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Advisory Committee Chair

Gerald McGwin

Advisory Committee Members

S Louis Bridges

Elizabeth Brown

Laura Hughes

David Redden

Document Type

Dissertation

Date of Award

2012

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

The aims of this project were to: 1) compare disease activity scores 28 joints (DAS28) based on erythrocyte sedimentation rate (ESR) versus that based on C-reactive protein (CRP), and 2) describe prevalence of complementary and alternative medicine (CAM) use and examine differences of CAM use stratified by disease duration and sex. This analysis included participants from the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis (CLEAR) Registry. Using tender and swollen joint counts separate ESR-based and CRP-based DAS28 scores (DAS28-ESR3 and DAS28-CRP3) were calculated, as were DAS28-ESR4 and DAS28-CRP4, which included the patient¡¯s assessment of disease activity. Data on CAM use included food supplements, topical applications, activities, and alternative care providers. Mean DAS28-ESR3 was significantly higher than DAS28-CRP3 (4.8 vs. 3.9; p<0.001). Similarly, mean DAS28-ESR4 was significantly higher than DAS28-CRP4 (4.7 vs. 3.9; p<0.001). ESR-based DAS28 remained higher than CRP-based DAS28 even when stratified by age, sex, and disease duration. Overall agreement was not high between DAS28-ESR3 and DAS28-CRP3 (50%) or between DAS28-ESR4 and DAS28-CRP4 (59%). DAS28-CRP3 underestimated disease activity in 47% of the participants relative to DAS28-ESR3 and DAS28-CRP4 in 40% of the participants relative to DAS28-ESR4. Overall, ever use of any of the CAM treatments, activities, and providers was 95%, 98%, and 51%, respectively (median number of treatments=3, activities=5, and providers=1). Those with late disease duration (>2 years) were significantly more likely (odds ratio, OR ¡Ã2.0 and p-value ¡Ãœ0.05) to use raisins soaked in vodka/gin, to take fish oils, or to drink alcoholic beverages for RA than those with early disease. As compared to men, women were significantly more likely to pray/attend church, write a journal, use biofeedback but less likely to smoke tobacco or topically apply household oils. In conclusion, there was significant discordance between the ESR-based and CRP-based DAS28 which could impact clinical treatment decisions. Healthcare providers need to be aware of the patterns of CAM use as some treatments could interfere or have interactions with conventional medicines. This could be important within this cohort of AAs where racial disparities are known to affect access to conventional care.

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