International Journal of Rheumatic Diseases 2010; 13 (Suppl.

1): 230231

3.5 Alternative medicine (e.g. acupuncture)

0101

Survey on the use of complementary therapies among lipinos with Arthritis ES VISTA1,2, LA HAMIJOYO1, SV NAVARRA1,2
1 2

period that they are using CAMs. Seventy three (88%) used conventional treatments together with CAMs and nearly half (47%) of the total population visit their doctors each quarter of the year. Comparing the 3 arthritis groups, more rheumatoid arthritis patients use herbal medicines (P = 0.053), topical medications (0.019) and items worn (0.014). Conclusion: Filipino arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment strategies. 0128

University of Santo Tomas, Manila, Philippines, St. Lukes Medical Center, Quezon city, Philippines

Introduction: Use of complementary and alternative medicine (CAM) for chronic conditions has been part of the Philippine healthcare setting. There is little information, however, on CAM use among adults with clinic-conrmed diagnoses, particularly rheumatic diseases. Objective: To assess the frequency and types of CAM therapy used by Filipinos with chronic arthritic conditions namely, osteoarthritis (OA), rheumatoid arthritis (RA) and spondyloarthropathies (SpA). Methods: Eighty three participants were randomly selected from the rheumatology clinic population at two tertiary care centers. Written and Informed consent were obtained. Patient demographics were collected and respondents completed an interviewer- administered survey including quality of life and visual analog pain scale written in English and Filipino. The selected CAM items were based on a review of the literature and feedback from members of Special Interest Groups of the Philippine Rheumatology Association.

Effect of neck-type Magnetotherapeutic Device (Magneloop) for neck and shoulder pain N TANIGUCHI1,3, S KANAI1,2
1 Kansai University of Health Science, Osaka, Japan,2Kinki University School of Medicine, Osaka, Japan,3PIP-FUJIMOTO Co.,Ltd, Osaka, Japan

Objectives: Recently, the application of a static magnetic eld (SMF) has been used for the treatment of orthopedic conditions. Numerous reports on magnetic therapy have been published, including reports the alleviation of neck-shoulder pain, lower back pain and so on by exposure to SMF. To study the effect of applying an SMF to treat chronic neck-shoulder pain, we compared the effect of applying two devices, a neck-type magnetotherapeutic device (magneloop) and a neck-type non-magnetotherapeutic device (dummy-magneloop).

Rheumatoid arthritis Osteoarthritis Spondyloarthritis 11 (13.3%)

Methods: 1. Sixty-two patients (29 men and 33 women; mean age, 34.0 years, range, 21 58 years) were studied. A magneloop or a Dummy-magneloop was randomly assigned to patients under a double-blind test. The magneloop (55 5 mT, 500 millimeter and /4.5 millimeter) was applied externally at the site of pain. The dummy-magneloop (0 mT) was applied as the control.We performed a pathophysiological study on neck-shoulder pain by the assessment of Visual Analogue Scale (VAS) and objective symptoms (using thermography, deep body thermometer and muscle meter). All patients received treatment for seven days. 2. Twenty-eight patients (6 men and 22 women; mean age, 34.4 years, range, 1959 years) with neck-shoulder pain were investigated. After application of the magneloop, we performed a pathophysiological study on neck-shoulder pain by the assessment of VAS and objective symptoms and blood serum data for three months. Results: 1. In the magneloop group, VAS score of neck-shoulder pain showed 14.1% (mean) alleviation at three hours after the start of treatment. The alleviation of pain was maximal (39.6%) at seven days after the start of treatment. In the dummy-magneloop group, VAS score of neck-shoulder pain showed -0.9% (mean) alleviation at three hours after the start of treatment and alleviation of pain became maximal (10.0%) 24 h after treatment.Skin (surface) temperature and deep body temperature were signicantly increased at three hours, muscle stiffness were signicantly decreased at one day in the magneloop group, but not dummy-magneloop group. 2. VAS and objective symptoms were improving. Blood serum marker was not signicantly different before and after.

