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Wang Z, Jones G, Blizzard L, Aitken D, Zhou Z, Wang M, Balogun S, Cicuttini F, Antony B. Prevalence and correlates of the use of complementary and alternative medicines among older adults with joint pain. Int J Rheum Dis 2023; 26:1760-1769. [PMID: 37431712 DOI: 10.1111/1756-185x.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional medicines in osteoarthritis (OA) patients. OBJECTIVES This study aimed to describe the prevalence and correlates of the use of CAMs among community-dwelling older adults. METHODS Data from the Tasmania Older Adult Cohort Study (TASOAC, n = 1099) were used to describe the prevalence of CAM use. Correlates of CAM use were assessed by comparing CAM users and non-users. To further assess correlates of CAM use, participants with at least one joint with pain were classified into four categories: CAM-only, analgesics-only, co-therapy, and "neither CAMs nor analgesics" (NCNA). RESULTS In all, 385 (35.0%) of our participants reported use of CAMs, among which vitamins/minerals were used most (22.6%, n = 232). Compared with CAM non-users, CAM users were more likely to be female, were less likely to be overweight, were better educated, had more joints with OA, had fewer WOMAC scores, and did more steps per day. Among participants with any joint pain, the CAM-only group were less likely to be overweight, consumed more alcohol, had higher quality of life, had more steps per day, and had fewer pain-related symptoms compared with the analgesic-only group. CONCLUSION Complementary and alternative medicines were commonly used among Tasmanian older adults, with 35% of the population using CAMs either alone or in combination with conventional analgesics. CAM users were more likely to be female, be better educated, have more joints with OA, and had healthier lifestyles, including lower body mass index and higher number of steps per day.
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Affiliation(s)
- Zhiqiang Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mengmeng Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Almalag HM, Almuhareb AM, Alsharafi AA, Alhawassi TM, Alghamdi AA, Alarfaj H, Omair MA, Alomari BA, Alblowi MS, Abouzaid HH, Alarfaj AS. Relationship between different anti-rheumatic drug therapies and complementary and alternative medicine in patients with rheumatoid arthritis: an interview based cross-sectional study. Saudi Pharm J 2021; 29:462-466. [PMID: 34135672 PMCID: PMC8180625 DOI: 10.1016/j.jsps.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives The use of complementary and alternative medicine (CAM) by patients with rheumatoid arthritis (RA) is highly prevalent. The relationship of these remedies with disease therapy are not fully studied. We aimed to explore the relationship between different anti-rheumatic drug therapy and CAM use in RA patients. Methods The study used an interview-based cross-sectional survey in two major referral centres in Riyadh, Saudi Arabia. Patients were adults with confirmed RA that attended rheumatology clinics. Information on the utilization of CAM, RA duration, drug therapy, and laboratory parameters were obtained. Descriptive statistics as well as adjusted odds ratio using bivariate logistic regression were used to explore the different factors related to CAM use, including drug therapy. Results A total of 438 adult patients with RA were included. The mean (±SD) age of the patients was 49 (±15.0) years. The majority were women 393 (89.7%). Two hundred and ninety-two patients (66.7%) had used CAM. The CAM users who had a longer disease duration (AOR 1.041 [95% CI: 1.011, 1.073]; p = 0.008) were more likely to be female (AOR 2.068 [95% CI: 1.098, 3.896]; p = 0.024), and use methotrexate (AOR 1.918 [95% CI: 1.249, 2.946]; p = 0.003) as opposed to celecoxib (AOR 0.509 [95% CI: 0.307, 0.844]; p = 0.009) and biologic monotherapy (AOR 0.443 [95% CI: 0.224, 0.876]; p = 0.019). Other factors related to CAM were meloxicam use (AOR 2.342 [95% CI: 1.341, 4.089]; p = 0.003) and traditional therapy (AOR 2.989 [95% CI: 1.647, 5.425]; p = 0.000). The remaining factors were not significant. Conclusion CAM use is prevalent in patients with RA. Understanding patients and disease related factors associated with higher use of CAM is warranted to improve RA management and provide more rational use of these remedies.
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Affiliation(s)
- Haya M Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aseel M Almuhareb
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aya A Alsharafi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy and Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed A Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hussain Alarfaj
- Rheumatology Unit, Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed A Omair
- Rheumatology Unit, Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Bedor A Alomari
- Rheumatology Clinical Pharmacist, Department of Pharmaceutical Service, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maysoon S Alblowi
- Rheumatology Unit, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hanan H Abouzaid
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdurhman S Alarfaj
- Rheumatology Unit, Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
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Scott R, Nahin RL, Weber W. Longitudinal Analysis of Complementary Health Approaches in Adults Aged 25-74 Years from the Midlife in the U.S. Survey Sample. J Altern Complement Med 2021; 27:550-568. [PMID: 33877882 DOI: 10.1089/acm.2020.0414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Complementary health approaches include herbal products and mind-body practices. Several studies have identified predictors for complementary health approach use, yet there are two gaps: (1) How does use change? (2) Do factors associated with use influence this change over time? Using the Midlife in the United States (MIDUS), we examined how sociodemographic factors affected use longitudinally, and whether these associations differed between new and continued/discontinued use of herbal products, meditation, chiropractic, and massage therapy. Design: MIDUS is a national probability sample of adults aged 25 or older that has collected more than 20 years of longitudinal data, including the use of complementary health approaches. We employed the Andersen Model as a framework to identify predisposing, enabling, and health need factors associated with complementary health approach use based on previously identified and hypothesized factors. We ran Chi-square analyses to first test bivariate associations between our independent variables and four modalities to further guide logistic regression models. Results: Each of the four approaches examined saw substantial increases in prevalent use. However, only about 25% to 38% of individuals continued use from one wave to the next, whereas only 2%-9% of individuals who did not use a given approach in a wave reported use in the subsequent wave. Age, spiritual importance, and previous wave one use were all significantly associated with new use across all four modalities. Previous wave one use was associated with continued/discontinued use for all modalities. Age and education were significantly associated with discontinued use of chiropractic. Conclusion: We present the first longitudinal analysis of complementary health approaches in a nationally representative sample. These data distinguish between new and continued/discontinued use of complementary health approaches over time and provide insights into the interpretation of complementary health approach prevalence data, as well as important predictors of use.
