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Targeted questions may aid GPs in diagnosing hip OA
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TORONTO — Asking patients about difficulty with activities like walking, shopping, or removing socks may aid general practitioners in making earlier diagnoses of hip osteoarthritis, according to findings presented here.
Annamaria C. van Berkel , PhD , of Erasmus Medical Center in Rotterdam, the Netherlands, said that most patients with hip complaints, including hip OA, are first diagnosed and treated by a GP. She added that the WOMAC questionnaire requires 11 minutes to complete, and then 5 to 10 minutes are required for doctors to interpret the results. “Therefore, the WOMAC questionnaire takes more time than a GP has in one consultation,” she said. “Our team wanted to know if selected WOMAC questions, along with other measurements, could identify persons at higher risk for incident hip OA.”
The analysis used data from the CHECK study. The adjusted analysis accounted for age, sex and BMI in a cohort of 284 patients who were followed for 10 years. Eligible participants were aged 45 to 65 years and had not yet visited a clinician for hip-related symptoms at baseline.
All patients were asked the selected WOMAC items, underwent a physical exam and radiographs, and were asked about hip pain from the previous week. Incident hip OA served as the primary outcome of interest. Hip OA was defined by three definitions: clinical evidence as defined by American College of Rheumatology criteria, radiographic OA combined with hip pain, and hip replacement, according to van Berkel.
Results showed that 167 participants developed hip OA, while 117 did not. A closer look at the outcomes revealed that 50 patients had OA as defined by more than one of the criteria. Eight patients fell into all three groups.
The researchers also investigated factors that could have been associated with hip OA, including morning stiffness, knee pain, use of pain medication and four other components that the researchers specifically designated for this study. “In the interest of our study, I will only address component three, which consists of a negative and a positive part,” van Berkel said.
She defined this component as difficulty putting socks on and taking them off, rising from bed, or walking and shopping. Difficulty with each of these activities was assigned negative or positive values, for an overall negative or positive score. The multivariate analysis showed that this component carried the most significant association with the development of hip OA of any of the criteria they studied (OR = 1.5; P = .02). The other components the group developed were not significantly related to hip OA, van Berkel said.
Age (OR = 1.1; P =.03) and reported knee pain (OR = 0.4; P = .02) were the other factors that were significantly associated with hip OA in multivariate analysis (OR = 0.4; P = .02), according to van Berkel.
If general practitioners ask patients about walking, shopping, putting socks on and taking them off, and rising from bed, they may be able to identify hip OA earlier, van Berkel concluded. “There was no association between physical examination and incident hip OA,” she said. – by Rob Volansky
Reference:
Van Berkel AC, et al. Abstract #74. Presented at: OARSI 2019 World Congress on Osteoarthritis; May 2-5; Toronto.
Disclosure: van Berkel reports no relevant financial disclosures.