Alternative Medicine Use in Arthritis Patients
“Complementary and alternative” (or “CAM”) medicine is among expressions applied to treatments not usually prescribed by practitioners of “conventional” medicine. A study published in the Sept. 21 issue of the Annals of Internal Medicine revealed the extent of utilization of “complementary, alternative medicine” among 232 patients of six Indiana arthritis (Rheumatology) practices.
CAM use in the United States has skyrocketed, particularly in the five years since so-called “nutritional supplements” have no longer been required to be under the regulation of the federal Food and Drug Administration. A recent survey showed that in 1997, about four out of 10 Americans used CAM, making an estimated 629 million visits to practitioners of alternative medicine, almost double the number of visits to primary care physicians. Total out-of-pocket expenses related to CAM use were $27 billion, an amount equivalent to expenditures for all physician services.
The use of CAM in arthritis patients was studied because arthritic conditions — including osteoarthritis, rheumatoid arthritis and fibromyalgia — are chronic, painful, and of unknown cause and cure. Also, prior studies have shown that arthritis sufferers are particularly prone to using CAM. Since patients with rheumatoid arthritis are often on multiple medications with potentially serious side effects, it is especially important to attempt to fully understand the process of decision making about CAM use in such patients. This study analyzed both past and current CAM use, as well as correlates of such use with education, diagnosis, and patient-physician satisfaction.
Analysis of survey data revealed that two-thirds of the patients used CAM at some point. Fifty-six percent of these were current users, and 90 percent of these were currently or recently had been regular CAM users. One-quarter had used three or more types of the following CAM techniques: herbal remedies, chiropractic manipulation, high-dose vitamins or elimination diets. People who used CAM regularly were more likely to have osteoarthritis and severe pain, and were more likely to be college-educated, than patients who never used CAM.
Less than half of those who used CAM discussed its use with their physician. Rather than being fearful of revealing this information, the most common reason for this communication barrier was simply that the MD had neglected to inquire about this therapy. Surprisingly, almost three-quarters of the patients who had discussed their CAM use reported that their physicians supported their continued use of CAM.
“The treatment of arthritis is often frustrating for doctor and patient alike,” noted Dr. Robert A. Greenwald, Chief of Rheumatology at Long Island Jewish Medical Center, and Professor of Medicine at the Albert Einstein College of Medicine in New York City. “Therefore, it is not surprising that such patients will seek out alternative remedies to help relieve their suffering. When used in addition to accepted medical treatment, and with the knowledge of their physician, such use is reasonable. But patients who abandon standard treatments for unproven alternative methods are a cause for concern, as this therapy may prove not only worthless, but dangerous.”
It is essential, given the burgeoning use of these methodologies, that more information be collected and analyzed concerning CAM use in other patient populations, especially among primary care practices. The potential for adverse effects of these remedies, both on their own and regarding adverse interactions with traditional, regulated medications, should require caregivers to be alerted to such usage and discuss it with their patients, since many will not volunteer this information.