Biomedical subjects

Ann E Clarke

Publications and source records attributed to Ann E Clarke.

At least 19 recordsLinked to original sources

PubMed2006

Risk for incident arterial or venous vascular events varies over the course of systemic lupus erythematosus.

OBJECTIVE: We describe the pattern of incidence of thrombovascular events after diagnosis of systemic lupus erythematosus (SLE) in a cohort of lupus patients. METHODS: Descriptive study of prospectively collected data using incidence rates of thrombovascular events and 95% confidence intervals (CI) calculated for predetermined periods of observation. Kaplan-Meier survival curves were plotted to estimate thrombovascular event-free survival. RESULTS: Among 426 individuals, person-years contributed were as follows: 399 persons and 4356.0 person-years for all events; 417 persons and 4691.9 person-years for arterial events; and 408 persons and 4846.6 person-years for venous events. The incidence of thrombovascular events was highest during the first year after SLE diagnosis (4.00, 95% CI 2.24-6.59) and after 20 years (ranging from 3.32, 95% CI 1.52-6.30, to 4.99, 95% CI 0.60-18.01), and was lowest between 1 and 5 years after SLE diagnosis (1.00, 95% CI 0.53-1.72). A similar pattern was observed for arterial events, while venous events showed a higher incidence rate only in the first 30 days after SLE diagnosis (12.06, 95% CI 3.29-30.87) and remained low afterwards. The probabilities of remaining event-free at 5, 10, and 15 years were as follows: 0.92, 0.85, and 0.78, respectively, for all thrombovascular events; 0.95, 0.88, and 0.82, respectively, for arterial events; and 0.98, 0.95, and 0.94, respectively, for venous events. CONCLUSION: Thrombovascular events occur throughout the course of lupus, with the highest risk of arterial or venous events in the first year after diagnosis, and the pattern of occurrence varying thereafter.

Adult↗

PubMed2006

Dimensions of fatigue in systemic lupus erythematosus: relationship to disease status and behavioral and psychosocial factors.

OBJECTIVE: To characterize the experience of fatigue in patients with systemic lupus erythematosus (SLE) using a multidimensional assessment and to delineate contributors to physical and mental dimensions of fatigue. METHODS: Fatigue in 130 women with SLE was assessed using the Multidimensional Fatigue Inventory (MFI-20). Participants completed standardized questionnaires assessing sleep quality, depressed mood, social support, and leisure-time physical activity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled American College of Rheumatology criteria for fibromyalgia (FM). A series of hierarchical multiple regressions were computed to identify contributors to physical and mental fatigue. RESULTS: Patients scored high on all 5 MFI-20 fatigue dimensions, with general fatigue and physical fatigue having the highest scores. A hierarchical multiple regression showed that greater disease damage and disease activity, the presence of FM, depressed mood, sleep disturbance, and less participation in leisure-time physical activity contributed to higher physical fatigue scores. The results of the second model found depressed mood to be the strongest determinant of mental fatigue. Disease-related variables were not associated with mental fatigue. CONCLUSION: Fatigue in SLE is multidimensional and multidetermined, with physical and mental aspects likely having different etiologies. A multidimensional assessment of fatigue in SLE is needed to tailor and optimize interventions aimed at alleviating fatigue.

Depressive Disorder↗

PubMed2006

Lymphoma in a patient with systemic lupus erythematosus.

BACKGROUND: A 40-year-old woman with a 10-year history of systemic lupus erythematosus (SLE) presented with fever, lymphadenopathy and fatigue. Before that time, her SLE symptoms had been controlled with hydroxychloroquine, NSAIDs, and an occasional short course of moderate-dose prednisone. Two months before presentation, she experienced fevers ranging from 38.3 to 39.7 degrees C, but she had no specific symptoms that suggested local infection. INVESTIGATIONS: Physical examination, multiple blood cultures, and laboratory investigations that included the following tests: hemoglobin concentration; erythrocyte sedimentation rate; C-reactive protein level; serum lactate dehydrogenase level; aspartate aminotransferase level; alanine aminotransferase level; serum complement C3 and C4 levels; white-blood-cell count; platelet count; urinalysis; serum creatinine level; CT of the chest and abdomen; bone-marrow biopsy; serum electrophoresis; and tests for Epstein-Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, HIV-1, antinuclear antibodies, antibodies to Smith antigen, antibodies to double-stranded DNA, and antibodies to Ro and La. DIAGNOSIS: Stage IVB diffuse large B-cell lymphoma with marrow and liver involvement concurrent with SLE. MANAGEMENT: The patient promptly underwent chemotherapy, receiving three courses of 3 mg/m(2) vindesine on day 1, 1,500 mg/m(2) cyclophosphamide and 80 mg/m(2) doxorubicin on day 2, and 50 mg/m(2) prednisolone on days 1-5.