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Affiliation(s)
- Remle Scott
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Richard L Nahin
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Wendy Weber
- Clinical Research in Complementary and Integrative Health Branch, National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
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The Reason of Discontinuation of Inflammatory Romatism Patients and Evaluation of the Application Method for Non-Drug Treatment. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.671529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Corp N, Jordan JL, Croft PR. Justifications for using complementary and alternative medicine reported by persons with musculoskeletal conditions: A narrative literature synthesis. PLoS One 2018; 13:e0200879. [PMID: 30024952 PMCID: PMC6053199 DOI: 10.1371/journal.pone.0200879] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is very popular with patients frequently combining it with orthodox health care. The high prevalence of CAM use and satisfaction with CAM reported by patients directly challenges an orthodox system that can only approve such use if it results from the application of biomedical concepts and science. Studies highlighting this as a cultural, sociological and historical phenomenon emphasise the value of choice for consumers of health care. Musculoskeletal conditions typify common problems for which the effectiveness of orthodox care is often unclear. We postulated that the reasons people give for using or not using CAM for musculoskeletal conditions, would therefore indicate the full range of expectations that people have of health care. Furthermore, these reasons would indicate how much people feel orthodox health care is or is not meeting their expectations. Therefore, this study aims to investigate people's reasons for choosing or avoiding CAM for non-traumatic musculoskeletal conditions. METHODS A systematic search and narrative synthesis was conducted of published qualitative and quantitative studies related to CAM and non-traumatic musculoskeletal conditions. RESULTS We identified 169 relevant papers detailing 152 separate studies, from which 1486 justifications were extracted concerning CAM use. Content analysis resulted in 11 distinct categories across four themes: practical aspects of care, clinical effectiveness, non-clinical outcomes of care, and a person's philosophy of illness and care. People provided similar rationales for both using and avoiding CAM, emphasising that, whilst CAM is perceived by many patients with musculoskeletal conditions to fill gaps in care (such as practitioner time or quality of the therapeutic relationship), orthodox care also seeks to deliver these aspects of care. However, people who used CAM also highlighted its alignment with their general philosophy and ideas about illness and health care, and often emphasised CAM's capacity to give them control over their condition and its treatment. CONCLUSION Currently, CAM appears to have a significant role for patients with common painful long-term conditions in providing choices to enable individual needs to be met.
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Affiliation(s)
- Nadia Corp
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Peter R. Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
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Nik Shafii NAH, Yaacob LH, Ishak A, Kadir AA. Traditional and Complementary Medicine Use in Knee Osteoarthritis and its Associated Factors Among Patients in Northeast Peninsular Malaysia. Oman Med J 2018; 33:148-153. [PMID: 29657684 DOI: 10.5001/omj.2018.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to determine the prevalence of traditional and complementary medicine (TCM) use for knee osteoarthritis and its associated factors among patients attending a referral hospital in an eastern coastal state of Malaysia. Methods This cross-sectional study included 214 patients with knee osteoarthritis. A universal sampling method was applied to patients who attended the outpatient clinic in Hospital Universiti Sains Malaysia from May 2013 to October 2013. Participants were given a questionnaire to determine their sociodemographic information and a validated Bahasa Malaysia version of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). This questionnaire was used to assess the severity of knee osteoarthritis (i.e., pain, stiffness, and disturbances in daily activity). Results Over half (57.9%) of patients reported using TCM to treat knee osteoarthritis. Factors associated with TCM use were gender (odd ratio (OR) = 2.47; 95% confidence interval (CI): 1.28-4.77), duration of knee osteoarthritis (OR = 1.51; 95% CI: 1.03-2.23), and the severity of knee pain (OR = 2.56; 95% CI: 1.71-3.86). Conclusions The prevalence of TCM use among eastern Malaysian patients with knee osteoarthritis was high. Physicians caring for these patients should be aware of these findings so that inquiries regarding TCM use can be made and patients can be appropriately counseled.
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Affiliation(s)
- Nik Abdul Hafiz Nik Shafii
- Department of Family Medicine, School of Medical Sciences, Health Campus Universiti Sains Malaysia, Kubang Kerian Kelantan, Malaysia
| | - Lili Husniati Yaacob
- Department of Family Medicine, School of Medical Sciences, Health Campus Universiti Sains Malaysia, Kubang Kerian Kelantan, Malaysia
| | - Azlina Ishak
- Department of Family Medicine, School of Medical Sciences, Health Campus Universiti Sains Malaysia, Kubang Kerian Kelantan, Malaysia
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Health Campus Universiti Sains Malaysia, Kubang Kerian Kelantan, Malaysia
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Hamre HJ, Pham VN, Kern C, Rau R, Klasen J, Schendel U, Gerlach L, Drabik A, Simon L. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs versus conventional therapy including DMARDs for patients without preference. Patient Prefer Adherence 2018; 12:375-397. [PMID: 29588576 PMCID: PMC5859899 DOI: 10.2147/ppa.s145221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND While disease-modifying antirheumatic drugs (DMARDs) are a mainstay of therapy for rheumatoid arthritis (RA), some patients with early RA refuse DMARDs. In anthroposophic medicine (AM), a treatment strategy for early RA without DMARDs has been developed. Preliminary data suggest that RA symptoms and inflammatory markers can be reduced under AM, without DMARDs. PATIENTS AND METHODS Two hundred and fifty-one self-selected patients aged 16-70 years, starting treatment for RA of <3 years duration, without prior DMARD therapy, participated in a prospective, non-randomized, comparative Phase IV study. C-patients were treated in clinics offering conventional therapy including DMARDs, while A-patients had chosen treatment in anthroposophic clinics, without DMARDs. Both groups received corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Primary outcomes were intensity of RA symptoms measured by self-rating on visual analog scales, C-reactive protein, radiological progression, study withdrawals, serious adverse events (SAE), and adverse drug reactions in months 0-48. RESULTS The groups were similar in most baseline characteristics, while A-patients had longer disease duration (mean 15.1 vs 10.8 months, p<0.0001), slightly more bone destruction, and a much higher proportion of women (94.6% vs 69.7%, p<0.0001). In months 0-12, corticosteroids were used by 45.7% and 81.6% (p<0.0001) and NSAIDs by 52.8% and 68.5% (p=0.0191) of A- and C-patients, respectively. During follow-up, both groups not only had marked reduction of RA symptoms and C-reactive protein, but also some radiological disease progression. Also, 6.2% of A-patients needed DMARDs. Apart from adverse drug reactions (50.4% and 69.7% of A- and C-patients, respectively, p=0.0020), none of the primary outcomes showed any significant between-group difference. CONCLUSION Study results suggest that for most patients preferring anthroposophic treatment, satisfactory results can be achieved without use of DMARDs and with less use of corticosteroids and NSAIDs than in conventional care. LIMITATION Because of the non-randomized study design, with A-patients choosing anthroposophic treatment, one cannot infer how this treatment would have worked for C-patients.
