Background/Purpose: High adherence is crucial for the management of rheumatic diseases. Nonadherence is more common among immigrants and minorities and may contribute to known outcome disparities. Chinese-American patients commonly use Traditional Chinese Medicine (TCM) and have worse outcomes in lupus and rheumatoid arthritis. Adherence among Chinese-American rheumatology patients has not been previously studied, and whether TCM use affects adherence to prescribed rheumatic disease medications is unknown.

Methods: Subjects were recruited from two rheumatology clinics that serve a predominantly Chinese-American immigrant population. Inclusion criteria were Chinese ethnicity, Mandarin or English fluency, and actively followed and prescribed ≥1 non-pro re nata (PRN), non-intravenous medication for a systemic rheumatic disease by rheumatologist. TCM use, adherence, Patient-Reported Outcomes Measurement Information System (PROMIS) domains, and other variables were assessed using validated instruments available in English and Chinese. Adherence was classified as high or medium/low based on the 8-item Morisky Medication Adherence Scale. Medication complexity was assessed using the Medication Regimen Complexity Index; higher score indicates more complexity. Chart review was performed to gather additional clinical data. Parametric and nonparametric statistics were performed as appropriate. Multivariable logistic regression using step-wise selection was used to assess factors independently associated with high adherence.

Results: 230 enrolled, median age 55 years (range 20-97), 65% female, 71% ≤ high school education, 70% Medicaid, and 22% reported English fluency. 50% reported TCM use in the past year, most frequently tuina massage (47%), acupuncture (45%), and herbs (37%). The three most common diagnoses were RA (41%), SLE (17%), and spondyloarthritis (15%), with median time since diagnosis of 4.1 years (range 0.2-52). High adherence to western medicine was found in 28.3%, while 37.4% and 34.4% had medium and low adherence. Both herb and non-herb TCM users had better rates of high adherence to western medicine compared to TCM nonusers (33% and 39% vs. 20% respectively, p=0.02). In multivariable analysis, high adherence was independently associated with TCM use (Odds Ratio [OR] 3.2, 95% confidence interval [CI] 1.6-6.7, p=0.002), older age (OR 1.1, 95% CI 1.03-1.1, p<0.001), unemployment (OR 4.1, 95% CI 1.5-11, p=0.005), married/living with partner (OR 2.3, 95% CI 1.2-5.9, p=0.02), more complex rheumatologic medication regimen (OR 1.1, 95% CI 1.02-1.2, p=0.02), and lower levels of anxiety (OR 0.9, 95% CI 1.02-1.1, p=0.001).

Conclusion: Among poorly integrated, low education, and low socioeconomic status Chinese-American rheumatology patients, high adherence rate was poor. TCM use was statistically significantly associated with high adherence to western medication. TCM use does not appear to represent an alternate but rather complementary approach to disease management. Future studies should evaluate whether TCM use is associated with disease activity and outcomes over time.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-chinese-american-rheumatology-patients-who-use-traditional-chinese-medicine-less-adherent-to-prescribed-western-medications/