In response to new evidence that more than one in three US adults continue to use at least one form of complementary and alternative medicine (CAM), some rheumatologists report that that these numbers most likely include continually increasing numbers of arthritis patients, especially in light of the abrupt withdrawal of rofecoxib (VioxxR) from the market due to increased risk of cardiovascular (CV) events and the growing suspicion that this is, in fact, a class effect.
"I think there will be an increase [in use of alternative therapies among arthritis patients] and it will be good and bad," said Jason Theodosakis, MD, of the University of Arizona College of Medicine in Tucson, Arizona, and author of Arthritis Cure and Maximizing the Arthritis Cure. "It will be bad if people are scammed by bad products or those with little evidence and good if people can stay off of drugs, institute lifestyle changes, and learn that they can help their joints even if pain relief doesn't occur right away or at all."
The new report, which appears in the January/February issue of Alternative Therapies in Health and Medicine, compares results of the 2002 National Health Interview Survey with a similar survey conducted by researchers at Harvard Medical School in Boston, Massachusetts, in 1997. Prior to this study, there had been no head-to-head comparisons utilizing a common definition of CAM. The new study analyzed use of 15 modalities similar to both surveys.
While the overall incidence in the use of CAM by Americans remained stable at about 72 million over the 5-year period (36.5% in 1997 and 35% in 2002), there was fluctuation in choice of CAM therapies, the study showed.1
Specifically, there was a 50% leap in use of herbal supplements during the 5-year period. In 1997, 12.1% of adults reported using herbal supplements, compared with 18.6% in 2002. Moreover, the practice of yoga increased 40% from 1997 to 2002, the study found.
Acupuncture, biofeedback, and energy healing remained unchanged between 1997 and 2002. By contrast, use of homeopathy, high-dose vitamins, and chiropractic and massage therapy dipped slightly during the 5-year period. Among users of CAM, 41% used two or more such therapies. The factors most associated with use include ages 40 to 64 years, female gender, non-African-American/non-Hispanic ethnicity and an annual income of $65,000 or higher, according to the new study.
Expert predicts further increase of CAM among arthritis community
In the wake of the rofecoxib withdrawal, rheumatologists will probably recommend more ice and acetaminophen, Dr. Theodosakis said, but most are now learning about avocado-soybean unsaponifiable (ASU), glucosamine, and chondroitin. "They may be more likely to recommend these products now," he predicted. To that end, results from the large-scale National Institutes of Health (NIH)-sponsored Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) are now being tallied. These results may provide a definitive answer on the effectiveness of these supplements.
Onus on Rheumatologists
Rheumatologists need to "keep up on drug-herb interactions and be wary
of herbal COX-2 inhibitors," Dr. Theodosakis said. "They should ask patients what they're taking, including the dose, form, and brand, and chart the interventions to determine what may actually be helping and what's a waste of money." Patients are often not forthcoming with their physicians about CAM use.
The new study authors concur. "These survey data underscore the need for continuing efforts to rigorously evaluate the safety, efficacy, mechanism, and cost-effectiveness of CAM therapies used by the American public."
CAM and arthritis actively being studied
In related recent news, acupuncture was shown to provide pain relief and improve function for people with knee osteoarthritis (OA).2 The phase III clinical trial also showed that acupuncture is an effective complement to standard care. Patients were randomly assigned to receive acupuncture, sham acupuncture, or to participate in a control group that followed the Arthritis Foundation's self-help course for managing their condition. Patients continued to receive standard medical care from their primary physicians including anti-inflammatory medications.
By week 8, participants receiving acupuncture were showing a significant increase in function and by week 14, a significant decrease in pain compared with the sham and control groups. These results, illustrated by declining scores on the Western Ontario McMasters Osteoarthritis Index (WOMAC) index, held through week 26. Overall, those who received acupuncture had a 40% decrease in pain and a nearly 40% improvement in function compared to baseline assessments.
Use of CAM will continue to grow in the arthritis community, predicted acupuncture study author Marc Hochberg, MD, professor of medicine at the University of Maryland School of Medicine in Baltimore. "More people will be turning to these measures because, as the population ages, more people will develop symptomatic musculoskeletal disease including arthritis," he told CIAOMed.
"People are more risk averse and they feel that CAM is safe because it's not a drug," Dr. Hochberg said. As a result, "people will continue to seek out these types of therapies." Adding that randomized controlled clinical trials on use of CAM therapies are extremely important, he emphasized that "the data are actually fairly crucial in order to demonstrate the efficacy and safety of these treatments."
In the meantime, Dr. Hochberg cautioned, "doctors should be asking their patients whether they take nonprescription medications, which include vitamins, minerals, and OTC products, including supplements, and whether they utilize any type of CAM including acupuncture, massage, chiropractice, etc."
References:
- Tindle HA, Davis RB, Phillips RS, Eisenberg DM.. Trends in Use of Complementary and Alternative Medicine by US Adults: 1997-2002 . Altern Ther Health Med. 2005;11:42-49.
- Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled tiral. Ann Intern Med. 2004;141:901-910.