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017 Sep 21;358:j4008.

Funding Statement

The authors declare that this study received no financial support.