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Affiliation(s)
- Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany
- Correspondence: Harald J Hamre, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg, Germany, Tel +49 761 1560 307, Fax +49 761 6125 6125, Email
| | - Van N Pham
- Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Christian Kern
- Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany
| | - Rolf Rau
- Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Ratingen, Germany
| | - Jörn Klasen
- Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany
| | - Ute Schendel
- Department of Rheumatology, m&i-Fachklinik Bad Pyrmont, Bad Pyrmont, Germany
| | - Lars Gerlach
- Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany
| | - Attyla Drabik
- Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ludger Simon
- Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany
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Schlaeger JM, Roach K, Golas M, Takayama M, Wilkie DJ. Treatment-Seeking Behaviors of Persons With Rheumatoid Arthritis. J Holist Nurs 2017; 36:179-191. [PMID: 28506103 DOI: 10.1177/0898010117693539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Describe perceptions of patients with rheumatoid arthritis (RA) regarding disease-related pain, tendency to tell others about their pain, and treatments used since diagnosis. DESIGN Cross sectional, exploratory. METHOD A total of 63 participants responded to telephone interview about their treatments and tendency to tell others about their RA pain. They also responded to McGill Pain Questionnaire and Health Assessment Questionnaire (HAQ) items. Participants marked pain location on mailed body outlines. FINDINGS RA diagnosis occurred an average of 11 years prior. Mean HAQ Standard Disability Index score was 1.26. Previous week symptoms were joint pain (97%), joint swelling (83%), decreased movement/function (83%), fatigue (70%), muscle weakness (65%). Mean morning stiffness duration was 120 ± 137 minutes. Mean pain intensity was 1.15 ± 0.6 at its least and 3.8 ± 1.1 at its worst. 65% were not satisfied with pain levels. 57% stated a tendency not to tell others about their pain; 43% tended to tell. 78% used medications and alternative therapies, none solely used alternative therapies, and 22% only used medications. CONCLUSIONS RA patients reported high rates of alternative therapy use. Dissatisfaction with pain levels indicates need for improved pain management. Not talking about pain lends insights into the importance of teaching patients to communicate their pain to others.
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Affiliation(s)
| | | | - Mary Golas
- University of Illinois at Chicago, Chicago.,Jesse Brown VA Medical Center Chicago, Chicago
| | - Miho Takayama
- Tokyo Ariake University of Medical and Health Sciences, Japan
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Hall JJ, Dissanayake TD, Lau D, Katz SJ. Self-reported use of natural health products among rheumatology patients: A cross-sectional survey. Musculoskeletal Care 2017; 15:345-349. [PMID: 28052563 DOI: 10.1002/msc.1178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To describe the self-reported use of natural health products (NHPs) and identify characteristics that predict selected NHP use in rheumatology patients. METHODS We conducted a cross-sectional survey of consecutive rheumatology patients in two major clinics in Edmonton, Alberta. Survey items included demographic data, rheumatologic diagnoses, prescribed medications, NHPs, and information regarding patients' use of NHPs. Selected NHPs of interest - defined to include joint-specific products, oils with putative joint benefits, and other non-vitamin, non-mineral products - were classified by 2 reviewers. The characteristics of selected NHP users and non-users were compared using chi-squared and ANOVA tests, followed by multivariable-adjusted logistic regression. RESULTS 1063 patients completed the survey (response rate = 36%, mean age 53 [sd 15], 70% female). 36% of respondents reported using one or more of a wide range of selected NHPs (mean 1.8, range 1-9). The most common source of NHP recommendations for selected NHP users were physicians (42%). Significant predictors of selected NHP use were: being female (aOR 1.41, 95%CI [1.05-1.90], p = 0.02), having a post-secondary degree (aOR 1.60 [1.15-2.22], p = 0.005), and the number of non-rheumatic medications (aOR 1.08 [ 1.00-1.15], p = 0.03) and NSAIDs (aOR 1.32 [1.06, 1.63], p = 0.01). Similar findings were observed among only inflammatory arthritis patients. CONCLUSIONS Our study confirms the frequent use of selected NHPs, possibly to mitigate persistent symptoms of rheumatologic illness. Rheumatologists appear to be trusted sources of advice and recommendations on NHP use and should provide balanced counselling for their patients.
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Affiliation(s)
- Jill J Hall
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alta, Canada
| | - Tharindri D Dissanayake
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta, Canada
| | - Darren Lau
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta, Canada
| | - Steven J Katz
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta, Canada
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Predicting adherence to acupuncture appointments for low back pain: a prospective observational study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:5. [PMID: 28049527 PMCID: PMC5209924 DOI: 10.1186/s12906-016-1499-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 12/06/2016] [Indexed: 01/03/2023]
Abstract
Background Acupuncture is a popular form of complementary and alternative medicine (CAM), but it is not clear why patients do (or do not) follow acupuncturists’ treatment recommendations. This study aimed to investigate theoretically-derived predictors of adherence to acupuncture. Methods In a prospective study, adults receiving acupuncture for low back pain completed validated questionnaires at baseline, 2 weeks, 3 months, and 6 months. Patients and acupuncturists reported attendance. Logistic regression tested whether illness perceptions, treatment beliefs, and treatment appraisals measured at 2 weeks predicted attendance at all recommended acupuncture appointments. Results Three hundred twenty-four people participated (aged 18–89 years, M = 55.9, SD = 14.4; 70% female). 165 (51%) attended all recommended acupuncture appointments. Adherence was predicted by appraising acupuncture as credible, appraising the acupuncturist positively, appraising practicalities of treatment positively, and holding pro-acupuncture treatment beliefs. A multivariable logistic regression model including demographic, clinical, and psychological predictors, fit the data well (χ2 (21) = 52.723, p < .001), explained 20% of the variance, and correctly classified 65.4% of participants as adherent/non-adherent. Conclusions The results partially support the dynamic extended common-sense model for CAM use. As hypothesised, attending all recommended acupuncture appointments was predicted by illness perceptions, treatment beliefs, and treatment appraisals. However, experiencing early changes in symptoms did not predict attendance. Acupuncturists could make small changes to consultations and service organisation to encourage attendance at recommended appointments and thus potentially improve patient outcomes.
