Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 May;63(5):549–554. doi: 10.1136/ard.2003.010637

Use of complementary medicines for osteoarthritis—a prospective study

J Zochling 1, L March 1, H Lapsley 1, M Cross 1, K Tribe 1, P Brooks 1
PMCID: PMC1754991  PMID: 15082486

Abstract

Background: Patients with osteoarthritis commonly use complementary and alternative medicines (CAM), either as an adjunct to or in place of conventional analgesics.

Objectives: To undertake a prospective investigation of the prevalence of CAM use for osteoarthritis and the direct costs incurred.

Methods: The subjects were 341 patients with osteoarthritis of the knee or hip drawn from central and northern Sydney, Australia, and comprising 83 community based patients and 258 awaiting joint replacement. Information on CAM use was obtained from prospective three monthly diaries. Variables of interest included health related quality of life scores. Prospective out of pocket costs were recorded over a 12 month follow up period.

Results: The prevalence of CAM use was 40%, which falls within the range of previous studies. Average annual expenditure on CAM was A$32.25 (range 0 to 603.30). CAM users were more likely to be female (odds ratio (OR) 1.8 (95% confidence interval, 1.1 to 3.0)), reported a higher level of bodily pain (OR 0.97 (0.95 to 0.99)), and were less likely to purchase conventional analgesics (OR 3.3 (1.6 to 7.0)), either prescribed or over the counter. Vitamin supplementation was the most common CAM reported, followed by celery extract, fish oils, and garlic extracts.

Conclusions: There are no good quality clinical trials to support the use of most preparations purchased by patients with osteoarthritis. There is a need for patient education on the risks and benefits of complementary medicine in osteoarthritis.

