Complementary and Alternative Medicine Use in Rheumatoid Arthritis
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COMPLEMENTARY AND ALTERNATIVE MEDICINE (S KOLASINSKI, SECTION EDITOR)
Complementary and Alternative Medicine Use in Rheumatoid Arthritis Sara Baig 1
&
Dana D. DiRenzo 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Despite advances in pharmacologic management of rheumatoid arthritis (RA), complementary and alternative medicine (CAM) remains popular adjuncts to therapy among patients for ongoing symptomatology. Recent Findings Mind-body interventions are becoming increasingly popular, including yoga and meditation. Randomized controlled trials have found these interventions to be helpful regarding pain, mood, and energy in RA patients. Other CAM modalities, such as natural products, special diets, acupuncture, and body-based therapies, also continue to be used by RA patients with limited evidence for efficacy and safety. Summary While there are numerous CAM interventions available, the data is very limited at this time with only low-quality evidence supporting various therapies. Medical providers are more open to the addition of CAM in their patients and require increased education on the topic. Additional research needs to be conducted in order to provide evidence-based recommendations to our patients. Keywords Complementary and alternative medicine . Rheumatoid arthritis . Integrative medicine . Mind-body practices
Introduction Over the past two decades, there have been major advances in the pharmacologic management of rheumatoid arthritis (RA) and implementation of treat-to-target approaches [1]. Despite this, the use of complementary and alternative medicine (CAM) remains prevalent and may even delay time to initiation of DMARD therapy [2]. Major CAM modalities include alternative medical systems (traditional Chinese medicine, Ayurveda, homeopathic treatment, naturopathy, acupuncture), biologically based therapies (chelation therapies, folk medicine, herbs, and supplements), diet-based therapies, megavitamin therapies, body-based and manipulative medicines (chiropractic use, massage), and mind-body feedback (biofeedback, yoga, tai chi, qigong, mindfulness, meditation, healing rituals, Reiki), among others [3•, 4•]. This article is part of the Topical Collection on Complementary & Alternative Medicine * Dana D. DiRenzo [email protected] 1
Johns Hopkins University, 5501 Hopkins Bayview Circle/Asthma & Allergy Building, Suite 1B.1, Baltimore, MD 21224, USA
Specifically, in arthritis, a survey of primary care clinics found that 90% of patients had “ever use” of CAM and about 70% were using CAM therapy at the time of the survey [5]. More broadly, the economic impact of CAM use is substantial and estimated to be $28.3 billion–$30.2 billion for all adults based on a 2016 analysis of the National Health Interview Survey (NHIS) [6]. These amounts represent 9.2% of total out-of-pocket expenditure by Americans on healthcare and 1.1% of all healthcare expenditure in the USA. For patients with arthritis, preferences for CAM modalities have shifted between the last two
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