The use of 'alternative treatments' by patients with rheumatoid arthritis

Natural Product Dietary Supplement Use by Individuals With Rheumatoid Arthritis: A Scoping Review

OBJECTIVE

Natural product dietary supplements (NDS), defined as non-mineral, non-vitamin, ingested, natural product-derived, substances, are the most frequently used complementary and alternative medicine modality in the US, with musculoskeletal disease being the most frequent reason for their use. Because NDS usage is frequently unreported, and patients with RA may be at higher risk for NDS-related side effects due the underlying nature of the disease and frequent use of complex pharmaceutical regimens, a scoping review of the literature was undertaken to examine population-based patterns of NDS use for RA self-management.

METHODS

Using guidelines for scoping reviews, Allied and Complementary Medicine, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Embase, Ovid/Medline, and Web of Science databases were searched to identify references presenting primary data related to the prevalence or patterns of use of NDS in RA populations.

RESULTS

Twenty-three studies, which were published between 1980 and 2015 and conducted in 11 countries, met the inclusion criteria. The overall prevalence of NDS use in patients with RA was 47% worldwide and did not differ by geographic region. On average, 47% of patients found NDS to be effective and 13% reported adverse side effects, with only 30% informing their physicians about the use of NDS, which in a majority of cases were used concomitantly with RA pharmaceuticals. Marine oils, glucosamine, vinegar, and chondroitin were among the most commonly reported NDS worldwide.

CONCLUSION

Given the apparent communication gap between patients and providers regarding NDS use and higher potential risks associated with this usage in RA, ongoing surveillance of population-based practices may help facilitate RA management and direct future NDS research.

Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements or health foods

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.

The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain

Background

Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM). Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be.

Methods

Aims and objectives

To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care.

Study design

Face-to-face interview-based survey.

Setting

Three general practices in North Staffordshire.

Participants

Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year.

Results

138 interviews were completed. 116 participants (84%) had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80%) had used conventional treatment. 95 (69%) were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used.

Conclusion

We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and assess safety. The observation that most users of conventional medicine also used CAM suggests a continuing need for more investigation of effective pain management in primary care.

Antinociceptive effect and the mechanism of bee venom acupuncture (Apipuncture) on inflammatory pain in the rat model of collagen-induced arthritis: Mediation by alpha2-Adrenoceptors

The antinociceptive effect and the mechanism of bee venom acupuncture (BVA) on inflammatory pain, especially in the rat model of collagen-induced arthritis (CIA), have not yet been fully studied. This study was designed to investigate the antinociceptive effect and its mu-opioid and alpha2-adrenergic mechanism of BVA in the CIA rat model. To induce CIA, male Sprague-Dawley rats were immunized with bovine type II collagen emulsified in Freund's incomplete adjuvant followed by a booster injection 14 days later. The antinociceptive effect was evaluated by tail flick latency (TFL). After induction of arthritis, the inflammatory pain threshold decreased as time passed, and there was no big change of the pain threshold after 3 weeks. Three weeks after the first immunization, BVA (0.25 mg/kg) injected into the Zusanli acupoint (ST36) showed the antinociceptive effect. Furthermore, the antinociceptive effect of BVA was blocked by yohimbine (alpha2-adrenergic receptor antagonist, 2 mg/kg, i.p) pretreatment, but not by naloxone (mu-opioid receptor antagonist, 2 mg/kg, i.p.) pretreatment. These results suggest that BVA can relieve inflammatory pain in CIA and the antinociceptive effect of BVA can be mediated by alpha2-adrenergic receptor.

Assessing the effects of race and ethnicity on use of complementary and alternative therapies in the USA

OBJECTIVE

To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics.

DESIGN

Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures.

RESULTS

Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites.

CONCLUSIONS

The use of alternative and complementary therapies varied across racial/ ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

Rheumatology patients' use of complementary therapies: results from a one-year longitudinal study

OBJECTIVE

To examine the natural history of complementary and alternative medicine (CAM) use and its impact on outcomes within a cohort of rheumatology patients.

