{'fraction_non_alphanumeric': 0.0322341608002964, 'fraction_numerical': 0.00444609114486847, 'mean_word_length': 5.338028169014085, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Natural Product Supplement Use for Rheumatoid Arthritis Self‐Management in the United States: A Literature Review

Natural‐product dietary supplements (NDS) are a frequently used complementary and alternative medicine (CAM) modality in the United States (U.S.), with complaints of musculoskeletal symptoms being a primary reason for use. Rheumatoid arthritis (RA) is a less common, but particularly aggressive, inflammatory form of arthritis where pharmaceutical treatment is associated with potential toxicities and high cost. NDS use for the purpose of reducing symptoms could be associated with higher risks of supplement‐drug interactions in this population. To examine patterns of NDS use for self‐management of RA in the U.S., a comprehensive literature search was carried out using the Medline database; bibliographies were also reviewed to identify additional articles. Key words used included: botanicals, osteoarthritis, arthritis, rheumatoid arthritis, RA, supplements, complementary, herbal, alternative, and CAM. Included articles were those with ≥ 50% RA patients that evaluated NDS use. In total, 23 articles were identified, of which 4 pertained to patients in the US (California, New York, North Carolina and Alabama). CAM use was highly prevalent in all US studies, however the types of CAM varied widely across studies and included ointments, special diets, and nutritional supplements. Special diets (e.g. vegan, arthritis diet) were among the least commonly used forms of CAM in all but one study. NDS use was reported by 30–52% of RA patients. Despite temporal and regional differences across surveys, including disparate or undocumented demographics, particular supplements were consistently reported. Glucosamine and chondroitin were included in the top 4 most commonly used NDS in 3 of the 4 surveys. Fish oil, cod liver oil, garlic, and vinegar/honey were among the top supplements used in more than one survey. Other frequently used supplements appearing in a single survey included green tea, gingko biloba, alfalfa and yucca. Common reasons for use included perceived helplessness, disease manifestations, duration of illness and failure of biomedical treatments. The prevalence of NDS use appears to be higher in RA patients than in the general U.S. population. Still, specific use by individuals with RA is not well documented, and in many regions of the U.S., remains largely unknown. Because of the potential for supplement‐drug interactions in this population due to intensive treatment with pharmacologic agents, elucidation of additional information about specific NDS use by RA patients should be an important focus in both clinical practice and future research.