A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs versus conventional therapy including DMARDs for patients without preference

作者：Harald J. Hamre, Van N. Pham, Christian Kern, Rolf Rau, Jörn Klasen, Ute Schendel, Lars Ole Gerlach, Attyla Drabik, Ludger Simon · 发表于：Patient Preference and Adherence · 年份：2018 · DOI：10.2147/ppa.s145221 · 被引用次数：11 · 研究领域：Complementary and Alternative Medicine Studies、Pain Management and Placebo Effect、Therapeutic Uses of Natural Elements

Background: While disease-modifying antirheumatic drugs (DMARDs) are a mainstay of therapy for rheumatoid arthritis (RA), some patients with early RA refuse DMARDs. In anthroposophic medicine (AM), a treatment strategy for early RA without DMARDs has been developed. Preliminary data suggest that RA symptoms and inflammatory markers can be reduced under AM, without DMARDs. Patients and methods: Two hundred and fifty-one self-selected patients aged 16–70 years, starting treatment for RA of <3 years duration, without prior DMARD therapy, participated in a prospective, non-randomized, comparative Phase IV study. C-patients were treated in clinics offering conventional therapy including DMARDs, while A-patients had chosen treatment in anthroposophic clinics, without DMARDs. Both groups received corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Primary outcomes were intensity of RA symptoms measured by self-rating on visual analog scales, C-reactive protein, radiological progression, study withdrawals, serious adverse events (SAE), and adverse drug reactions in months 0–48. Results: The groups were similar in most baseline characteristics, while A-patients had longer disease duration (mean 15.1 vs 10.8 months, p <0.0001), slightly more bone destruction, and a much higher proportion of women (94.6% vs 69.7%, p <0.0001). In months 0–12, corticosteroids were used by 45.7% and 81.6% ( p <0.0001) and NSAIDs by 52.8% and 68.5% ( p =0.0191) of A- and C-patients, respectiv...