32 (38.6%)

40 (48.2%)

Figure 1. Disease Frequency According to Type of Arthritis (n=83 patients)

Conclusions: Magneloop might gradually increase the blood circulation in areas with ischemic pain Therefore, signicantly greater pain relief observed with the magneloop compared with the dummy-magneloop may primarily be due to a deeper and more widespread magnetotherapeutic effect. Beside, in the magneloop, no deleterious effects were noted.

0197

Rheumatoid Arthritis & Complementary Indian Medicine : six years experiences of indian public healthcare NGO DS PRAMOD
Health Alert Organisation of India, [NGO], Dhule, India
Issues: Rheumatoid Arthritis [RA] high incidence in India. NSAIDS cause GI-ADR. Rural/ tribal Indian population unable to afford long-term-drug-therapy. No specic centre in India for RA patients treatment/rehabilitation. Hence our Indian Health NGO used locally available Complementary-Indian-Medicines [CAM] for providing home-based-care of RA-patients in rural/tribal areas. Aim: provide CAM to poor-patients in collaboration with Traditional-faith-hearers [TFH]. Our Project-nurses evaluated cost-efcacy of CAM. Assess response of pain to CAM. Methods: from April 2004 to November 2007, 122 patients [n = 122] of RA aged 34 67 years enrolled. 68% females, 32% males. 43% returned to villages after therapy in city hospitals on allopathic drugs [NSAIDs + Steroids + Methotrexate]. 12% physical deformities. self report questionnaire distributed in NGO-clinics. Results: Among the 83 patients included in the study 32 were diagnosed with RA (38.6%), 40 with OA (48.2%) and 11 with SpA (13.3%). Sixty seven (80.7%) were women and nearly half of them were housewives or unemployed (43.4%). Majority of the group nished until high school (39.8%) with 43.4% belonging to the group below the countrys annual per capita income. Among the CAMs, a total of 66 (79.5%) used vitamins and minerals, 54 (65.1%) used topical medications, 50 (60.2%) employed massage therapists/hilot, 40 (48.2%) used nutriceuticals, 28 (33.7%) used movement therapies and 16 (19.3%) used diet. Most of the patients had their disease diagnosed for more than ve years before they tried using CAMs (61.4%) and 66 (79.5%) claimed to have improved pain scores and quality of life during the NGO-nurses provided CAM with TFH. Mud therapy 21%, Bach-ower remedy 40%, Accupressure/Accupuncture 57%, Hydrotherapy 24%, Hypnotherapy 75%, ayurvedic therapy 82%, 26% Unani Medicines, 61% Homeopathic medicines, 72% Herbal-Oil-TFH massage, 58% Aromatherapy. We treated patients in eight sessions CAM. feedback Performa given & responses-evaluatedperiodically to modify treatment-methodology. Our NGO module in functioning stages shown-graphically to EULAR-2009-participants. Average pain recorded weekly on 1 to 10 scale. mean score pain fell from 8.2 (SD 1.4) to 3.8 (SD 2.7) points(P < 0.001).

