Brief Report: Use of Complementary and Alternative Medicine and Psychological Functioning in Latino Children With Juvenile Idiopathic Arthritis or Arthralgia

Kathy Zebracki, PhD; Katherine Holzman; Kathyrn J. Bitter, BA; Kelly Feehan, BS; Michael L. Miller, MD;


J Pediatr Psychol. 2007;32(8):1006-1010. 

In This Article

Abstract and Introduction


Objective To describe the use of complementary and alternative medicine (CAM) and its relationship to symptoms of anxiety, depression, and dysthymia in Latino children with juvenile idiopathic arthritis (JIA) or arthralgia.
Methods Parents of 36 children between the ages of 6 and 16 years with either JIA (n = 17) or arthralgia (n = 19) completed questionnaires during routine pediatric rheumatology clinic visits assessing use of CAM and psychological functioning.
Results CAM was used by the majority of children primarily to treat pain episodes. The most common modalities were prayer and massage therapy. CAM use was associated with decreased symptoms of anxiety and dysthymia in children with arthralgia, but not in children with JIA.
Conclusion Preliminary findings suggest that CAM use is associated with improved psychological functioning in children with arthralgia. Healthcare providers are encouraged to routinely screen for CAM usage and to educate families about the potential benefits and limitations of CAM.


Complementary and alternative medicine (CAM) consists of healthcare approaches currently not considered to be standard medical practice. CAM modalities such as massage and herbal preparations are often utilized as a supplement to traditional medical treatments. The incidence of CAM use is notably rising among adults and children with chronic health conditions, such as arthritis (Feldman et al., 2004; Hagen, Schneider, Stephens, Modrusan, &Feldman, 2003; Southwood, Malleson, Roberts-Thomson, &Mahy, 1990), and within adult ethnic minority groups with rheumatological conditions (Herman, Dente, Allen, &Hunt, 2006). Less is known, however, about ethnic preferences of CAM use in children with chronic health conditions.

Juvenile idiopathic arthritis (JIA) is comprised of a heterogeneous group of chronic diseases (e.g., oligoarthritis, polyarthritis, systemic arthritis) characterized by joint inflammation with onset at or before 16 years of age. Estimates of JIA in children vary from 80,000 to 285,000 [Centers for Disease Control and Prevention (CDC), 2005]. Children with arthralgia, which occurs more commonly than arthritis, experience joint pain without signs of inflammation. Although JIA is considered a chronic health condition, whereas arthralgia is considered a symptom, both youth with JIA and those with arthralgia may experience acute and chronic pain, stiffness, decreased mobility, and functional disabilities. Latino individuals in particular experience disproportionate rates of impairment secondary to arthritis as compared to Caucasian individuals (CDC, 2005). Youth with JIA are also at an increased risk for experiencing psychological symptomatology, especially internalizing symptoms (LeBovidge, Lavigne, Donenberg, & Miller, 2003). To our knowledge, there are no data concerning psychological functioning in children with arthralgia.

Standard medical management for JIA and arthralgia involves a variety of therapies (e.g., nonsteroidal anti-inflammatory drugs, physical therapy); however, conventional treatment alone may not meet the needs of some patients with chronic rheumatic diseases. Studies suggest that some families with children with rheumatic disease seek CAM therapies in addition or as an alternative to conventional treatment due to concerns about medication side effects and a perception that the child's health condition is not improving (Rosenberg, 1996).

CAM utilization is better documented in the adult population than in children with rheumatic disease; however, of the few studies examining use in pediatric patients, CAM use was found to be common (Feldman et al., 2004; Hagen et al., 2003). Canadian studies have noted that 34–64% of pediatric rheumatology patients use at least one form of CAM (Feldman et al., 2004; Hagen et al., 2003). Furthermore, a study assessing CAM use in children attending an arthritis camp in either Australia or Canada found that 70% of children use CAM (Southwood et al., 1990). To our knowledge, there are no data regarding CAM use in children with arthralgia.

In an effort to address these gaps in the literature and to advance the understanding of CAM use in Latino children with rheumatic disease, the purpose of this study was 3-fold. First, the study described the prevalence, type, and reason for CAM use in Latino children with JIA or arthralgia. Consistent with previous pediatric rheumatology studies (Feldman et al., 2004; Hagen et al., 2003), we hypothesized that CAM usage would be common, with frequency of use associated with increased identification with culture of origin. Second, we assessed the relationship between CAM use and psychological functioning. Based on findings from a pediatric oncology sample (Post-White, 2006), we hypothesized that CAM use would be associated with decreased symptoms of anxiety, depression, and dysthymia. Finally, we provided preliminary data regarding potential group differences that exist between children with JIA and children with arthralgia regarding CAM use and psychological functioning. Due to the chronic nature of JIA and previous research (LeBovidge et al., 2003), we hypothesized that children with JIA would be more likely to use CAM to reduce symptoms than children with arthralgia.


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