Full Text

The Full Text of this article is available as a PDF (224.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altman R. D., Marcussen K. C. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001 Nov;44(11):2531–2538. doi: 10.1002/1529-0131(200111)44:11<2531::aid-art433>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  2. Ausiello John C., Stafford Randall S. Trends in medication use for osteoarthritis treatment. J Rheumatol. 2002 May;29(5):999–1005. [PubMed] [Google Scholar]
  3. Bachmeier C. J., March L. M., Cross M. J., Lapsley H. M., Tribe K. L., Courtenay B. G., Brooks P. M., Arthritis Cost and Outcome Project Group A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage. 2001 Feb;9(2):137–146. doi: 10.1053/joca.2000.0369. [DOI] [PubMed] [Google Scholar]
  4. Bernstein J. H., Shuval J. T. Nonconventional medicine in Israel: consultation patterns of the Israeli population and attitudes of primary care physicians. Soc Sci Med. 1997 May;44(9):1341–1348. doi: 10.1016/s0277-9536(97)84076-2. [DOI] [PubMed] [Google Scholar]
  5. Bliddal H., Rosetzsky A., Schlichting P., Weidner M. S., Andersen L. A., Ibfelt H. H., Christensen K., Jensen O. N., Barslev J. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage. 2000 Jan;8(1):9–12. doi: 10.1053/joca.1999.0264. [DOI] [PubMed] [Google Scholar]
  6. Boisset M., Fitzcharles M. A. Alternative medicine use by rheumatology patients in a universal health care setting. J Rheumatol. 1994 Jan;21(1):148–152. [PubMed] [Google Scholar]
  7. Bruyere O., Honore A., Ethgen O., Rovati L. C., Giacovelli G., Henrotin Y. E., Seidel L., Reginster J-Y L. Correlation between radiographic severity of knee osteoarthritis and future disease progression. Results from a 3-year prospective, placebo-controlled study evaluating the effect of glucosamine sulfate. Osteoarthritis Cartilage. 2003 Jan;11(1):1–5. doi: 10.1053/joca.2002.0848. [DOI] [PubMed] [Google Scholar]
  8. Buchbinder R., Gingold M., Hall S., Cohen M. Non-prescription complementary treatments used by rheumatoid arthritis patients attending a community-based rheumatology practice. Intern Med J. 2002 May-Jun;32(5-6):208–214. doi: 10.1046/j.1445-5994.2002.00213.x. [DOI] [PubMed] [Google Scholar]
  9. Chantre P., Cappelaere A., Leblan D., Guedon D., Vandermander J., Fournie B. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine. 2000 Jun;7(3):177–183. doi: 10.1016/S0944-7113(00)80001-X. [DOI] [PubMed] [Google Scholar]
  10. Cherniack E. P., Senzel R. S., Pan C. X. Correlates of use of alternative medicine by the elderly in an urban population. J Altern Complement Med. 2001 Jun;7(3):277–280. doi: 10.1089/107555301300328160. [DOI] [PubMed] [Google Scholar]
  11. Elders M. J. The increasing impact of arthritis on public health. J Rheumatol Suppl. 2000 Oct;60:6–8. [PubMed] [Google Scholar]
  12. Felson D. T., Naimark A., Anderson J., Kazis L., Castelli W., Meenan R. F. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914–918. doi: 10.1002/art.1780300811. [DOI] [PubMed] [Google Scholar]
  13. Jacobs JWG, Kraaimaat F. W., Bijlsma J. W. Why do patients with rheumatoid arthritis use alternative treatments? Clin Rheumatol. 2001;20(3):192–196. doi: 10.1007/pl00011199. [DOI] [PubMed] [Google Scholar]
  14. Kaboli P. J., Doebbeling B. N., Saag K. G., Rosenthal G. E. Use of complementary and alternative medicine by older patients with arthritis: a population-based study. Arthritis Rheum. 2001 Aug;45(4):398–403. doi: 10.1002/1529-0131(200108)45:4<398::AID-ART354>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
  15. Kaufman David W., Kelly Judith P., Rosenberg Lynn, Anderson Theresa E., Mitchell Allen A. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002 Jan 16;287(3):337–344. doi: 10.1001/jama.287.3.337. [DOI] [PubMed] [Google Scholar]
  16. Lapsley H. M., March L. M., Tribe K. L., Cross M. J., Brooks P. M. Living with osteoarthritis: patient expenditures, health status, and social impact. Arthritis Rheum. 2001 Jun;45(3):301–306. doi: 10.1002/1529-0131(200106)45:3<301::AID-ART264>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
  17. Lawrence R. C., Helmick C. G., Arnett F. C., Deyo R. A., Felson D. T., Giannini E. H., Heyse S. P., Hirsch R., Hochberg M. C., Hunder G. G. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998 May;41(5):778–799. doi: 10.1002/1529-0131(199805)41:5<778::AID-ART4>3.0.CO;2-V. [DOI] [PubMed] [Google Scholar]
  18. Leeb B. F., Schweitzer H., Montag K., Smolen J. S. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000 Jan;27(1):205–211. [PubMed] [Google Scholar]
