Longitudinal Use of Complementary and Alternative Medicine Among Older Adults With Radiographic Knee Osteoarthritis

Abstract

Background Osteoarthritis (OA) accounts for more mobility issues in older adults than any other disease. OA is a chronic and often painful disease for which there is no cure. Cross-sectional studies have shown that older adults frequently use complementary and alternative medicine (CAM) and arthritis is the most common reason for CAM use. While previous research has profiled the sociodemographic and clinical characteristics of CAM users, few have provided information on variation in CAM use over time and most only considered use of any CAM, which was often a mixture of heterogeneous therapies. Objectives This study sought to describe the longitudinal patterns of CAM use among older adults with knee OA, and to identify correlates/predictors of different commonly-used CAM therapies. Methods The Osteoarthritis Initiative included 1,121 adults aged 65 years and above with radiographic tibiofemoral OA in one or both knees at baseline. Annual surveys captured current use of conventional therapies and 25 CAM modalities (grouped into 6 categories) for joint pain or arthritis at baseline and during the 4-year follow-up. We assessed longitudinal use of CAM modalities by summing the number of visits with participants reporting use of each modality. Correlates of CAM use under consideration included sociodemographic indicators, body mass index, overall measures of mental and physical wellbeing, and clinical indices of knee OA. Generalized estimation equations provided adjusted odds ratio estimates and 95% confidence intervals. Results Nearly one third of older adults reported using ≥ one CAM modality for treating OA at all assessments. With the exception of glucosamine and chondroitin (18%), few were persistent users of other CAM modalities. One in five of those using NSAIDs or glucosamine/chondroitin were using them concurrently. Adjusted models showed: 1) adults aged ≥75 years were less likely to use dietary supplements than those aged between 65 and 75 years; 2) persons with more severe knee pain or stiffness reported more CAM use; 3) better knee-related physical function was correlated with more use of chiropractic/massage; 4) older adults with more comorbidities were less likely to report use of dietary supplements. Conclusion Patterns of CAM use are, to some extent, inconsistent with current guidelines for OA treatment. Evaluating the potential risks and benefits in older adults from commonly-used CAM modalities, with or without combination use of conventional analgesics, is warranted.

Inhibition of cartilage degradation and suppression of PGE2 and MMPs expression by pomegranate fruit extract in a model of posttraumatic osteoarthritis

“…Currently, goals of OA management include controlling pain, maintaining and improving the range of movement and stability of affected joints, and limiting functional impairment [20, 21]. Because of the association of severe adverse events with the use of NSAIDs, at least one third of the older adults use some form of complementary and alternative medicine (CAM) for pain [22, 23]. …”

Acceptability of a Guided Imagery Intervention for Persons Undergoing a Total Knee Replacement

“…Rispler, Sara, Davenport, Mills, & Iskra, 2011; D. T. Rispler & Sara, 2011; Yang, Dubé, Eaton, McAlindon, & Lapane, 2013). Guided imagery (GI), the generation of positive sensory and affective images to promote therapeutic outcomes (Nelson et al, 2013), is a complementary approach for persons with osteoarthritis (Fouladbakhsh, 2012).…”

Complementary medicine for the management of knee and hip osteoarthritis – A patient perspective

“…For example, in the UK, the National Institute for Health and Care Excellence (NICE) recommend the integration of manual therapy, but not acupuncture, in their OA management guidelines (National Institute for Health and Care Excellence, ), whereas acupuncture is recommended management in the US (National Institute of Arthritis and Musculoskeletal and Skin Diseases, ). In line with such inconsistency, a longitudinal study of 1121 older adults with knee OA found that about one‐third used at least one or more complementary medicines or therapies (CMTs) to manage their OA, but that such use was to some degree inconsistent with treatment guidelines (Yang, Dubé, Eaton, McAlindon, & Lapane, ). A recent US population‐based study similarly found that more than one‐third of adults with arthritis sought complementary care to manage their health, concluding that dialogues that foster open and nonjudgmental communication and sharing between conventional and complementary healthcare providers and patients should be encouraged, to facilitate best possible patient care (Zhang et al, ).…”