2010

Asia Pacic League of Associations for Rheumatology

3.5 Alternative medicine (e.g. acupuncture)

Results: Group-1 NSAIDs + corticosteroids [n = 60], Group-2 CAM [n = 122], Group-3 NSAIDs + corticosteroids + CAM [n = 32]. Symptom relief(n = 90), Gr-1 wanting to nd alternatives to Rheumatology drugs(n = 95). Cost of CAM 52% cheaper compared to Allopathic medicines. Additionally its available locally & has high-acceptance in patients. Conclusion: 122 of RA patients used & preferred CAMs. its cheaper & patient-compliance is very high. Hence better outcome of RA-Rx. we noted that 36% RA patients had sexual incapacitation. This was attributed to pain 51%, Depression 72% & fatigue 75%. During course of our study 12% dropped out of sheer frustration/fatigue. RA has emerged as social/ community disease. Apart from drug-therapy it needs Psychosocial-Rx, Palliative-care-centers, Community NGO nurses must be made part of decision-making-body of APLAR to evolve newer concepts in RA management. Realizing divergent versions of cost-analysis a multicentre study on this burning issue must be carried out in developing nations. RA-therapy is long-term commitment that must also consider nancial constraints of population from south. At APLAR-2010, We shall form group with RA-researchers to substantially improve RA-patients care policy. We all can collaborate at Hongkong-2010 conference to exchange experiences/knowledge on CAM-Therapy for better RA-care in resource-poor settings. We NGO-health-care-workers from developing nations need exposure to research technicalities/methodologies used by senior R.A. experts. This is indeed possible by my participation at APLAR-2010-conference.

mean number of 14.13 acupuncture sessions. The mean baseline TJC, VAS P, DAS28, HAQ score, FACIT-F score were 6.12, 50.63, 5.14, 0.53 and 62 respectively. TJC improved by 33.3% to 100% in six patients. VAS P score improved by 12.5% to 87.5% in four patients. DAS28 score dropped by 3.4% to 29.1% in 6 patients. HAQ score remained unchanged in ve patients and improved by 37% to 60% in two patients. Regarding functional assessment by FACIT-F questionnaire, physical well- being improved by 28.6% to 71.4% and social well-being improved by 4.4% to 75% in one-half of our patients, emotional well-being improved by 25% to 57.2% in three patients, functional well-being improved by 16.7% to 35.3% in two patients, fatigue sub-scale improved by 10% to 56.5% in three patients. No patients required adjustment of DMARDs, anti-inammatory drugs or steroid during the therapy. Conclusion: The observations suggest that acupuncture may be helpful in alleviating pain, improving disease activity, quality of life and functional ability in some patients with RA.

0860

The comparison between wet cupping and diclofenac sodium in pain reduction of knee osteoarthritis Elham AFLAKI1,2, Fatemeh BAHMANI2, Amir AZIZI2
1 2

0385

Use of Complementary and Alternative Medicine among Filipinos with Arthritis ES VISTA, LA HAMIJOYO, SV NAVARRA
University of Santo Tomas, Manila, Philippines
Introduction: Use of complementary and alternative medicine (CAM) for chronic conditions has been part of the Philippine healthcare setting. There is little information, however, on CAM use among adults with clinic-conrmed diagnoses, particularly rheumatic diseases. Objective: To assess the frequency and types of CAM therapy used by Filipinos with chronic arthritic conditions namely, osteoarthritis (OA), rheumatoid arthritis (RA) and spondyloarthropathies (SpA). Methods: Eighty three participants were randomly selected from the rheumatology clinic population at 2 tertiary care centers. Written and Informed consent were obtained. Patient demographics were collected and respondents completed an interviewer- administered survey including quality of life and visual analog pain scale written in English and Filipino. The selected CAM items were based on a review of the literature and feedback from members of Special Interest Groups of the Philippine Rheumatology Association. Results: Among the 83 patients included in the study 32 were diagnosed with RA (38.6%), 40 with OA (48.2%) and 11 with SpA (13.3%). Sixty seven (80.7%) were women and nearly half of them were housewives or unemployed (43.4%). Majority of the group nished until high school (39.8%) with 43.4% belonging to the group below the countrys annual per capita income. Among the CAMs, a total of 66 (79.5%) used vitamins and minerals, 54 (65.1%) used topical medications, 50 (60.2%) employed massage therapists/hilot, 40 (48.2%) used nutriceuticals, 28 (33.7%) used movement therapies and 16 (19.3%) used diet. Most of the patients had their disease diagnosed for more than ve years before they tried using CAMs (61.4%) and 66 (79.5%) claimed to have improved pain scores and quality of life during the period that they are using CAMs. Seventy three (88%) used conventional treatments together with CAMs and nearly half (47%) of the total population visit their doctors each quarter of the year. Comparing the 3 arthritis groups, more rheumatoid arthritis patients use herbal medicines (P = 0.053), topical medications (0.019) and items worn (0.014). Conclusion: Filipino arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment strategies.