Adult↗

PubMed2005

Cancer screening in patients with systemic lupus erythematosus.

OBJECTIVE: To examine whether patients with systemic lupus erythematosus (SLE) undergo cancer screening according to established guidelines, to compare their reported screening practices with information from the general population, and to examine potential predictors of screening within our SLE sample. METHODS: We conducted a patient survey of cancer screening practices within the Montreal General Hospital lupus cohort. We compared self-reported frequency of cancer screening to guidelines suggested for the general population, and to figures for cancer screening reported in the general population. We also developed logistic regression models to establish potential predictors of screening for patients with SLE, with cervical cancer screening being the outcome of interest in our primary analyses. RESULTS: Of 48 women aged 50-69, 53% (95% confidence interval, CI: 38-68) had had a mammogram in the past 12 months, compared to 74% (95% CI: 73-75) for similarly aged Quebec women. Of 51 subjects aged 50 and older, only 18% (95% CI: 8-34) reported screening (fecal occult blood check with or without endoscopy) within the recommended time frame, compared to 48% (95% CI: 45-51) for colorectal screening for persons > 50 in the general population. Only 9 of 27 patients with SLE aged less than 30 had Pap tests in the past 12 months (33%, 95% CI: 19-52), compared with a general population rate of 56% (95% CI: 53-59) for similarly aged Quebec women. Our logistic regression model suggested that, among the SLE patients, non-whites, those with lower education, and those with higher disease damage scores were less likely to undergo cervical Pap testing. CONCLUSION: These data suggest that appropriate cancer screening may be overlooked in patients with SLE.

Adult↗

PubMed2005

Use of complementary and alternative therapies by patients with self-reported chronic back pain: a nationwide survey in Canada.

OBJECTIVE: Complementary and alternative medicine (CAM) is gaining popularity among patients with chronic back pain. We looked for factors associated with CAM use. METHODS: The data came from the cross-sectional household component of the 1996-1997 National Population Health Survey on the health status and behaviors of Canadians. The sample comprising 66.999 individuals aged 20 years or older represented 21 million adults. Cross tabulations were used to estimate the percentage of CAM use among adults with chronic back pain. Factors independently associated with CAM use during the year before the surveys were identified using multiple logistic regression. RESULTS: CAM use was highest in the subgroup of Canadian adults reporting chronic back pain (39.07%). CAM use was associated with younger age, being married, having a higher level of education, and earning a higher income. Overall, the CAM users reported less pain, greater analgesic use, more depression, and more co-morbidities. In addition to CAM, these patients used conventional medical services. CONCLUSION: Our results show that patients with chronic back pain who use CAM are more active, more involved in social life, and healthier, suggesting better management of their condition. They use CAM in addition to, rather than instead of, conventional care. CAM use in these patients may be ascribable to dissatisfaction with mainstream physicians.

Adult↗

PubMed2005

Determinants of sleep quality in women with systemic lupus erythematosus.

