Objectives To study the frequency of use of complementary and alternative medicine (CAM) in Chinese patients with rheumatic diseases and the associated demographic, clinical and social factors.
Methods A cross-sectional questionnaire study on the use of CAM was carried out in patients who attended the rheumatology clinics of Tuen Mun and Pok Oi Hospital between June and December 2014. Inclusion criteria: adult patients (≥18 years) with chronic autoimmune rheumatic diseases. Exclusion criteria: illiterate or mentally incapable. Basic demographic, psychosocial factors and clinical information were obtained by questionnaire completion and medical record review. The self-perceived control of the underlying disease process was assessed on a visual analog scale (0-100), with higher score being a more sense of disease remission. Missing information was clarified with phone contact of the participants by our research assistants. A multivariate logistic regression model was established to study the factors associated with the use of CAM.
Results 1335 patients were studied (75% women, age 48.4±13 years). The underlying rheumatic diseases were: rheumatoid arthritis (RA) (N=642), systemic lupus erythematosus (SLE) (N=347), spondyloarthritis (SpA) (N=142), psoriatic arthritis (PSA) (N=91), systemic sclerosis (SSc) (N=39), inflammatory myopathies (N=14), systemic vasculitides (N=10) and miscellaneous rheumatic disorders (N=50). The mean disease duration was 9.7±8.4 years and the mean years of education in the participants was 10.4±2.9 years. 473 (35%) patients were single/divorced/widowed and 142 (11%) patients were receiving government subsidy for living (poverty). 400 (30%) patients had religious belief: Buddhism (46%), Christianity (43%). The self-perceived score of disease control was 64.8±23. CAM was ever used in 705 (53%) patients and the most common forms of CAM were: traditional Chinese medicine (TCM)(59%), acupuncture (44%), massage (24%), cupping (17%) and omega-3 fatty acid (15%). The proportions of patients with different underlying diseases who had ever used CAM were: SpA (64%), PSA (60%), SSc (59%), RA (54%), SLE (44%), systemic vasculitides (40%). Only 41% of these patients had informed medical staff about the use of CAM and 4% patients had altered the dosage of western medicine without advice from their attending rheumatologists. 505 (72%) patients found CAM somehow effective in alleviating their symptoms. Logistic regression analysis showed that the use of CAM was associated with the presence of religious belief (odds ratio [OR] 1.29 [1.00-1.67]; p=0.047), years of education (OR 1.08 [1.02-1.13]; p=0.005), disease duration (per year) (OR 1.02 [1.006-1.04]; p=0.005) and self-perceived score for disease control (per point) (OR 0.992 [0.99-0.997]; p=0.003). Age, sex, family income and marital status were not associated with the use of CAM.
Conclusions The use of CAM is common in Chinese patients with rheumatic diseases, and may affect treatment adherence or aggravate the toxicities of existing therapies. Associated factors for CAM use are inflammatory arthritis, longer disease duration, higher educational background and a lower sense of perceived disease control. Better communication on the use of CAM should be made to our patients, particularly those who are more likely to adopt these measures.
Disclosure of Interest None declared