Complementary and Alternative Medicine in Rheumatoid Arthritis: No Longer the Last Resort

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Complementary and Alternative Medicine in Rheumatoid Arthritis: No Longer

the Last Resort

Category:  16 RA‹clinical aspects

Petros Efthimiou, J on, C. Mackenzie, A Paget

Hospital for Special Surgery, New York, NY

Presentation Number: 867

Poster Board Number: 332

Keywords: rheumatoid arthritis, complementary therapy, alternative medicine

Background: Complementary and Alternative Medicine (CAM) is increasing in

popularity and usage in western societies and accounts for significant

private and public health expenditures. Such high usage is thought to

reflect the negative impact of the rheumatic diseases, with the chronicity

of pain, limitation of movement and partial response to mainstream

therapies. Therefore, physicians may think of RA patients who utilize CAM as

a uniform group of severely affected patients who may have even lost faith

in traditional medicine.

Objective: To identify demographic and disease characteristics associated

with use of specific alternative therapies in RA.

Methods: A secondary analysis of data extracted from our institutionŒs RA

longitudinal registry was performed. The Registry contains demographics,

baseline RA information, use of CAM, medication history, Charlson

Comorbidity Index (CCI) scores, functional disability measured by the Health

Assessment Questionnaire (HAQ) and the Rheumatology Attitudes Index (RAI).

Patients reporting a history of CAM use were identified and compared to

non-users. Several demographic and RA disease characteristics were compared

between the 2 groups using Student's t-test for continuous and Mann Whitney

U for categorical variables.

Results: Of the 166 RA subjects 75.9%(126) reported current or past use of

CAM. Twelve different modalities were used by >10% of our patients. When

compared to non-users, CAM users were more likely to have more

extra-articular manifestations (0.95 ±1.2 vs 0.55±0.8) and have failed more

DMARDs (2.01±1.8 vs 1.5±1.2). But when individual therapies or groups of

therapies were compared between the 2 groups, unexpected associations came

in light. Mind-body therapy users (31.3%) were younger (mean age 54±20 vs

62±14 years, p=0.012); Yoga, Tai Chi or Qi Gong followers (18.7%) were

better educated (years of education 16.5±2.5 vs 14.6±3.5, p=0.001) and

reported less arthritic pain (visual analogue scale 3.2±2.8 vs 4.5±2.9 cm,

p=0.033). As a group, when supplement usage alone was excluded, non

supplement users had fewer co-morbidities (CCI 1.85± 0.9 vs 2.31±1.6,

p=0.048). Nutritional supplements were widely used (52.4%), especially among

younger patients (mean age 57.0±15 vs 63.1±15 years, p=0.009) with shorter

disease duration (13.8±11 vs 17.9±13 years, p=0.041) who experienced more

fatigue (4.95± 3.1 vs 3.89±2.9 cm visual analogue scale, p=0.029).

Interestingly, there was no association between the HAQ disability score and

any of the above CAM modalities.

Conclusion: This report, as well as others, demonstrates that use of CAM in

RA patients is both broad and deep. CAM is no longer the option of last

resort.