Patient attitudes toward western medicine and the future of Chinese medicine for spondyloarthritis

Spondyloarthritis (SpA) and ankylosing spondylitis (AS) have a significant social and economic impact on ethnic Chinese patients. Western medicine, especially NSAIDs and disease-modifying anti-rheumatic drugs (DMARDs), are standard mainstream therapies for patients with SpA and AS. However, patient compliance with these medications is poor, due to the fear of side effects. In spite of their poor functional status and disease activity, less than 40% of AS patients are regularly treated. Complementary and alternative medicine (CAM) is very popular in Asian countries like China, Korea, Japan, India and Taiwan. A Korean survey in university hospital rheumatology clinics showed that 155 patients (68.5%) reported using at least one form of CAM during the previous 12 months. Herbal remedies and acupuncture were the most frequently used categories of CAM. Compared to conventional Western treatments, CAM is seen to have advantages in terms of a lower incidence of adverse reactions, greater patient choice, psychological comfort, and an increased quality, of the patient/therapist relationship. Common symptoms treated by CAM were pain (80%), decreased functioning (43%), and lack of energy (24%). Tripterygium wilfordii Hook. f. (Lei Gong Teng), Tetrandrine (Tet), acupuncture and Tai Chi are some examples of potential Chinese medicine treatments for spondyloarthritis. CAM usage is a worldwide trend. However, further study, including basic research and well-designed clinical trials, is warranted. Patients should be instructed to discuss treatment strategies for their disease, and the use of CAM, with their rheumatologists.