Ann Intern Med. 1999 Sep; 131(6): 409-16.

Use of complementary therapies for arthritis among patients of rheumatologists.

Rao JK, Mihaliak K, Kroenke K, Bradley J, Tierney WM, Weinberger M.

Roudebush Veterans Affairs Medical Center, Indiana University School of Medicine, and Regenstrief Institute for Health Care, Indianapolis 46202, USA.

BACKGROUND: Use of complementary and alternative medicine (CAM) is common among persons with chronic conditions. OBJECTIVE: To identify correlates of and describe patients' perspective on use of CAM for rheumatologic conditions. DESIGN: Telephone survey. SETTING: Three university practices and three private rheumatology practices. PATIENTS: 232 of 428 eligible consecutive patients (54%) with scheduled appointments. MEASUREMENTS: Patients answered questions on CAM use, functional status, pain, provider satisfaction, and health services utilization. Chart reviews provided demographic information and rheumatologic diagnoses. Bivariate analyses identified correlates of four CAM outcomes (history, magnitude, and frequency of CAM use and communication about CAM use with a physician), and multiple logistic regression identified independent correlates of regular CAM use. RESULTS: Approximately two thirds of the respondents (n = 146) had used CAM. Of these 146 respondents, 82 (56%) currently used CAM and 132 (90%) regularly used CAM or had done so in the past. Fifty-five respondents (24%) had used three or more types of CAM. In multivariate analyses, persons who used CAM regularly were more likely to have osteoarthritis (odds ratio, 5.6 [95% CI, 1.9 to 16.8]), severe pain (odds ratio, 2.5 [CI, 1.4 to 4.8]), and a college degree (odds ratio, 2.6 [CI, 1.3 to 5.4]) than patients who had never used CAM. Nearly half of the respondents discussed CAM use with their physicians. The most common reasons for not disclosing CAM use were that the physician had not asked about it and that the patient forgot to tell the physician; fear of disapproval was rarely cited. Discussions about CAM use between patient and physician occurred more frequently among patients with fibromyalgia and persons who regularly used CAM or used several types of CAM. CONCLUSIONS: Patients with rheumatologic conditions frequently use CAM. Severe pain and osteoarthritis predict regular use of CAM but do not predict a greater likelihood of discussing CAM use with physicians. Routine inquiry by physicians will probably detect CAM use.