Complementary med use linked to delayed DMARD initiation
The use of complementary or alternative medicines was associated with a longer delay to initiation of disease-modifying anti-rheumatic drug (DMARD) therapy in patients with early inflammatory arthritis, according to a Singapore study.
Participants in the Singapore Early Arthritis Cohort study were 180 adults with early inflammatory arthritis (median age 51.1 years, 70.6 percent female, median symptom duration 16.6 weeks), 41.3 percent of whom (n=74) used complementary or alternative medicines. Of the cohort, 83.9 percent (n=151) had rheumatoid arthritis, 12.8 percent (n=23) had psoriatic arthritis, and 3.3 percent (n=6) had undifferentiated inflammatory arthritis.
Compared with nonusers, patients who used complementary or alternative medicines were more likely to delay starting DMARD therapy (median 21.5 vs 15.6 weeks, hazard ratio [HR], 0.69, 95 percent confidence interval [CI], 0.50–0.95; p=0.02). [Int J Rheum Dis 2017;20:567-575]
Higher DAS28* was also associated with delay in initiating DMARDs (HR, 0.63, 95 percent CI, 0.43–0.91; p=0.01). In contrast, an elevated mHAQ** score was associated with a shorter delay to initiating DMARDs (HR, 1.59, 95 percent CI, 1.08–2.34; p=0.02).
Use of complementary or alternative medicines was especially common in patients of Chinese ethnicity (odds ratio [OR], 5.76; p<0.001), smokers (OR, 3.35; p=0.02), non-English speaking patients (OR, 2.68; p=0.02), and patients with high DAS28 scores (OR, 2.73; p=0.04).
Median time between symptom onset and DMARD initiation was 17.4 weeks. According to the researchers, the delay in DMARD initiation in this study was primarily due to delays from the patients or primary care physicians.
“It is possible that patients with higher DAS28 were more likely to be prescribed non-steroidal anti-inflammatory drugs or corticosteroids ... or have blood tests ordered by their [primary care physician] prior to referral, thus increasing [primary care physician] delay,” they said.
“[There] is a window of opportunity for treatment in early [rheumatoid arthritis]; patients treated early with DMARDs have a higher chance of attaining remission ... and accrue less joint damage, leading to less risk of future disability and work loss and increased quality of life,” said the researchers, who acknowledged the small number of patients in this study and inability to account for patients who visited private rheumatologists as limitations.
“[Complementary or alternative medicine use] is highly prevalent ... and is associated with a delay in presentation and initiation of DMARD therapy. Healthcare professionals should be aware of these unique challenges in treating patients with [early inflammatory arthritis] in Asia,” they said.