{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:59:50Z","timestamp":1793145590396,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T00:00:00Z","timestamp":1495152000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2017,5]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>To study the predictors of complementary and alternative medicine (CAM<\/jats:styled-content>) use in patients with early inflammatory arthritis (EIA<\/jats:styled-content>), and its impact on delay to initiation of disease\u2010modifying anti\u2010rheumatic drugs (DMARD<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>Data were collected prospectively from EIA<\/jats:styled-content> patients aged \u2265 21 years. Current or prior CAM<\/jats:styled-content> use was ascertained by face\u2010to\u2010face interview. Predictors of CAM<\/jats:styled-content> use and its effect on time to DMARD<\/jats:styled-content> initiation were determined by multivariate logistic regression and Cox proportional hazards, respectively.<\/jats:p><\/jats:sec>Results<\/jats:title>One hundred and eighty patients (70.6% female, 58.3% Chinese), of median (interquartile range [IQR<\/jats:styled-content>]) age 51.1 (40.9\u201359.8) years and symptom duration 16.6 (9.2\u201326.6) weeks were included: 83.9% had rheumatoid arthritis, 57% were seropositive. Median (IQR<\/jats:styled-content>) Disease Activity Score in 28\u2010joints (DAS<\/jats:styled-content>28) was 4.3 (2.8\u20135.7), modified Health Assessment Questionnaire (mHAQ<\/jats:styled-content>) was 0.38 (0.0\u20130.88) and 41.3% were CAM<\/jats:styled-content> users. Chinese race (odds ratio [OR<\/jats:styled-content>] 5.76 [95%CI<\/jats:styled-content> 2.53\u201313.1]), being non\u2010English speaking (OR<\/jats:styled-content> 2.68 [95% CI 1.18\u20136.09]), smoking (OR<\/jats:styled-content> 3.35 [95% CI 1.23\u20139.15] and high DAS<\/jats:styled-content>28 (OR<\/jats:styled-content> 2.73 [95% CI 1.05\u20137.09] were independent predictors of CAM<\/jats:styled-content> use. CAM<\/jats:styled-content> users initiated DMARD<\/jats:styled-content> later (median [IQR<\/jats:styled-content>] 21.5 [13.1\u201330.4] vs<\/jats:italic>. 15.6 [9.4\u201322.7] weeks in non\u2010users, P<\/jats:italic> = 0.005). CAM<\/jats:styled-content> use and higher DAS<\/jats:styled-content>28 were associated with a longer delay to DMARD<\/jats:styled-content> initiation (hazard ratio [HR<\/jats:styled-content>] 0.69, 95% CI 0.50\u20130.95 and 0.63, 95% CI<\/jats:styled-content> 0.43\u20130.91, respectively) while higher mHAQ<\/jats:styled-content> was associated with a shorter delay (HR<\/jats:styled-content> 1.59, 95% CI 1.08\u20132.34) and race, education level, being non\u2010English speaking, smoking and seropositivity were not associated.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Healthcare professionals should be aware of the unique challenges in treating patients with EIA<\/jats:styled-content> in Asia. Healthcare beliefs regarding CAM<\/jats:styled-content> may need to be addressed to reduce treatment delay.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.13091","type":"journal-article","created":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T11:24:24Z","timestamp":1495193064000},"page":"567-575","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Use of complementary and alternative medicines is associated with delay to initiation of disease\u2010modifying anti\u2010rheumatic drug therapy in early inflammatory arthritis"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3482-6017","authenticated-orcid":false,"given":"Manjari","family":"Lahiri","sequence":"first","affiliation":[{"name":"Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"},{"name":"Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Santosa","sequence":"additional","affiliation":[{"name":"Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"},{"name":"Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lay Kheng","family":"Teoh","sequence":"additional","affiliation":[{"name":"Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane A.","family":"Clayton","sequence":"additional","affiliation":[{"name":"Department of Medicine Ng Teng Fong General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheen Yee","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine Ng Teng Fong General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gim Gee","family":"Teng","sequence":"additional","affiliation":[{"name":"Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"},{"name":"Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter P. 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