METHODS

Consecutive patients were recruited from 3 university and 3 private rheumatology practices. Baseline chart reviews provided demographic information and rheumatic diagnoses. Patients answered questions on CAM use and health status during 1 year. We identified correlates of 4 CAM usage patterns (started, maintained, stopped, nonuse) and compared outcomes among these groups.

RESULTS

Of 232 baseline participants, 203 (87%) and 177 (76%) responded to the 6- and 12-month surveys. In each survey, approximately 34% reported currently using CAM. During the year, 44% of patients remained nonusers whereas 12% started, 22% maintained, and 22% stopped use. The most frequent reasons for stopping CAM were lack of effectiveness and expense. CAM users and nonusers had no difference in outcomes.

CONCLUSIONS

Arthritis patients' usage behavior varied substantially, but CAM use was not associated with a difference in outcomes.

A randomized controlled trial of homeopathy in rheumatoid arthritis

OBJECTIVE

To test the hypothesis that homeopathy is effective in reducing the symptoms of joint inflammation in rheumatoid arthritis (RA).

METHOD

This was a 6-month randomized, cross-over, double-blind, placebo-controlled, single-centre study set in a teaching hospital rheumatology out-patient clinic. The participants of the study were 112 patients who had definite or classical RA, were seropositive for rheumatoid factor and were receiving either stable doses of single non-steroidal anti-inflammatory drugs (NSAIDs) for > or =3 months or single disease-modifying anti-rheumatic drugs (DMARDs) with or without NSAIDs for > or =6 months. Patients who were severely disabled, had taken systemic steroids in the previous 6 months or had withdrawn from DMARD therapy in the previous 12 months were excluded. Two series of medicines were used. One comprised 42 homeopathic medicines used for treating RA in 6cH (10(-12)) and/or 30cH (10(-30)) dilutions (a total of 59 preparations) manufactured to French National Pharmacopoeia standards, the other comprised identical matching placebos. The main outcome measures were visual analogue scale pain scores, Ritchie articular index, duration of morning stiffness and erythrocyte sedimentation rate (ESR).

RESULTS

Fifty-eight patients completed the trial. Over 6 months there were significant decreases (P<0.01 by Wilcoxon rank sum tests) in their mean pain scores (fell 18%), articular indices (fell 24%) and ESRs (fell 11%). Fifty-four patients withdrew before completing the trial. Thirty-one changed conventional medication, 10 had serious intercurrent illness or surgery, 12 failed to attend and three withdrew consent. Placebo and active homeopathy had different effects on pain scores; mean pain scores were significantly lower after 3 months' placebo therapy than 3 months' active therapy (P=0.032 by Wilcoxon rank sum test). Articular index, ESR and morning stiffness were similar with active and placebo homeopathy.

CONCLUSIONS

We found no evidence that active homeopathy improves the symptoms of RA, over 3 months, in patients attending a routine clinic who are stabilized on NSAIDs or DMARDs.

Bee venom injection into an acupuncture point reduces arthritis associated edema and nociceptive responses

Bee venom (BV) has traditionally been used in Oriental medicine to relieve pain and to treat inflammatory diseases such as rheumatoid arthritis (RA). While several investigators have evaluated the anti-inflammatory effect of BV treatment, the anti-nociceptive effect of BV treatment on inflammatory pain has not been examined. Previous studies in experimental animals suggest that the therapeutic effect of BV on arthritis is dependent on the site of administration. Because of this potential site specificity, the present study was designed to evaluate the anti-nociceptive effect of BV injections into a specific acupoint (Zusanli) compared to a non-acupoint in an animal model of chronic arthritis. Subcutaneous BV treatment (1 mg/kg per day) was found to dramatically inhibit paw edema caused by Freund's adjuvant injection. Furthermore, BV therapy significantly reduced arthritis-induced nociceptive behaviors (i.e. the nociceptive scores for mechanical hyperalgesia and thermal hyperalgesia). These anti-nociceptive/anti-inflammatory effects of BV were observed from 12 days through 21 days post-BV treatment. In addition, BV treatment significantly suppressed adjuvant-induced Fos expression in the lumbar spinal cord at 3 weeks post-adjuvant injection. Finally, injection of BV into the Zusanli acupoint resulted in a significantly greater analgesic effect on arthritic pain as compared to BV injection in to a more distant non-acupoint. The present study demonstrates that BV injection into the Zusanli acupoint has both anti-inflammatory and anti-nociceptive effects on Freund's adjuvant-induced arthritis in rats. These findings raise the possibility that BV acupuncture may be a promising alternative medicine therapy for the long-term treatment of rheumatoid arthritis.