  19. Linde K., Clausius N., Ramirez G., Melchart D., Eitel F., Hedges L. V., Jonas W. B. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834–843. doi: 10.1016/s0140-6736(97)02293-9. [DOI] [PubMed] [Google Scholar]
  20. Linde K., Jonas W. B., Melchart D., Willich S. The methodological quality of randomized controlled trials of homeopathy, herbal medicines and acupuncture. Int J Epidemiol. 2001 Jun;30(3):526–531. doi: 10.1093/ije/30.3.526. [DOI] [PubMed] [Google Scholar]
  21. Long L., Soeken K., Ernst E. Herbal medicines for the treatment of osteoarthritis: a systematic review. Rheumatology (Oxford) 2001 Jul;40(7):779–793. doi: 10.1093/rheumatology/40.7.779. [DOI] [PubMed] [Google Scholar]
  22. MacLennan A. H., Wilson D. H., Taylor A. W. Prevalence and cost of alternative medicine in Australia. Lancet. 1996 Mar 2;347(9001):569–573. doi: 10.1016/s0140-6736(96)91271-4. [DOI] [PubMed] [Google Scholar]
  23. March L. M., Cross M. J., Lapsley H., Brnabic A. J., Tribe K. L., Bachmeier C. J., Courtenay B. G., Brooks P. M. Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Med J Aust. 1999 Sep 6;171(5):235–238. [PubMed] [Google Scholar]
  24. March L. M., Schwarz J. M., Carfrae B. H., Bagge E. Clinical validation of self-reported osteoarthritis. Osteoarthritis Cartilage. 1998 Mar;6(2):87–93. doi: 10.1053/joca.1997.0098. [DOI] [PubMed] [Google Scholar]
  25. March Lyn, Cross Marita, Tribe Kate, Lapsley Helen, Courtenay Brett, Brooks Peter. Cost of joint replacement surgery for osteoarthritis: the patients' perspective. J Rheumatol. 2002 May;29(5):1006–1014. [PubMed] [Google Scholar]
  26. McAlindon T. E., Jacques P., Zhang Y., Hannan M. T., Aliabadi P., Weissman B., Rush D., Levy D., Felson D. T. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996 Apr;39(4):648–656. doi: 10.1002/art.1780390417. [DOI] [PubMed] [Google Scholar]
  27. McAlindon T. E., LaValley M. P., Gulin J. P., Felson D. T. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000 Mar 15;283(11):1469–1475. doi: 10.1001/jama.283.11.1469. [DOI] [PubMed] [Google Scholar]
  28. Menniti-Ippolito Francesca, Gargiulo Lidia, Bologna Emanuela, Forcella Emanuela, Raschetti Roberto. Use of unconventional medicine in Italy: a nation-wide survey. Eur J Clin Pharmacol. 2002 Mar 14;58(1):61–64. doi: 10.1007/s00228-002-0435-8. [DOI] [PubMed] [Google Scholar]
  29. Pavelká Karel, Gatterová Jindriska, Olejarová Marta, Machacek Stanislav, Giacovelli Giampaolo, Rovati Lucio C. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002 Oct 14;162(18):2113–2123. doi: 10.1001/archinte.162.18.2113. [DOI] [PubMed] [Google Scholar]
  30. Pioro-Boisset M., Esdaile J. M., Fitzcharles M. A. Alternative medicine use in fibromyalgia syndrome. Arthritis Care Res. 1996 Feb;9(1):13–17. doi: 10.1002/art.1790090105. [DOI] [PubMed] [Google Scholar]
  31. Ramsey S. D., Spencer A. C., Topolski T. D., Belza B., Patrick D. L. Use of alternative therapies by older adults with osteoarthritis. Arthritis Rheum. 2001 Jun;45(3):222–227. doi: 10.1002/1529-0131(200106)45:3<222::AID-ART252>3.0.CO;2-N. [DOI] [PubMed] [Google Scholar]
  32. Randall C., Randall H., Dobbs F., Hutton C., Sanders H. Randomized controlled trial of nettle sting for treatment of base-of-thumb pain. J R Soc Med. 2000 Jun;93(6):305–309. doi: 10.1177/014107680009300607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Rao J. K., Mihaliak K., Kroenke K., Bradley J., Tierney W. M., Weinberger M. Use of complementary therapies for arthritis among patients of rheumatologists. Ann Intern Med. 1999 Sep 21;131(6):409–416. doi: 10.7326/0003-4819-131-6-199909210-00003. [DOI] [PubMed] [Google Scholar]
  34. Reginster J. Y., Deroisy R., Rovati L. C., Lee R. L., Lejeune E., Bruyere O., Giacovelli G., Henrotin Y., Dacre J. E., Gossett C. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001 Jan 27;357(9252):251–256. doi: 10.1016/S0140-6736(00)03610-2. [DOI] [PubMed] [Google Scholar]
  35. Uebelhart D., Thonar E. J., Delmas P. D., Chantraine A., Vignon E. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage. 1998 May;6 (Suppl A):39–46. doi: 10.1016/s1063-4584(98)80011-3. [DOI] [PubMed] [Google Scholar]
  36. Zhang W. Y., Li Wan Po A. The effectiveness of topically applied capsaicin. A meta-analysis. Eur J Clin Pharmacol. 1994;46(6):517–522. doi: 10.1007/BF00196108. [DOI] [PubMed] [Google Scholar]
  37. van Saase J. L., van Romunde L. K., Cats A., Vandenbroucke J. P., Valkenburg H. A. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989 Apr;48(4):271–280. doi: 10.1136/ard.48.4.271. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES