Management of OA varies widely between specialties.
MONTREAL -- Rheumatologists and general practitioners report significant variations in the way they manage patients with knee osteoarthritis, and in addition, their patient populations are also quite different, according to a French study sponsored by Wyeth Pharmaceuticals.
"This study identified variability in key aspects of management of knee OA as a function of medical specialty," reported Dr. Pascal Richette of Hopital Lariboisihre, Paris, and colleagues in a poster at the World Congress on Osteoarthritis.
The study used a cross-sectional survey of 808 general practitioners and 134 rheumatologists, representing 1,570 and 251 patients respectively. Each physician completed a medical questionnaire for their two most recent patients who fulfilled criteria for knee OA as defined by the American College of Rheumatology.
The clinical profiles of patients varied considerably between the specialties, with patients in the care of general practitioners experiencing more pain than did patients under the care of a rheumatologist (49.8 vs. 46.2 on a 0-100 Visual Analog Scale). In addition, general practitioners reported that their patients' pain had been of longer duration than that of patients reported by the rheumatologists (7.9 vs. 6.8 years). Patients of general practitioners were also more likely to have a second joint affected by IDA (71.2% vs. 63.7%).
In terms of prescribing practices, general practitioners prescribed symptomatic slow-acting drugs in OA significantly less frequently than did rheumatologists (39% vs. 45% of the time), the authors reported. Instead, general practitioners prescribed more low-dose, oral, and topical NSAIDs. The use of symptomatic slow-acting drugs in OA has been controversial because of conflicting data on the efficacy of these agents. This category of drugs includes nutritional supplements and medications designed to reduce the symptoms of OA over the long term.
In addition, intra-articular injection of steroids or hyaluronic acid was performed significantly less often by general practitioners (7.6% and 2.5% of the time, respectively) than by rheumatologists (31.5% and 46.2% of the time). Rheumatologists performed joint puncture significantly more frequently (18% vs. 4% of the time).
Rehabilitation and weight loss were prescribed more often by general practitioners (in 34% and 65% of cases, respectively) than by rheumatologists (in 22% and 51% of cases, respectively), whereas exercise was prescribed by 47% of rheumatologists vs. 34% of general practitioners.
General practitioners prescribed NSAIDs significantly more frequently and symptomatic slow-acting drugs in OA significantly less frequently than did rheumatologists.
The congress was sponsored by the Osteoarthritis Research Society International. There was no conflict of interest disclosure.
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|Title Annotation:||MUSCULOSKELETAL DISORDERS|
|Publication:||Family Practice News|
|Date:||Oct 15, 2009|
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