Demographic and health-related correlates to visits to complementary and alternative medical providers

OBJECTIVES

The objective of this study was to ascertain the extent to which demographic and health-related variables are related to visits to a complementary or alternative medicine (CAM) practitioner.

METHODS

This study reports a secondary analysis of visits to CAM practitioners during the year before the 1996 Medical Expenditure Panel Survey (n = 16,038).

RESULTS

Overall visits to CAM providers (9%) were lower than reported in widely cited surveys but quite consistent with a previous Robert Wood Johnson study that used a similar sampling procedure. Gender, education, age, geographic location, and race (Hispanics and African Americans proved to be less likely to visit CAM providers than whites) were statistically significant predictors of visits to CAM providers. Individuals in poorer health and those suffering from mental, musculoskeletal, and metabolic disorders also tended to be more likely to have visited a CAM provider.

CONCLUSIONS

Although the choice of alternative versus orthodox treatment appears to be a complex phenomenon, these data suggest that the heaviest users of CAM therapies tend to be individuals with comorbid, non-life-threatening health problems. This finding may help to ameliorate concerns that this type of care is being used in lieu of therapies with more definitive efficacy evidence.

Prevalence and patterns of alternative medication use in a university hospital outpatient clinic serving rheumatology and geriatric patients

A random sample of 176 patients seen at least once during 1997 in a University hospital outpatient clinic serving rheumatology and geriatric patients were surveyed in a telephone interview to determine the prevalence of, and reasons for taking, alternative medications. Interviews were conducted from November 1997-March 1998. The survey elicited information about patients' ability to provide self-care, demographics, work status, satisfaction with current disease management, types of alternative medications taken, sources of information about the products, where they obtained the products, and reasons for taking the products. Patients also were questioned as to their knowledge of safety of these products. Statistical comparisons were determined between patients who used alternative agents and those who did not. Prevalence of use was 66%. Most patients thought that the agents were safe and took them because they believed they have "added benefits."

Quackery: the National Council Against Health Fraud perspective

Quackery is the promotion of false and unproven health schemes for a profit. It is rooted in the traditions of marketplace. Scientific thinking and standards of conduct underlie professionalism and consumer protection law. At the present time, commercialism has overwhelmed professionalism in the marketing of alternative remedies. Neither patients nor legitimate businesses that adhere to the standards of science and consumer protection are well served by a double standard.

Use of complementary therapies for arthritis among patients of rheumatologists

BACKGROUND

Use of complementary and alternative medicine (CAM) is common among persons with chronic conditions.

OBJECTIVE

To identify correlates of and describe patients' perspective on use of CAM for rheumatologic conditions.

DESIGN

Telephone survey.

SETTING

Three university practices and three private rheumatology practices.

PATIENTS

232 of 428 eligible consecutive patients (54%) with scheduled appointments.

MEASUREMENTS

Patients answered questions on CAM use, functional status, pain, provider satisfaction, and health services utilization. Chart reviews provided demographic information and rheumatologic diagnoses. Bivariate analyses identified correlates of four CAM outcomes (history, magnitude, and frequency of CAM use and communication about CAM use with a physician), and multiple logistic regression identified independent correlates of regular CAM use.