OBJECTIVE: To characterize sleep complaints in women with systemic lupus erythematosus (SLE) and to identify correlates of sleep quality. METHODS: Sleep quality in 100 women with SLE was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants completed standardized questionnaires assessing depressed mood, leisure time physical activity, functional disability, and pain severity. A clinical examination determined disease activity, cumulative damage, and whether patients fulfilled the American College of Rheumatology criteria for fibromyalgia. A series of hierarchical multiple regressions were computed. RESULTS: The mean +/- SD global PSQI score was 6.98 +/- 4.03, with moderate to severe sleep impairment reported by 56% of the sample. The first model testing the importance of demographic factors was not statistically significant. In the disease-related model, the use of prednisone and functional disability both contributed to poor sleep quality (P < 0.001). The addition of level of exercise participation to the demographic set significantly added to the model (P = 0.001). Depression significantly added to the demographic set, explaining 29% of the variance (P < 0.0001). When these variables, along with disease related variables, were simultaneously regressed on the PSQI Global Score, only depressed mood appeared as a significant independent determinant of global sleep quality (P < 0.001). However, the point estimates for the Beta coefficients were consistent with effects for lack of exercise and prednisone use. CONCLUSION: A significant proportion of women with SLE suffer from poor sleep quality. The findings suggest that depressed mood, prednisone use, and lack of exercise contribute to decreased overall sleep quality.

Disability Evaluation↗

PubMed2005

Revisiting the issue of malignancy risk in systemic lupus erythematosus.

Certain cancers occur more frequently in systemic lupus erythematosus (SLE) as compared with the general population, as recent data substantiates. The risk appears to be most heightened for lymphoma. Several pathogenic mechanisms may explain these observations, although little is definitively known. One particular concern relates to whether cancer risk in SLE is increased by medication exposures. Cooperative efforts to evaluate this have been undertaken by the Systemic Lupus International Collaborating Clinics and the Canadian Network for Improved Outcomes in Systemic Lupus research groups. This and other works in progress will, it is hoped, considerably advance the knowledge regarding the association between autoimmune diseases and malignancy.

Comorbidity↗

PubMed2005

What is the impact of adolescent arthritis and rheumatism? Evidence from a national sample of Canadians.

OBJECTIVE: Adolescent arthritis or rheumatism (AAR) has been shown to influence the activities, mental health, and healthcare utilization of affected individuals. However, these effects have never been estimated in a population-based sample. We examined the association of AAR with health status, health services use, health behaviors, and activity limitations. We also investigated the effect of socioeconomic status and family background on respondents with AAR. METHODS: The 1996 National Population Health Survey is a nationally representative survey exploring the health status and behaviors of Canadians. Among the 26,012 individuals aged 12 to 19 with complete responses on the presence of chronic illnesses, the 213 self-reporting arthritis or rheumatism (AAR) were compared to: (1) all other adolescents as a single group; or (2) the group of 9161 adolescents reporting other chronic diseases (OCD) but not AAR, and the group of 16,638 adolescents without chronic disease (WCD). Between-group differences were examined for the following variables: health status; use of health services; presence of activity limitations in school, work, or at home; and school enrollment and work status. RESULTS: Compared to those without, respondents with AAR reported more diagnoses of non-AAR chronic illnesses. Depression among AAR individuals was more prevalent than among non-AAR individuals, as was suffering from moderate or severe pain. Those with AAR were more likely than WCD individuals to use physician services, hospital services, and pain relief medications. AAR patients were more likely to be limited in their activities, and less likely to be enrolled in school than OCD or WCD individuals. CONCLUSION: This study indicates a broad range of effects of AAR in a nationally representative sample. Arthritis or rheumatism affected measures of mental health, health service use, and the school, work, and home activities of affected individuals, compared to individuals without chronic disease or with other chronic disease.

Activities of Daily Living↗

PubMed2005

Valuing a hypothetical cure for rheumatoid arthritis using the contingent valuation methodology: the patient perspective.