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11
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Wilson PB. Dietary supplementation is more prevalent among adults with arthritis in the United States population. Complement Ther Med 2016; 29:152-157. [DOI: 10.1016/j.ctim.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/12/2016] [Accepted: 10/06/2016] [Indexed: 12/31/2022] Open
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Lu WW, Zhang JM, Lv ZT, Chen AM. Update on the Clinical Effect of Acupuncture Therapy in Patients with Gouty Arthritis: Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9451670. [PMID: 27847529 PMCID: PMC5099464 DOI: 10.1155/2016/9451670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/01/2016] [Accepted: 08/24/2016] [Indexed: 01/18/2023]
Abstract
Objective. The aim of this study is to evaluate the clinical efficacy and safety of acupuncture therapy in the treatment of acute gouty arthritis. Methods. A literature search of PubMed, EMBASE, ISI Web of Science, CENTRAL, and CNKI was conducted from the inception date of each database up to October 2015. Two investigators screened each article independently and were blinded to the findings of the other reviewer. Data was extracted according to the predetermined collection form. Meta-analysis was performed. Results. We analyzed data from 28 RCTs involving 2237 patients with gouty arthritis. Compared with conventional pharmacological treatments acupuncture was more effective in rendering patients free from symptoms after 24 hours, lowering serum urate, alleviating pain associated with gouty arthritis, and decreasing the ESR; regarding CRP, no statistically significant difference was found. In addition, the frequency of adverse events in acupuncture treatment was lower than that in control group. Conclusion. Based on the findings of our study, we cautiously suggest that acupuncture is an effective and safe therapy for patients with gouty arthritis. However, the potential beneficial effect of acupuncture might be overstated due to the methodological deficiency of included studies. High quality RCTs with larger scale are encouraged.
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Affiliation(s)
- Wei-wei Lu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jin-ming Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zheng-tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - An-min Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Mbizo J, Okafor A, Sutton MA, Burkhart EN, Stone LM. Complementary and Alternative Medicine Use by Normal Weight, Overweight, and Obese Patients with Arthritis or Other Musculoskeletal Diseases. J Altern Complement Med 2016; 22:227-36. [PMID: 26938367 DOI: 10.1089/acm.2014.0390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Justice Mbizo
- Department of Public Health, Clinical and Health Sciences, University of West Florida, Pensacola, FL
| | - Anthony Okafor
- Department of Mathematics and Statistics, College of Science, Engineering and Health, University of West Florida, Pensacola, FL
| | - Melanie A. Sutton
- Department of Public Health, Clinical and Health Sciences, University of West Florida, Pensacola, FL
| | - Erica N. Burkhart
- Department of Public Health, Clinical and Health Sciences, University of West Florida, Pensacola, FL
| | - Leauna M. Stone
- Department of Public Health, Clinical and Health Sciences, University of West Florida, Pensacola, FL
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Wong WH, Litwic AE, Dennison EM. Complementary medicine use in rheumatology: A review. World J Rheumatol 2015; 5:142-147. [DOI: 10.5499/wjr.v5.i3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 06/27/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023] Open
Abstract
Complementary and alternative medicine (CAM) use is increasing worldwide; specifically it appears that these treatment modalities are popular among rheumatology patients. The most commonly reported CAM therapies are herbal medicines, homeopathy, chiropractic, acupuncture and reflexology. Despite high reported rates of CAM use, the number of patients disclosing use to their rheumatologists remains low. This review highlights rates of current CAM use in rheumatology in studies performed worldwide, and discusses potential reasons for nondisclosure of CAM use to clinicians.
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Berman B, Lewith G, Manheimer E, Bishop FL, D'Adamo C. Complementary and alternative medicine. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Liu Q, Zhao J, Tan R, Zhou H, Lin Z, Zheng M, Romas E, Xu J, Sims NA. Parthenolide inhibits pro-inflammatory cytokine production and exhibits protective effects on progression of collagen-induced arthritis in a rat model. Scand J Rheumatol 2014; 44:182-91. [DOI: 10.3109/03009742.2014.938113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Berg EAB, McGregor JG, Burkart ME, Poulton CJ, Hu Y, Falk RJ, Hogan SL. What Everybody is Doing but No One is Talking About: Use of Complementary and Alternative Medicine in the ANCA Associated Vasculitis Population. JOURNAL OF AUTOIMMUNE DISEASES AND RHEUMATOLOGY 2014; 2:74-91. [PMID: 25599078 PMCID: PMC4295716 DOI: 10.12970/2310-9874.2014.02.03.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The use and impact of complementary and alternative medicine (CAM) for anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) has not been reported. AAV patients seeking care at our center inquired about CAM, prompting a formal study. Study objectives were to discern how many AAV patients used CAM and its perceived helpfulness in disease management.
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Affiliation(s)
- Elisabeth A B Berg
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - JulieAnne G McGregor
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - Madelyn E Burkart
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - Caroline J Poulton
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - Yichun Hu
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ronald J Falk
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - Susan L Hogan
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, NC, USA
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Yang S, Dubé CE, Eaton CB, McAlindon TE, Lapane KL. Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis. Clin Ther 2013; 35:1690-702. [PMID: 24145044 DOI: 10.1016/j.clinthera.2013.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/20/2013] [Accepted: 09/25/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteoarthritis (OA), a chronic and often painful disease for which there is no cure, accounts for more mobility issues in older adults than any other disease. Cross-sectional studies have found that arthritis is the most common reason for older adults to use complementary and alternative medicine (CAM). Although previous research has profiled the sociodemographic and clinical characteristics of CAM users, few studies have provided information on variation in CAM use over time and most only considered use of any CAM, which was often a mixture of heterogeneous therapies. OBJECTIVES This study sought to describe the longitudinal patterns of CAM use among older adults with knee OA and to identify correlates and predictors of different commonly used CAM therapies. METHODS The Osteoarthritis Initiative included 1121 adults aged ≥65 years with radiographic tibiofemoral OA in one or both knees at baseline. Annual surveys captured current use of conventional therapies and 25 CAM modalities (grouped into 6 categories) for joint pain or arthritis at baseline and during the 4-year follow-up. We assessed longitudinal use of CAM modalities by summing the number of visits with participants reporting use of each modality. Correlates of CAM use under consideration included sociodemographic indicators, body mass index, overall measures of mental and physical well-being, and clinical indices of knee OA. Generalized estimation equations provided adjusted odds ratio estimates and 95% CIs. RESULTS Nearly one-third of older adults reported using ≥1 CAM modality for treating OA at all assessments. With the exception of glucosamine and chondroitin (18%), few were persistent users of other CAM modalities. One in 5 of those using nonsteroidal anti-inflammatory drugs or glucosamine and/or chondroitin were using them concurrently. Adjusted models revealed the following: (1) adults aged ≥75 years were less likely to use dietary supplements than those between ages 65 and 75 years; (2) persons with more severe knee pain or stiffness reported more CAM use; (3) better knee-related physical function was correlated with more use of chiropractic care or massage; and (4) older adults with more comorbidities were less likely to report use of dietary supplements. CONCLUSION Patterns of CAM use are, to some extent, inconsistent with current guidelines for OA treatment. Evaluating the potential risks and benefits in older adults from commonly used CAM modalities, with or without combination use of conventional analgesics, is warranted.
