Background/Purpose: Complementary and Alternative Medicine (CAM) is commonly used when traditional medicine cannot reliably alter the disease.  Over the past decade, rheumatoid arthritis (RA) treatment has improved dramatically whereas osteoarthritis (OA) treatment has not.  Accordingly, CAM use should be trending downward in RA relative to OA.  Previous studies of CAM use by RA and OA patients have been limited by inaccurate diagnosis of arthritis and lack of long term trending.  The purpose of this study was to evaluate the use of CAM in a well-defined population of RA and OA patients now and compared with a similar population 12 years previously.

Methods: 104 OA patients and 102 RA patients attending a Rheumatology clinic twice between May 1, 2011 and June 30, 2012 returned an 84 item questionnaire assessing their CAM use in the past 6 months.  Inclusion criteria were met with ICD-9 codes; patients with other co-existing rheumatologic conditions were excluded.  This survey was compared to survey results previously reported in 2000 assessing CAM use. 

Results: In 2012, most participants were female (OA, 84%; RA, 74%).  RA patients were younger and reported less pain than OA patients (57.9 vs. 70.1 years old, p<0.001; 3.5 vs. 4.9 on a 0-10 cm pain scale, p<0.001).  Only 25% of OA and 20% of RA patients reported that their rheumatologist asked about CAM use.  Likewise, only 30% of OA and 26% of RA patients reported that they told their rheumatologist about their CAM use. 

In 2012, prayer was the most popular form of CAM for both OA and RA patients (63% and 61%) followed by glucosamine/chondroitin, green tea, fish oil, massage, and chiropracty (Figure 1).  Additionally, glucosamine, chondroitin, fish oil, and water therapy were tried more commonly by OA patients than RA patients.

No significant decreases were found overtime in CAM use by RA patients compared with trends observed in OA patients for CAM use overall or by CAM category.  Compared to 2000, RA patients in 2012 reported having tried several forms of CAM for specific treatment of their arthritis more often including cartilage, flaxseed, green tea, and melatonin (p=0.049, 0.049, 0.046, 0.014).  Chiropracty, fish oil, and yoga were also tried more often by RA patients in 2012 (p=0.078, 0.007, 0.008). 

Conclusion: Despite pharmacologic advances for RA compared to OA over the past decade, there was not a decline in the use of CAM among RA patients.  Prayer remains the most common CAM for both OA and RA patients in 2012.  Increased use of certain individual therapies may reflect current cultural/market trends or possible immunologically active properties.  A gap in communication between patient and physician about CAM use was identified, which is concerning due to the undetermined efficacies of the majority of CAM therapies.  This may serve as an opportunity to change current practice and to improve shared medical decision making.