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Most patients with chronic rheumatic diseases seek adjunctive care outside the medical mainstream. Although patients usually maintain relationships with medical physicians and take prescription medications, most will add some form of complementary and alternative therapy at some point during the course of their illness. Patient choices reflect their cultural and ethnic background, their financial resources, the availability of alternative providers, and their perception and satisfaction with conventional medicine. Not all interventions have been studied in a scientifically rigorous manner, but well-designed clinical trials continue to be published in a wide range of areas relevant to patients with rheumatic diseases.


Complementary and alternative medicine (CAM) has been defined as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. With the recognition of its widespread use and the provision of services like acupuncture within academic medical centers, however, defining the limits of alternative medicine has become more difficult. The National Center for Complementary and Alternative Medicine (NCCAM), established by Congress in 1998 as one of the centers within the National Institutes of Health (NIH), has revised its categorization of CAM therapies into (1) natural products (herbal medicines, vitamins, minerals, dietary supplements, probiotics); (2) mind-body medicine (meditation, yoga, acupuncture, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, qi gong, tai chi); (3) manipulative and body-based practices (spinal manipulation, massage therapy); (4) movement therapies (Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, Trager psychophysical integration); (5) practices of traditional healers (Native American practices); (6) energy medicine (magnet therapy, light therapy, Reiki, healing touch); and (7) whole medical systems (Ayurvedic medicine, traditional Chinese medicine). Furthermore, with the increasing number of randomized controlled trials examining these therapies, practitioners have a growing body of resources with which to evaluate the usefulness of CAM therapies, provide advice to patients, and consider incorporating CAM into standard treatment plans.


Epidemiologic evidence from the 2007 National Health Interview Survey suggests that about 38% of the general public seek alternative care in a given year. Demographic data show that patients who use CAM are more likely to be older than age 65, have some college education, be in higher income brackets, and are less likely to be a member of a racial or ethnic minority. Patients with rheumatic disease who seek alternative care, however, use CAM more frequently and are more demographically diverse. Use correlates with pain and, for instance, over 90% of patients with diagnoses such as fibromyalgia may seek alternative care. Similarly, a variety of ethnic and racial groups and the elderly with musculoskeletal complaints have higher rates of CAM use than average American populations. Furthermore, recent data show that patients are considerably more likely to discuss their CAM use with their physician than they were in the past.

Quality & Safety Issues

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