RESULTS

Approximately two thirds of the respondents (n = 146) had used CAM. Of these 146 respondents, 82 (56%) currently used CAM and 132 (90%) regularly used CAM or had done so in the past. Fifty-five respondents (24%) had used three or more types of CAM. In multivariate analyses, persons who used CAM regularly were more likely to have osteoarthritis (odds ratio, 5.6 [95% CI, 1.9 to 16.8]), severe pain (odds ratio, 2.5 [CI, 1.4 to 4.8]), and a college degree (odds ratio, 2.6 [CI, 1.3 to 5.4]) than patients who had never used CAM. Nearly half of the respondents discussed CAM use with their physicians. The most common reasons for not disclosing CAM use were that the physician had not asked about it and that the patient forgot to tell the physician; fear of disapproval was rarely cited. Discussions about CAM use between patient and physician occurred more frequently among patients with fibromyalgia and persons who regularly used CAM or used several types of CAM.

CONCLUSIONS

Patients with rheumatologic conditions frequently use CAM. Severe pain and osteoarthritis predict regular use of CAM but do not predict a greater likelihood of discussing CAM use with physicians. Routine inquiry by physicians will probably detect CAM use.

The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-controlled cross-over study

OBJECTIVE

Acupuncture is commonly used by patients with chronic painful musculoskeletal disorders. There are, however, few well-designed studies of its efficacy. This paper describes a randomized placebo-controlled cross-over design to evaluate acupuncture as a useful treatment adjunct in the management of patients with rheumatoid arthritis (RA).

METHODS

Sixty-four patients were centrally randomized from a hospital-based rheumatology out-patient clinic. Fifty-six patients were suitable for study, all were on second-line therapy and aged 18-75 yr. There had been no change in therapy for the preceding 3 months. Patients who had previous acupuncture, anticoagulation, fear of needles or infection were excluded. Single-point (Liver 3) acupuncture or placebo was given with an intervening 6 week wash-out period. The acupuncturist, patient and statistician were blinded as far as possible. The outcome measures included the inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), visual analogue scale of pain, global patient assessment, 28 swollen and tender joint count, and a general health questionnaire.

RESULTS

The results demonstrated no significant effect of treatment or period and no significant interaction between treatment and period for any outcome variable. No adverse effects were reported.

CONCLUSION

Acupuncture of this type cannot be considered as a useful adjunct to therapy in patients with RA. Possible reasons why this is the case are discussed.

Usage of complementary therapies in rheumatology: a systematic review

Complementary medicine (CM) is more popular than ever before. Rheumatology patients seem particularly keen to try CM. In this paper, surveys on rheumatology patients' use of CM are reviewed. The issues of perceived effectiveness, safety and costs are also addressed. In addition surveys of doctors' attitudes towards CM in rheumatology are summarised. Fourteen surveys on patients' use of CM and three on patients' attitudes towards CM were found and analysed. The results imply that the prevalence of CM varies between 30% and nearly 100%. Overall, patients perceive CM as being moderately effective. The survey contains only few data on adverse events of CM as perceived by these patients; collectively they suggest that adverse events are uncommon. Data on costs are similarly sparse; they imply that expenditure for CM is rarely high. Physicians seem to be more sceptical about CM than are their patients. It is concluded that, on average, CM is frequently used by rheumatology patients. The patients' level of satisfaction with CM is often considerable and few adverse effects are being reported. On the basis of these findings, a rigorous investigation of the effectiveness, safety and costs of CM in rheumatology seems desirable.

The arthritis sufferer and the community: a comparison of arthritis sufferers in rural and urban areas

One hundred and two rural patients and 100 urban patients with rheumatoid arthritis and osteoarthrosis and 203 age and sex matched controls were visited in their homes to evaluate their problems, needs, and expectations. Although one would expect disability to affect the mobility of a person, it was found that rural patients were more mobile than their urban counterparts despite the same degree of functional disability. They were more content with their lot, even though their circumstances were less favourable. Both groups of patients had little contact with their general practitioners, social workers, or district nurses, and lacked information about their disease and the availability of financial grants or home adaptations. The main problem for the individual patient was not pain, but the frustration of being unable to do things they used to do and of dependency on others.