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Complementary medicine in patients with rheumatic diseases,CAM

Can the use of complementary and alternative medicine be a predictor of outcomes in patients with rheumatic conditions, and is there a change of this theme over time in patients with early rheumatoid arthritis? The aim is to determine the use of CAM in patients with all types of rheumatic diseases and to evaluate how its use may correlate with or predict the outcome of patients with early RA.

Study description

Questionnaires will be utilized in this study based on earlier national and international investigations in complementary and alternative medicine (CAM) and rheumatic diseases. The actual questionnaire targeting CAM status and utilization in patients with rheumatic diseases has previously been developed by a research group in Gothenburg University who published results on CAM use in patients with rheumatic diseases in western Sweden. The CAM questionnaire, together with established questionnaires covering health related quality of life (EQ-5D and SF-36) and functional status (HAQ), will be administered to patients at the Rheumatology Clinic at Karolinska University Hospital who are treated according to standard clinical practice. Quantitative variables will be gathered from standardized measures of clinical practice by the doctors who meet the patients, such as tender/swollen joints, DAS28, and the visual analog scale (VAS). Data from each patient’s log (with information of all their treatments, and so forth) will also be included. In the first phase of this study, a wide variety of patients with all rheumatic conditions with varying sickness durations will be included. This will be performed to identify eventual differences in CAM use across the different patient groups, type of disease, sickness duration, etc. Previous findings have shown that the likelihood of patients using CAM is directly proportional to the length of the disease duration and/or if they are so called “non-responders” to conventional treatment. In phase two of this study – after completion of phase one – a follow-up will be performed at months 6 and 12 only on those patients who were remitted to the clinic and diagnosed with early RA. Differences between phase one and two will be evaluated. The gathered data from both phases will aid in the estimation of the proportion of patients with all types of rheumatic diseases that utilize CAM; the utilization of CAM over time for patients with early RA; the patients' characteristics; which types of CAM that are utilized; and how CAM may or may not correlate with treatment outcomes and disease activity as measured by standard medical procedures. For phase one, about 100 patients with rheumatic diseases visit the Rheumatology Clinical weekly, so we estimate that at least 100-200 can be included. For phase two, about 5-6 patients are remitted to the Rheumatology Clinic every week for early RA diagnosis and are then allocated to various studies. It is estimated that about 26 patients with eventual early RA diagnosis will be included in the second phase of this study.


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Adrian Levitsky, Graduate student
Tobias Sundberg, Ronald van Vollenhoven
08-517 730 65