Use of complementary and alternative medicines is associated with delay to initiation of disease-modifying anti-rheumatic drug therapy in early inflammatory arthritis

Objectives To study the predictors of complementary and alternative medicine (CAM) use in patients with early inflammatory arthritis (EIA), and its impact on delay to initiation of disease-modifying anti-rheumatic drugs (DMARD). Methods Data were collected prospectively from EIA patients aged ≥ 21 years. Current or prior CAM use was ascertained by face-to-face interview. Predictors of CAM use and its effect on time to DMARD initiation were determined by multivariate logistic regression and Cox proportional hazards, respectively. Results One hundred and eighty patients (70.6% female, 58.3% Chinese), of median (interquartile range [IQR]) age 51.1 (40.9–59.8) years and symptom duration 16.6 (9.2–26.6) weeks were included: 83.9% had rheumatoid arthritis, 57% were seropositive. Median (IQR) Disease Activity Score in 28-joints (DAS28) was 4.3 (2.8–5.7), modified Health Assessment Questionnaire (mHAQ) was 0.38 (0.0–0.88) and 41.3% were CAM users. Chinese race (odds ratio [OR] 5.76 [95%CI 2.53–13.1]), being non-English speaking (OR 2.68 [95% CI 1.18–6.09]), smoking (OR 3.35 [95% CI 1.23–9.15] and high DAS28 (OR 2.73 [95% CI 1.05–7.09] were independent predictors of CAM use. CAM users initiated DMARD later (median [IQR] 21.5 [13.1–30.4] vs. 15.6 [9.4–22.7] weeks in non-users, P = 0.005). CAM use and higher DAS28 were associated with a longer delay to DMARD initiation (hazard ratio [HR] 0.69, 95% CI 0.50–0.95 and 0.63, 95% CI 0.43–0.91, respectively) while higher mHAQ was associated with a shorter delay (HR 1.59, 95% CI 1.08–2.34) and race, education level, being non-English speaking, smoking and seropositivity were not associated. Conclusions Healthcare professionals should be aware of the unique challenges in treating patients with EIA in Asia. Healthcare beliefs regarding CAM may need to be addressed to reduce treatment delay.