– Therapy choices differ among races and genders — but so do benefits and limitations of each approach
by Sneha Patel, MD October 12, 2021

Osteoarthritis (OA) is a difficult condition to manage, as treatment options are limited. In a study in ACR Open Rheumatology of Veterans Affairs (VA) patients, Vina and colleagues sought to identify gender and racial differences in patients who use complementary and alternative medicine (CAM) to treat OA.

In this cross-sectional study, patients were recruited from another trial of the effects of positive psychological intervention on knee OA osteoarthritis pain. Those included were at least 50 years and non-Hispanic white or non-Hispanic Black; they reported characteristics of symptomatic knee OA and rated their scale of pain >4 out of 10. Key exclusion criteria were another diagnosis of arthritis, a plan for knee replacement surgery in the next six months, and steroid injection or knee replacement within last three months.

Most participants were male and all were recruited from VA medical centers.

CAM therapies included herbs, vitamins, minerals, joint health supplements, yoga, tai chi, chi gong, Pilates, massage therapy, acupuncture, chiropractic care, relaxation, homeopathy, copper bracelets, and spiritual activities. The 2019 American College of Rheumatology guideline includes strong recommendations for tai chi and self-efficiency/self-management systems for knee OA. It does not make strong recommendations for non-pharmacologic oral supplements.

Researchers identified racial and gender differences among these patients. Black patients were more likely to participate in spiritual activities (odds ratio (OR) 2.02; 95% CI 1.39-2.94) and less likely to use supplements (OR 0.53; 95% CI 0.31-0.90), yoga, tai chi or Pilates (OR 0.39; 95% CI: 0.19-0.77); or seek chiropractic care (OR 0.51; 95% CI: 0.26-1.00) compared to white patients. Women were more likely to use herbs (OR 2.42; 95% CI 1.41-4.14), perform yoga, tai chi, or Pilates (OR 2.09; 95% CI 1.04-4.19), receive acupuncture, acupressure, or massage (OR 2.45; 95% CI: 1.28-4.67; P=0.007), and participate in spiritual activities (OR: 1.68; 95% CI: 1.09-2.60).

This study does help shed light on the use of certain therapies, but it is very difficult to discern the reasons behind use and nonuse of these modalities. Patients’ prior experience with OA therapies, co-morbid conditions, and physicians’ experience with certain therapies may influence whether CAM therapies are optimally utilized. Perceived notions about the prognosis of OA and how it contributes to patient’s pain and overall performance status is also unclear.

Further studies identifying all these components are needed and treatment of OA should be based on a multisystemic approach.

Sneha Patel, MD, practices rheumatology in Fort Worth, Texas.

Read the study here and an interview with the first author here.