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Affiliation(s)
- Shibing Yang
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
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Quandt SA, Grzywacz JG, Neiberg RH, Lang W, Altizer K, Bell RA, Arcury TA. Daily symptom management practices for arthritis used by older adults. J Aging Health 2011; 24:598-615. [PMID: 22173224 DOI: 10.1177/0898264311428169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article describes the daily self-management practices of older adults with arthritis and examines the association of symptom experience with the use of self-management behaviors. METHOD 197 African American and White participants completed a baseline interview and six sets of three follow-up daily-diary interviews at monthly intervals. RESULTS Arthritis was reported by 63.5%. Arthritis self-management reported included complementary therapies, over-the-counter (OTC) and prescription medications, foods or beverages, and home remedies. Odds of implementing these self-care practices were greater on days with joint pain, swelling, and stiffness. Although, 78.0% and 72.4% of all participants reported staying in bed or cutting back on activities in response to joint symptoms, these self-management activities were not associated with having arthritis. CONCLUSIONS Focusing on daily responses to symptoms demonstrates that older adults actively manage arthritis symptoms using a wide variety of measures, including complementary therapies.
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Affiliation(s)
- Sara A Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Rajbhandary R, Bhangle S, Patel S, Sen D, Perlman A, Panush RS. Perspectives About Complementary and Alternative Medicine in Rheumatology. Rheum Dis Clin North Am 2011; 37:1-8. [DOI: 10.1016/j.rdc.2010.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
AIMS AND OBJECTIVES The aims of this study were to determine the prevalence of complementary and alternative medicine use in patients with arthritis, the types of complementary and alternative medicine used, pertinent socio-demographic factors associated with complementary and alternative medicine use and its perceived efficacy. BACKGROUND Arthritis is a major health issue, and the use of complementary and alternative medicine among patients with arthritis is common. DESIGN This is a descriptive cross-sectional study. METHODS Data were obtained from 250 patients with arthritis at the physiotherapy and immunology clinics Atatürk University Hospital in eastern Turkey between May-July 2005 using a questionnaire developed specifically for this study. The instrument included questions on socio-demographic information, disease specifics and complementary and alternative medicine usage. RESULTS Seventy-six per cent of participants reported use of at least one form of complementary and alternative medicine in the previous year. Complementary and alternative medicine users and non-users were not significantly different in most socio-demographic characteristics including age, gender, marital status and education level with the exception of economic status. We categorised treatment into six complementary and alternative medicine categories: 62.6% of patients used thermal therapies; 41.5% used oral herbal therapies; 40.5% used hot therapies; 32.6% used externally applied (skin) therapies; 28.4% used massage and 12.6% used cold therapies. All forms of complementary and alternative medicine except thermal and oral herbal therapies were perceived as very effective by more than half of study participants. CONCLUSIONS Complementary and alternative medicine therapy is widely used by patients with arthritis and has perceived beneficial effects. RELEVANCE TO CLINICAL PRACTICE It is important for nurses and other health care professionals to be knowledgeable about the use of complementary and alternative medicine therapies when providing care to patients with arthritis because of possible interactions with other treatments, delays in seeking care and the potential for poor quality products. It is also essential for health professionals to discuss treatment options with patients and to monitor treatment efficacy.
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Affiliation(s)
- Ayla Unsal
- Ahi Evran University School of Health, Ahi Evran Universitesi Sağlik Yüksekokulu, Turkey
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Klingberg E, Wallerstedt SM, Torstenson T, Håwi G, Forsblad-d'Elia H. The use of complementary and alternative medicine in outpatients with inflammatory rheumatic diseases in Sweden. Scand J Rheumatol 2009; 38:472-80. [PMID: 19922024 DOI: 10.3109/03009740902994280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To study the use of complementary and alternative medicine (CAM) drugs and methods in patients with inflammatory rheumatic diseases, at rheumatology clinics in western Sweden, and to investigate possible associations between CAM-using habits and other characteristics of the patients. METHODS Randomly selected rheumatology outpatients were asked to complete questionnaires about CAM usage, diagnoses, medication, quality of life (using the 36-item Short Form Health Survey, SF-36), fatigue (using the 20-item Multiple Fatigue Inventory, MFI-20), the Health Assessment Questionnaire (HAQ), and visual analogue scales (VAS) for global health, pain, and fatigue. RESULT A total of 200 patients were included, 137 women and 63 men, mean age 55+/-16 and 54+/-15 years, respectively. Ongoing CAM use was reported by 58 patients (29%): 45 (22.5%) were taking CAM drugs, 20 (10%) were using CAM methods. Altogether 130 patients (65%) had used CAM at some time of their lives; 103 patients (51%) had used CAM drugs ever and 90 patients (45%) had used CAM methods ever. Women used more CAM drugs compared with men. Younger patients used more CAM. CAM use was associated with parameters indicating poorer health, mental component score (MCS) and physical component score (PCS) of SF-36, and VAS for global health and fatigue. Ongoing CAM method was associated with less use of immunomodulatory drugs. CONCLUSION CAM use is widespread among rheumatology patients in Sweden. A total of 65% of the patients had experience of CAM treatment. Female sex, younger age, and poor health were associated with CAM utilization.
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Affiliation(s)
- E Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Sweden.
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Kikuchi M, Matsuura K, Matsumoto Y, Inagaki T, Ueda R. Bibliographical investigation of complementary alternative medicines for osteoarthritis and rheumatoid arthritis. Geriatr Gerontol Int 2009; 9:29-40. [PMID: 19260977 DOI: 10.1111/j.1447-0594.2008.00503.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A variety of complementary and alternative medicine (CAM) treatments are provided to the elderly. We investigated the efficacy and safety of CAM substances that are available to patients with osteoarthritis (OA) and rheumatoid arthritis (RA), both in Japan and overseas. METHODS Information on CAM products was collected from the World Wide Web, using the keywords "arthritis" and "supplement" in five languages (Japanese, English, French, Italian and German) using a popular search engine for each of the languages. References to published work on the products were researched using PubMed with the keywords of "arthritis", "anti-inflammatory" and "analgesics". Such published work was classified according to the evidence levels established by the Cochrane Library. RESULTS Two-hundred and sixty CAM products for OA or RA were available in Japan, of which 41 CAM products had been tested in randomized controlled trials (RCT); there was no scientific evidence for the remaining 219 CAM products. Most of the previous RCT suggested that CAM was effective in OA or RA. Herein, we confirmed the significant OA relieving effects of chondroitin sulfate through a meta-analysis. Effectiveness was assessed using subjective scores, not disease-specific immunological or serological markers for assessment. Toxicological investigations had only been performed for a few CAM products. CONCLUSION Some CAM products that are effective against RA may be used together with biological therapy. However, some of the CAM products available in Japan should be tested using objective markers. Some CAM products for OA could be used for the relief of pain.
