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Rheumatic drug adherence higher among users of traditional Chinese medicine
The use of traditional Chinese medicine among Chinese American patients with rheumatic diseases is associated with a higher adherence to prescribed Western medications, according to data published in Arthritis Care & Research.
“Chinese Americans are one of the fastest growing immigrant groups in the United States, and they are known to have higher prevalence and worse outcomes in certain rheumatic diseases, such as lupus,” Kai Sun, MD, MS, of Duke University Medical Center, told Healio Rheumatology. “However, they are typically not included in significant numbers in research studies, partly because of cultural and language barriers.”
“Culturally, it is common for Chinese American patients to use traditional Chinese medicine (TCM), which includes many herbal and non-herbal modalities,” Sun added. “This has implications on their conventional Western treatments and therefore rheumatic disease outcomes, as herbs may interact with rheumatic disease medications, and some patients may choose to replace conventional medications with TCM. Whether TCM use affects adherence to conventional rheumatic disease treatments has not been studied before.”
To evaluate whether the use of traditional Chinese medicine is associated with lower adherence to western rheumatic drugs, Sun and colleagues studied patients at two private-practice clinics located in New York City’s Chinatown neighborhood. Both clinics are staffed by three board-certified rheumatologists, all Chinese Americans who are fluent in Mandarin Chinese. Neither clinic offers traditional Chinese medicine as treatment.
The researchers included in their study 230 adults who were of Chinese ethnicity, fluent in either English or Mandarin Chinese and being annually followed for a rheumatic disease, for which they have been prescribed at least one Western medication.
Sun and colleagues collected self-reported health status updates from participants using the PatientReported Outcome Measurement Information System (PROMIS) short forms. Drug adherence was stratified using the 8item Morisky Medication Adherence Scale. Multivariate regression was used to identify factors independently associated with high adherence. Evaluated forms of traditional Chinese medicine among patients included oral and topical herbs, acupuncture, acupressure, moxibustion, therapeutic massage, cupping, gua sha, tai-chi, qigong and food therapy.
According to the researchers, 41% of participants were diagnosed with rheumatoid arthritis, 17% had systemic lupus erythematosus and 15% had seronegative spondyloarthropathies. Half of the participants reported using traditional Chinese medicine in the past year, and 28% reported high adherence to Western rheumatic drugs. The most common traditional medication among the patients were therapeutic massage, called tuina, which was used by 47%; acupuncture, used by 45% of participants; and herbs, administered by 37%.
After completing multivariate analysis, the researchers found that high adherence to western rheumatic drugs was associated with the use of traditional Chinese medicine (OR = 3.96; 95% CI, 1.86-8.4). Other factors independently associated with high adherence were being married (OR = 3.69; 95% CI, 1.52-9), medication regimen complexity (OR = 1.13; 95% CI, 1.04-1.22) and older age (OR = 1.06; 95% CI, 1.03-1.09). High adherence was negatively associated with anxiety (OR = 0.94; 95% CI, 0.91-0.97).
“We have all had patients who preferred natural or alternative treatments over conventional medicines, and Western-trained physicians tend view TCM and conventional Western medicines as competing therapies,” Sun said. “However, our study suggests that Chinese American patients view TCM as a complementary as opposed to an alternative form of treatment to conventional rheumatic disease medications.”
“In caring for this patient population, it would be important to ask about TCM use,” she added. “More open communication and discussion about traditional therapies and cultural beliefs may promote adherence to Western medications in less acculturated patient populations.” – by Jason Laday
Disclosure: The researchers report grant support from the NIH.
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