OBJECTIVE: A willingness-to-pay (WTP) survey measures the value of a given intervention in money terms. We examined the WTP of Canadian patients with rheumatoid arthritis (RA) for a hypothetical cure for RA under private and public scenarios. The validity of the survey was explored by studying the association between WTP and variables thought to be associated with WTP and randomly-varied variables of the survey materials. METHODS: A telephone survey was carried out in a sample of 121 patients with RA from 5 rheumatologists affiliated with the McGill University Health Centre. In advance, patients had been sent a 4-page brochure providing a comprehensive description of the disease (including photos or no photos). The hypothetical cure for RA was presented through 2 scenarios: a private insurance implying an annual premium and a public coverage requiring additional income taxes. The survey included questions related to their WTP, socioeconomic status (ability to pay), general health, opinion about the performance of the healthcare system, and their opinion about the difficulty of the survey. For elicitation of WTP, patients were randomized to one of 3 payment cards. Mailed questionnaires concerning RA health status were also completed. A series of univariate comparisons and multivariate ordered logit regressions were carried out to examine the association of WTP and patient and study variables. RESULTS: Patients were willing to pay annually significantly more for the private program (mean 1190 Canadian dollars) than for the public program (mean 502 Canadian dollars). Annual WTP was associated with age, household income, site of care (private program), private health insurance, opinion about the performance of the public healthcare system (public program), and presence of brochure photos. The payment card did not affect WTP for either program. CONCLUSION: The WTP survey was well understood and accepted by the patients with RA. Although measures of RA-specific health status (e.g., Health Assessment Questionnaire) were not found to be associated with WTP, many variables thought to be associated with WTP were found to be related in the expected directions. Since WTP for the private program was higher than that for the public program, our study design did not fully capture altruistic valuations of RA patients. Thus, our estimates represent a lower bound on patients' WTP for an RA cure.

Arthritis, Rheumatoid↗

PubMed2003

The development and preliminary validation of a Preference-Based Stroke Index (PBSI).

BACKGROUND: Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). METHODS: The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. RESULTS: Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioning stroke population. Moderately high correlations were found between the physical function (r = 0.78), vitality (r = 0.67), social functioning (r = 0.64) scales of the SF-36 and the PBSI. The lowest correlation was with the role emotional scale of the SF-36 (r = 0.32). Our results indicated that the PBSI can differentiate patients by severity of stroke (p < 0.05) and level of functional independence (p < 0.0001). CONCLUSIONS: Content validity and preliminary evidence of construct validity has been demonstrated. Further work is needed to develop a multiattribute utility function to gather information on psychometric properties of the PBSI.

Aged↗

PubMed2003

Peanut allergy: an overview.

Peanut allergy accounts for the majority of severe food-related allergic reactions. It tends to present early in life, and affected individuals generally do not outgrow it. In highly sensitized people, trace quantities can induce an allergic reaction. In this review, we will discuss the prevalence, clinical characteristics, diagnosis, natural history and management of peanut allergy.

Arachis↗

PubMed2003

Prevalence of peanut allergy in primary-school children in Montreal, Canada.

BACKGROUND: Peanut allergy is receiving increasing attention. Only one study has estimated the prevalence in North America, but it did not corroborate history with diagnostic testing. OBJECTIVE: We estimated the prevalence of peanut allergy in Montreal by administering questionnaires regarding peanut ingestion to children in kindergarten through grade 3 in randomly selected schools. METHODS: Respondents were stratified as follows: (1). peanut tolerant, (2). never-rarely ingest peanut, (3). convincing history of peanut allergy, and (4). uncertain history of peanut allergy. Groups 2, 3, and 4 underwent peanut skin prick tests (SPTs), and if the responses were positive in groups 2 or 4, measurement of peanut-specific IgE were undertaken. Children in group 3 with a positive SPT response were considered allergic to peanut without further testing. Children in groups 2 and 4 with peanut-specific IgE levels of less than 15 kU/L underwent oral peanut challenges. RESULTS: Of the 7768 children surveyed, 4339 responded, 94.6% in group 1. The prevalence of peanut allergy was 1.50% (95% CI, 1.16%-1.92%). When multiple imputation was used to incorporate data on those responding to the questionnaire but withdrawing before testing, the estimated prevalence increased to 1.76% (95% CI, 1.38%-2.21%). When data regarding the peanut allergy status of nonresponders (as declared to the school before the study) were also incorporated, the estimated prevalence was 1.34% (95% CI, 1.08%-1.64%). CONCLUSION: Our prevalence study is the first in North America to corroborate history with confirmatory testing and the largest worldwide to incorporate these techniques. We have shown that, even with conservative assumptions, prevalence exceeds 1.0%.

Arachis↗

PubMed2003

The predictive value of a positive prick skin test to peanut in atopic, peanut-naïve children.