Autoimmune Disease Research Center, Shiraz, Fars, Iran, Islamic Republic of, Shiraz University of Medical Sciences, Shiraz, Iran, Iran, Islamic Republic of

Background: Osteoarthritis causes chronic pain and disability. Wet cupping is a traditional modality which is used as a pain relieving modality in chronic conditions as low back pain. The effectiveness of wet cupping for pain relief in knee osteoarthritis is uncertain. Patients and Methods: A randomized controlled trial was done in 55 patients with knee osteoarthritis. The study was evaluated by medical ethics committee in our university. The patients who had the Visual Analogue Scale (VAS) of at least 30 were included in this study. They did not have hypertension and renal and kidney function tests were normal. The patients were assigned randomly to two groups. Group 1:30 patients (age 53.9 4.6) received diclofenac sodium 25 mg three times per day orally for 2 weeks, then 25 mg orally as needed for 4 consecutive weeks. Group 2: one session of wet cupping was done for 25 patients (age 56.5 6.5). The pain and disability of the patients were evaluated by Western Ontario and McMaster composite (WOMAC) index in weeks 0, 2 and 6. Data analysis was carried out by SPSS statistical software, using repeating measure and t-test. Results: Four patients in group 1 discontinued diclofenac sodium before 2 weeks due to gastrointestinal side effects. No side effect was seen in group 2. Pain subscale was decreased in both groups but there was no signicant difference between them (Group 1: pain subscale in week 0 was 7.52 3.38, in week 2 was 6.67 3.05 and in week 6 was 6.33, Group 2: pain subscale in week 0 was 9.0 3.18, in week 2 was 7.0 3.47 and in week 6 was 7.03 3.4). VAS, stiffness and function also improved in both groups but there was no signicant difference between them. Conclusion: Wet cupping is a safe method for decreasing pain in knee osteoarthritis and has comparable effect with diclofenac sodium.

0819

Effects of acupuncture on Rheumatoid Arthritis WN LAO, ML YIP, MH CHAN

KWONG WAH HOSPITAL, HONG KONG SAR, Hong Kong
Objective: Acupuncture has been noted to modulate pain transmission and response. Previous studies on the effects of acupuncture in rheumatoid arthritis (RA) were contradicting and controversial. We performed a pilot study to explore the effects of acupuncture on disease activity, pain scores, functional ability and quality of life in patients with RA in a regional hospital with collaboration between western medicine and traditional Chinese medicine. Methods: The patients were recruited from the Rheumatology Clinic of Kwong Wah Hospital between January 2008 to December 2008. All fullled the American College of Rheumatology (ACR) criteria for RA. They were thoroughly assessed by a Rheumatologist and a registered Chinese Medicine Practitioner before commencing acupuncture. Specic and standard needle insertion points were used during acupuncture. No change in disease modifying anti-rheumatic drugs (DMARDs) was allowed 3 months before the study. Tender joint count (TJC), swollen joint count (SJC), visual analogue scale for pain (VAS P), visual analogue scale for patients global health (VAS G), disease activity score using 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, geriatrics depression scale (GDS), pain self-efcacy questionnaire (PSEQ) score, functional assessment of chronic illness therapy-fatigue (FACIT-F) score, haemoglobin, erythrocyte sedimentation rate, C-reactive protein, total globulin levels were measured at baseline and after the last acupuncture session. Results: Eight patients with mean disease duration of 61 months enrolled. The mean age was 53.4 years. Six patients were positive for rheumatoid factor. The patients completed a

2010

International Journal of Rheumatic Diseases 2010; 13 (Suppl. 1): 230231 Asia Pacic League of Associations for Rheumatology

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