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Disease Burden, Prescription Use High in Patients With Both Knee, Hip OA
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Disease burden is high, and prescriptions for analgesics are frequent, among patients with both knee and hip osteoarthritis, according to findings published in Arthritis Care & Research.
“This study shows health care provision and disease burden for patients with polyarticular OA, hip OA and knee OA,” Johanna Callhoff, Dr. rer. medic., of the German Rheumatism Research Center in Berlin, told Healio Rheumatology. “It is important to see that OA patients who are not being seen by a specialist have a high disease burden. Many studies recruit only patients who are eligible for a total joint replacement surgery. Our design allowed us to contact also the patients who are not regularly seeing a physician.”
To examine the factors associated with OA disease burden, while taking into account pattern of involvement, Callhoff and colleagues conducted a study as part of the Linking Patient Reported Outcomes with Claims Data for Health Service Research in Rheumatology (PROCLAIR). The researchers collected a random sample of 8,995 patients with hip, knee or polyarticular OA form the German statutory health insurance fund Barmer, who had been continuously insured in 2014 and 2015.
A survey, which included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), was sent to all identified patients. Other survey items included joints with current or chronic pain, symptom duration, physician mainly treating the OA, the WHO-5 index of well-being, the impact of OA on personal and work life and various sociodemographic variables. A total of 3,775 returned the survey, of whom 3,564 gave consent to link their survey answers to claims data. These included 1,448 patients with knee OA, 959 with hip OA, 399 with knee and hip OA and 758 with polyarthritic OA.
Callhoff and colleagues used linked data to compare participants based on pain, stiffness, function, and impact on work and personal life. In addition, multiple linear regression models were used to examine associations with age, gender, BMI, symptom duration and WHO-5.
According to the researchers, concomitant knee and hip OA was accompanied by the highest WOMAC values — a mean of 44 — with 75% reporting frequent impairment of personal life. In addition, the concomitant group demonstrated the highest use of analgesics, with 52% reporting NSAID use, 22% receiving opioids and 37% taking other treatments. In the regression analyses, BMI per 5 units and WHO5 per 10% worsening were associated with a 4- to 5-point increase in WOMAC values, irrespective of the joint manifestations.
“We could see that physical therapy options are not utilized often enough,” Callhoff said. “Patients who have more than one affected joint have a higher disease burden. Among the well-known risk factors for OA like high BMI, depressive symptoms also go along with higher disease burden. Clinically, I think it is important to note that bilaterally affected patients, hip and/or knee OA patients who also have polyarthritic OA and patients with depressive symptoms need special attention.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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