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Affiliation(s)
- Motoo Kikuchi
- Department of Medicine, Fujita Health University, Nanakuri Sanatorium, Tsu, Mie, Japan.
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Alvarez-Nemegyei J, Bautista-Botello A. Complementary or alternative therapy use and health status in systemic lupus erythematosus. Lupus 2009; 18:159-63. [PMID: 19151118 DOI: 10.1177/0961203308095946] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite their unproven efficacy and safety concerns, complementary and alternative therapies (CAT) are used by a high proportion of patients with systemic lupus erythematosus (SLE). A prospective survey of past and present CAT use was done on 192 patients (36.5 +/- 12.7 years; 106 +/- 85 months of disease duration; 94% women) with an SLE diagnosis according to ACR criteria. Quality of life [Short Form 36 (SF-36)] and cumulated damage (SLICC/ACR) were compared between CAT users and non-users. In all, 103 (53.6%; 95% CI: 46.8-60.9) patients were CAT users (median: two remedies/patient): two (1%) in the alternative mode (CAT instead of allopathic treatment); 101 (52.6%) in the complementary mode (CAT in addition to allopathic treatment). A univariate analysis showed CAT users to have higher cumulated damage (P = 0.01) levels, as well as lower physical function (P = 0.05), social function (P = 0.05) and bodily pain (P = 0.02) domain scores in the SF-36 survey. After adjustment for disease duration with a linear model, only differences in bodily pain (P = 0.04) and cumulated damage (P = 0.05) remained statistically significant. CAT use is apparently associated with lower health status in patients with SLE from Yucatan, Mexico. Because the study was cross-sectional, more research is needed to define the directionality of this association.
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Affiliation(s)
- J Alvarez-Nemegyei
- Unidad de Investigación Médica, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México.
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Ikuyama S, Imamura-Takase E, Tokunaga S, Oribe M, Nishimura J. Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements or health foods. Mod Rheumatol 2009; 19:253-9. [PMID: 19255828 DOI: 10.1007/s10165-009-0156-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 01/22/2009] [Indexed: 11/28/2022]
Abstract
We conducted a survey on the use of dietary supplements and health foods (DS/HF) in definite rheumatoid arthritis (RA) patients treated by RA specialists. Among 296 patients (male 48, female 248), 179 patients (60.5%) had experience of DS/HF use. Prevalence of DS/HF use was significantly higher in female than in male patients (63.7% versus 43.8%). Overall, patients who have used DS/HF were significantly younger than those who have not used; it was particularly notable in female patients. The proportion of current users was significantly higher in those less than 5 years from diagnosis than those who had been diagnosed for 5 years or more. Products of herbs or algae (44.1%) and components of cartilage (40.8%) were the most popular DS/HF. Primary sources of product information were family members or friends (56.4%) and advertisements in the mass media (34.1%). Of the users, 73.7% did not disclose DS/HF use to their physicians. The users expected alleviation of the symptoms (35.2%) and improvement of health (34.6%). However, 59.2% of the users were unsure of the benefits. In conclusion, physicians should be aware of the high prevalence of DS/HF usage in patients with RA in Japan.
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Affiliation(s)
- Shoichiro Ikuyama
- Department of Rheumatology, Hematology and Metabolic Diseases, Kyushu University Hospital at Beppu, Beppu, 874-0838, Japan.
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Hunnicutt SE, Grady J, McNearney TA. Complementary and alternative medicine use was associated with higher perceived physical and mental functioning in early systemic sclerosis. Explore (NY) 2008; 4:259-63. [PMID: 18602619 DOI: 10.1016/j.explore.2008.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study assessed the use of complementary and alternative medicine (CAM) therapies in patients with early systemic sclerosis (scleroderma, SSc). METHODS At the annual visit, SSc patients enrolled in the Genetics versus Environment in Scleroderma Outcomes Study (GENISOS) were queried about their use of CAM therapies and intended symptom target, including herbal or nutraceutical therapy, acupuncture, transcutaneous electrical neural stimulation, and mind-body therapy (relaxation, meditative, imagery). The CAM-user SSc patients were compared with matched non-CAM users over two years for database results of demographic, clinical, and health-related quality of life SF-36 questionnaires by using analysis of covariance. RESULTS Twenty-five percent of the University of Texas Medical Branch GENISOS group were CAM users, with an average age of 54 years, 89% female, 47% diffuse cutaneous involvement, 13.5 total skin score, and a Medsger severity index of 5.8. Over 70% of patients used more than one CAM therapy for over one year, independent of health insurance. Symptoms targeted included arthritis/arthralgia, pain, gastrointestinal dysmotility, and fatigue. Complementary and alternative medicine users had significantly higher mean mental component summary scores on SF-36 at baseline and year 2, (49 and 49.9, respectively), compared with non-CAM users (42 and 40.2, respectively; P < .01). At year 2, the CAM user group had significantly higher scores of SF-36 domains physical component, role physical, bodily pain, and vitality, whereas scores declined in the non-CAM user group. CONCLUSION In SSc, 70% of those in the CAM user group reported a long-term commitment to CAM therapies. Higher perceived mental functioning in CAM users might reflect more self-motivation to manage symptoms, and subsequently, promote practices that result in higher perceived physical functioning.
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Affiliation(s)
- Sonya E Hunnicutt
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Medical skepticism and the use of complementary and alternative health care providers by patients followed by rheumatologists. J Clin Rheumatol 2008; 14:143-7. [PMID: 18525432 DOI: 10.1097/rhu.0b013e31817734cd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our understanding of the determinants of use of complementary and alternative (CAM) providers is limited, especially in regard to medical skepticism (ie, doubt in the ability of conventional medical care to appreciably alter health status). OBJECTIVES To determine whether medical skepticism was associated with CAM provider use in patients with arthritis and to explore the association between medical skepticism and demographic and health-related characteristics of persons with arthritis. METHODS A cross-sectional analysis of data from patients (N = 721) with osteoarthritis, rheumatoid arthritis, or fibromyalgia who completed a questionnaire about their health, health care use, and health-related attitudes/behaviors, including medical skepticism. Patients were recruited from 14 rheumatology practices in North Carolina. A multiple logistic regression analysis was conducted to examine the relationship between medical skepticism and the use of any CAM providers. Multiple linear regression analysis was conducted to examine relationships between medical skepticism and demographic and health-related measures. RESULTS Fifteen percent of the sample used one or more CAM providers. Medical skepticism was positively associated with CAM provider use. A one point increase in skepticism increased the probability of CAM provider use by approximately 70% (odds ratios =1.70; 95% confidence intervals [1.13-2.56]). Individuals, who were younger, had better perceived health, and had a diagnosis of osteoarthritis or fibromyalgia had greater skepticism. CONCLUSIONS By knowing more about medical skepticism and other determinants of CAM provider use, conventional practitioners can target patients to improve their uptake of appropriate conventional care, while also monitoring patients alternative therapy use.