BACKGROUND: Although allergy testing before food ingestion is generally not recommended, many peanut-naive children undergo prick skin tests (PSTs) to peanut because of atopy. Children with positive PSTs are generally advised to avoid peanuts either indefinitely or until a definitive diagnosis is made through challenge. OBJECTIVE: To describe peanut challenges in atopic, peanut-naive children with PST to peanuts > or = 3 mm and the PST properties in this population. METHODS: Between 1994 and 2001, 47 patients were identified who had a positive peanut PST, no previous peanut ingestion, and had undergone a peanut challenge. RESULTS: Forty-nine percent of the challenges were positive. The mean of the largest wheal diameter (95% confidence interval [CI]) of the PST in children having a negative and positive challenge was 6.3 mm (CI, 5.3 to 7.3) and 10.3 mm (CI, 8.9 to 11.8), respectively. At a PST cutoff of > or = 5 mm, the sensitivity and negative predictive value (95% CI) was 100% (85.2 to 100) and 100% (29.2 to 100), whereas the specificity and positive predictive value (95% CI) was 12.5% (2.7 to 32.4) and 52.3% (36.7 to 67.5), respectively. CONCLUSIONS: We show that 49% of atopic, peanut-naïve children sensitized to peanut developed allergic symptoms during oral provocation with peanut. Although the sensitivity of the PST at > or = 5 mm for the detection of peanut allergy in this study was 100%, our small sample size limits the applicability of this value. Further investigation is needed to determine whether children with wheal diameters of 3 or 4 mm, perhaps coupled with low peanut-specific IgE, could undergo less resource-intensive, accelerated challenges.

Antibody Specificity↗

PubMed2003

Group psychotherapy reduces illness intrusiveness in systemic lupus erythematosus.

OBJECTIVE: We investigated whether brief supportive-expressive group psychotherapy might reduce illness-induced interference with valued activities and interests (i.e., illness intrusiveness) among women with systemic lupus erythematosus (SLE) in relation to 3 life domains: (1) relationships and personal development (family relationships, other social relationships, self-expression), (2) intimacy (relationship with spouse, sex life), and/or (3) instrumental life (work, finances, active recreation). METHODS: Women with SLE recruited from 9 rheumatology centers were randomly assigned to receive either usual care (n = 66) or a 12 week brief supportive-expressive group psychotherapy followed by 3 monthly booster sessions (n = 58). Standard instruments assessed disease activity and damage, illness intrusiveness, and psychological distress at 4 measurement occasions: (1) pretreatment, (2) posttreatment, (3) 6 month followup, and (4) 12 month followup. RESULTS: Analysis of covariance, controlling for disease activity and household income, indicated that women who received brief supportive-expressive group psychotherapy experienced significant reductions in illness intrusiveness for 2 of 3 domains: (1) relationships and personal development and (2) intimacy. Benefits were evident at 6 and 12 month followups. CONCLUSION: Brief supportive-expressive group psychotherapy facilitates adaptation to SLE by assisting women in reducing illness-induced disruptions into important domains of life experience.

Adaptation, Psychological↗

PubMed2003

Determinants of discordance between patients and physicians in their assessment of lupus disease activity.

OBJECTIVE: We evaluated different methods for quantifying patient-physician discordance and identified factors associated with discordance in the assessment of lupus disease activity. METHODS: Data from 208 female patients who had a comprehensive annual examination were extracted from the Montreal General Hospital Lupus Registry. Discordance was measured by the difference between the patient self-reported 10 cm visual analog scale (VAS) and the physician VAS for global disease activity (VASDIFF). Multiple linear regression was used to identify the correlates of discordance, e.g., SF-36TM scales, Systemic Lupus Activity Measure (SLAM) components, etc. Four regression models were estimated using: (1) all patients; (2) only patients who evaluated disease activity higher than their physician's assessment; (3) only patients who evaluated disease activity lower than their physician's assessment; and (4) all patients, with the absolute value of VASDIFF as the dependent variable. RESULTS: Of the 208 observations, 150 (72%) of the VASDIFF scores were within +/- 2.5 cm on a 10 cm scale, indicating absence of marked discordance; 43 (20.7%) were from patients overscoring and 15 (7.2%) from patients underscoring their physician by at least 2.5 cm. Higher SF-36 role physical score, more bodily pain, and lower role emotional score in addition to the SLAM-skin component were independently associated with higher discordance. SF-36 social function and mental health scores as well as SLAM-neurological and kidney components were correlated with discordance in some subanalyses. Bodily pain was the most important variable for predicting "clinically relevant" discordance, followed by SLAM-skin and kidney components. CONCLUSION: Discordance between patients and physicians may result from patients scoring their disease activity based on their psychological and physical well-being, whereas physicians score disease activity based on the clinical and physical signs and symptoms of lupus.