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Abstract
OBJECTIVE To compare the use of complementary and alternative medicine (CAM) for arthritis between 2 ethnically distinct metropolitan Chicago community areas. METHODS A telephone interview survey of adults age 45 years or above living in North (88.9% white) or South (79.7% African American) areas. Of 763 respondents, 405 reported arthritis or chronic joint symptoms and were asked about use and satisfaction with 7 CAM therapies. Differences between areas were compared with population-weighted tests; multiple logistic regression was used to analyze the likelihood of CAM use controlled for demographics, behavioral risk factors, and arthritis severity. RESULTS South Chicago respondents had a higher prevalence and more severe arthritis symptoms such as mean joint pain and more functional limitations. Use of CAM therapy by South Chicago respondents, most commonly massage and relaxation techniques, was 10% greater than North Chicago respondents (61.5% to 51%) but this was not significantly different. Among CAM users, South Chicago respondents reported higher satisfaction with 6 of the 7 CAM therapies and greater future interest in CAM therapies. Poor overall health status (P=0.03), arthritis pain (P=0.005), and concomitant use of prescription medications (P=0.03) were the only significant predictors of CAM use. DISCUSSION Although there were only small differences in overall CAM use by area, older residents of largely African American communities were enthusiastic users of relaxation, massage, and nutritional and dietary techniques. CAM modalities could be important adjuncts to traditional medical treatment of arthritis pain for minority communities.
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Rosemann T, Joos S, Szecsenyi J, Laux G, Wensing M. Health service utilization patterns of primary care patients with osteoarthritis. BMC Health Serv Res 2007; 7:169. [PMID: 17956605 PMCID: PMC2190766 DOI: 10.1186/1472-6963-7-169] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 10/23/2007] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). METHODS Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. RESULTS 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the "symptom" scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. CONCLUSION Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully.
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Affiliation(s)
- Thomas Rosemann
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Stefanie Joos
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Joachim Szecsenyi
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Gunter Laux
- University Hospital Heidelberg, Department of General Practice and Health Services Research; Vosstr. 2, 69115 Heidelberg, Germany
| | - Michel Wensing
- Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
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Katz P, Lee F. Racial/Ethnic Differences in the Use of Complementary and Alternative Medicine in Patients With Arthritis. J Clin Rheumatol 2007; 13:3-11. [PMID: 17278941 DOI: 10.1097/01.rhu.0000255579.59597.d2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine use of complementary and alternative medicine (CAM) by individuals with osteoarthritis (OA) from 4 ethnic groups, differences in CAM use among groups, and correlates of CAM use. METHODS Data were obtained from individuals from 4 ethnic groups (African, Asian, and Hispanic Americans, and Caucasians) participating in trials assessing celecoxib efficacy. A questionnaire assessing CAMs specifically used to help arthritis was administered at screening. Use of 42 specific therapies within 7 categories-alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and 3 types of biologically based therapies--was queried. RESULTS More than 80% of subjects reported that they used some CAM for arthritis in the past month. In contrast, 50% reported the use of prescription medicines, and 52% reported the use of over-the-counter medicines. Dietary practices were the most common type of CAM (71.5%), followed by mind-body interventions (42.4%), topical agents (38.1%), use of supplements or herbs (32.9%), and manipulation and body-based methods (21.4%). African Americans were more likely to report any CAM use than other groups (89.1% versus 83.1% [Asian], 81.1% [Hispanic], 77.7% [Caucasian]). African and Asian Americans more commonly reported the use of mind-body interventions in general, and prayer in particular. African Americans were also most likely to report the use of topical agents. Asian Americans were most likely to report use of alternative medical systems, manipulation methods, and supplements. Caucasians were least likely to report use of dietary practices. CONCLUSION Individuals with OA commonly use CAM. Use of these therapies varies by racial/ethnic group. Some CAMs may be effective for symptom relief, while others may interact with prescription medications, suggesting that routine queries by physicians concerning CAM use would be beneficial.
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Affiliation(s)
- Patricia Katz
- Department of Medicine, University of California, San Francisco, California 94143-0920, USA.
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Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C. Health Services Research Related to Chiropractic: Review and Recommendations for Research Prioritization by the Chiropractic Profession. J Manipulative Physiol Ther 2006; 29:707-25. [PMID: 17142165 DOI: 10.1016/j.jmpt.2006.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 05/31/2006] [Accepted: 05/31/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE This project updates a previous effort to inventory health services research conducted on chiropractic and makes recommendations for a subsequent research agenda. A qualitative review of social sciences, medical, chiropractic, and health services research literature regarding chiropractic was done with emphasis on research published since the initial health services research agenda effort in 1995. This work informed development of updated health services research recommendations. METHODS Literature was gathered through searches of electronic health care database retrieval systems and citation tracking. In addition to general collecting of new studies, the authors considered to what extent the 1995 research recommendations had been addressed in the new literature. A seed set of refined recommendations was formulated and initially distributed expert review and revision. The recommendations were made available for public comment and hearing at the 10th Annual Research Agenda Conference for Chiropractic in March 2005. DISCUSSION The past 10 years have seen numerous health service research studies related to chiropractic; however, nearly all of the research priorities identified in 1995 remain unaddressed and remain as important priorities. Thus, recommendations were reprioritized and revised to submit for open comment and hearing. CONCLUSION A smaller number of more concise recommendations with more specific action steps are proposed for clinical quality improvement, performing cost analyses, and assessing use barriers for chiropractic.
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Affiliation(s)
- Robert D Mootz
- State of Washington, Department of Labor and Industries, Olympia, Washington 98504-4321, USA.
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Affiliation(s)
- Lan X Chen
- Rheumatology Division, School of Medicine, University of Pennsylvania Medical Center-Presbyterian and VAMC, 3600 Spruce Street, Philadelphia, PA 19104, USA.
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Setty AR, Sigal LH. Herbal Medications Commonly Used in the Practice of Rheumatology: Mechanisms of Action, Efficacy, and Side Effects. Semin Arthritis Rheum 2005; 34:773-84. [PMID: 15942912 DOI: 10.1016/j.semarthrit.2005.01.011] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To review the literature on herbal preparations commonly utilized in the treatment of rheumatic indications. METHODS Search of MEDLINE (PubMed) was performed using both the scientific and the common names of herbs. Relevant articles in English were collected from PubMed and reviewed. RESULTS This review summarizes the efficacy and toxicities of herbal remedies used in complementary and alternative medical (CAM) therapies for rheumatologic conditions, by elucidating the immune pathways through which these preparations have antiinflammatory and/or immunomodulatory activity and providing a scientific basis for their efficacy. Gammalinolenic acid suppresses inflammation by acting as a competitive inhibitor of prostaglandin E2 and leukotrienes (LTs) and by reducing the auto-induction of interleukin1alpha (IL-1alpha)-induced pro-IL-1beta gene expression. It appears to be efficacious in rheumatoid arthritis (RA) but not for Sjogrens disease. The antiinflammatory actions of Harpagophytum procumbens is due to its action on eicosanoid biosynthesis and it may have a role in treating low back pain. While in vitro experiments with Tanacetum parthenium found inhibition of the expression of intercellular adhesion molecule-1, tumor necrosis factor alpha (TNF-alpha), interferon-gamma, IkappaB kinase, and a decrease in T-cell adhesion, to date human studies have not proven it useful in the treatment of RA. Current experience with Tripterygium wilfordii Hook F, Uncaria tomentosa, finds them to be efficacious in the treatment of RA, while Urtica diocia and willow bark extract are effective for osteoarthritis. T. wilfordii Hook F extract inhibits the production of cytokines and other mediators from mononuclear phagocytes by blocking the up-regulation of a number of proinflammatory genes, including TNF-alpha, cyclooxygenase 2 (COX-2), interferon-gamma, IL-2, prostaglandin, and iNOS. Uncaria tomentosa and Urtica diocia both decrease the production of TNF-alpha. At present there are no human studies on Ocimum spp. in rheumatic diseases. The fixed oil appears to have antihistaminic, antiserotonin, and antiprostaglandin activity. Zingiber officinale inhibits TNF-alpha, prostaglandin, and leukotriene synthesis and at present has limited efficacy in the treatment of osteoarthritis. CONCLUSIONS Investigation of the mechanism and potential uses of CAM therapies is still in its infancy and many studies done to date are scientifically flawed. Further systematic and scientific inquiry into this topic is necessary to validate or refute the clinical claims made for CAM therapies. An understanding of the mechanism of action of CAM therapies allows physicians to counsel effectively on their proper and improper use, prevent adverse drug-drug interactions, and anticipate or appreciate toxicities. RELEVANCE The use of CAM therapies is widespread among patients, including those with rheumatic diseases. Herbal medications are often utilized with little to no physician guidance or knowledge. An appreciation of this information will help physicians to counsel patients concerning the utility and toxicities of CAM therapies. An understanding and elucidation of the mechanisms by which CAM therapies may be efficacious can be instrumental in discovering new molecular targets in the treatment of diseases.
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Affiliation(s)
- Arathi R Setty
- Massachusetts General Hospital, Department of Rheumatology, Boston, USA
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Lukaczer D, Darland G, Tripp M, Liska D, Lerman RH, Schiltz B, Bland JS. A Pilot trial evaluating meta050, a proprietary combination of reduced iso-alpha acids, rosemary extract and oleanolic acid in patients with arthritis and fibromyalgia. Phytother Res 2005; 19:864-9. [PMID: 16261517 DOI: 10.1002/ptr.1709] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this open-label, 8-week observational trial was to investigate the efficacy of Meta050 (a proprietary, standardized combination of reduced iso-alpha-acids from hops, rosemary extract and oleanolic acid) on pain in patients with rheumatic disease. Osteoarthritis, rheumatoid arthritis and fibromyalgia patients were given 440 mg Meta050 three times a day for 4 weeks, which was changed to 880 mg twice a day for the subsequent 4 weeks in the majority of patients. Pain and condition-specific symptoms were assessed using a standard visual analog scale (VAS), an abridged arthritis impact measurement scale (AIMS2) and the fibromyalgia impact questionnaire. Fifty-four subjects with rheumatic disease completed the trial. Following treatment, a statistically significant decrease in pain of 50% and 40% was observed in arthritis subjects using the VAS (p < 0.0001; Wilcoxon-ranked sums) and AIMS2 (p < 0.0001), respectively. Fibromyalgia subject scores did not significantly improve. A decreasing trend of C-reactive protein, a marker for inflammation, was also observed in those subjects who presented with elevated C-reactive protein. No serious side effects were observed. These observations suggest that Meta050 at a dosage of 440 mg three times a day has a beneficial effect on pain in arthritis subjects.
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Affiliation(s)
- Daniel Lukaczer
- Clinical Research at the Functional Medicine Research Center, Gig Harbor, WA 98332, USA.
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Quandt SA, Chen H, Grzywacz JG, Bell RA, Lang W, Arcury TA. Use of complementary and alternative medicine by persons with arthritis: Results of the National Health Interview Survey. ACTA ACUST UNITED AC 2005; 53:748-55. [PMID: 16208669 DOI: 10.1002/art.21443] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the complementary and alternative medicine (CAM) used by adults ages 45 years and older with and without arthritis, and to investigate the prevalence and predictors of CAM use by persons who report being told by a doctor they had arthritis. METHODS Data from the 2002 National Health Interview Survey with a supplemental section on CAM use were analyzed. Data on overall use and use by 4 CAM modalities were calculated by arthritis status. CAM use for treatment of any health condition, including arthritis, was calculated and compared by arthritis status. Logistic regression was used to identify predictors of CAM use among persons with arthritis. RESULTS Overall use of CAM and use of 3 of 4 major CAM categories were higher for persons who reported doctor-diagnosed arthritis compared with those without arthritis. Biologically based therapies were the most frequently reported modalities. Although persons with arthritis were more likely than those without arthritis to report using CAM for treatment, most of their CAM use was for conditions other than arthritis. Joint pain and poor functional status were the most common predictors of CAM modalities among persons with arthritis. CONCLUSION Health care providers of persons with arthritis should be aware that CAM use is common among their patients. A complete medication history is needed to obtain information on CAM use for all conditions.
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Affiliation(s)
- Sara A Quandt
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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