Adult↗

PubMed2002

Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee.

OBJECTIVE: To determine the predictors of outcome in patients with osteoarthritis 2 years after receiving total hip or knee replacement. METHODS: A prospective cohort study of 222 osteoarthritis patients undergoing total hip or knee replacement in Boston and Montreal was done. Their postoperative outcomes at 6 months were previously reported. This followup reports on the outcomes after 2 years among the 165 patients (74%) who remained. The subjects were divided into 2 groups according to the median value of their preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score. The Short Form 36-item physical function subscale and the WOMAC pain and function subscale scores were collected at baseline and at 3, 6, and 24 months postoperatively. Clinical outcomes were analyzed at 2 years, using descriptive and multiple regression analyses. RESULTS: Improvements in pain and function at 2 years were similar to those observed at 6 months. Those subjects with the worst function and pain at the time of surgery (baseline) had comparatively worse function 2 years after surgery. CONCLUSION: In this comparison, the poor outcomes observed at 6 months following total joint replacement in patients with worse baseline functional status persisted after 2 years. Although there are no validated indications for when a patient should optimally have total joint replacement, these data suggest that timing of surgery may be more important than previously realized and, specifically, that performing surgery earlier in the course of functional decline may be associated with better outcome.

Aged↗

PubMed2002

Counterbalancing patient demands with evidence: results from a pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus.

OBJECTIVE: To evaluate the effect of Brief Supportive-Expressive Group Psychotherapy as an adjunct to standard medical care in reducing psychological distress, medical symptoms, and health care costs and improving quality of life in women with systemic lupus erythematosus (SLE). METHODS: A randomized clinical trial was conducted with 133 SLE female patients from 9 clinics across Canada. Clinical and psychosocial measures were taken at baseline, posttreatment, and 6 and 12 months posttreatment. Outcomes assessed were psychological distress, quality of life, disease activity, health service utilization, and diminished productivity. RESULTS: Intention-to-treat analyses revealed that there were no clinically important group differences on any of the outcome measures. CONCLUSION: Although both groups improved over time on several measures (e.g., decreases in psychological distress, stress, and emotion-oriented coping), these changes could not be attributed to the psychotherapeutic intervention. Thus, evidence does not support the referral of these patients to this type of intervention.

Adaptation, Psychological↗

PubMed2002

Use of complementary and alternative therapies by patients self-reporting arthritis or rheumatism: results from a nationwide canadian survey.

OBJECTIVE: Arthritis or rheumatism (A/R) often leads patients to experiment with complementary and alternative medicine (CAM); we investigated the factors associated with use of CAM. METHODS: The source of the data is the cross sectional household component of the 1996-97 National Population Health Survey of the health status and behaviors of Canadians. The survey sample is based on 66,000 persons aged 20 years and older, representing 21 million adults. Cross tabulations were used to estimate the percentage of adults with A/R who used CAM. Multivariate logistic regression was used to identify those characteristics associated with the use of CAM in the year preceding the survey. RESULTS: In 1996-97, among the 3.3 million Canadian adults aged 20 years or older who self-reported arthritis, 22% utilized CAM in the past year. CAM users tended to be younger and with higher education and household income. They reported more pain, consumed more analgesics, and tended to be more depressed. The coexistence of back or bowel disorders, cancer, sinusitis, or food allergies with arthritis was also related to CAM use. Moreover, CAM users also used more traditional health resources. CONCLUSION: Our results indicate that patients with A/R consulting CAM providers self-report more intense symptoms than nonusers and often have other chronic conditions. They do not seem to reject the traditional health care system, but supplement it with CAM, possibly to fulfill needs insufficiently satisfied by traditional health care providers.

Adult↗