Comparison of general practitioners and rheumatologists' prescription patterns for patients with knee osteoarthritis
1 Univ Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, 75010, Paris, France
2 Service de Rhumatologie, Centre hospitalier Sud Francilien, Corbeil-Essonnes, France
3 Service de Rhumatologie, Hôpital Dupuytren, Limoges, France
4 Service de Biométrie, Cenbiotech et Ceren, Dijon, France
5 Nukleus, Département Etudes Cliniques, Paris, France
6 Université Paris 12, UFR médicale, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital Henri Mondor, Créteil, France
BMC Musculoskeletal Disorders 2011, 12:72 doi:10.1186/1471-2474-12-72Published: 12 April 2011
To compare the prescription modalities of general practitioners (GPs) and rheumatologists (RHs) for symptomatic knee osteoarthritis (OA) and to determine correlates with prescription of low-dose NSAIDs.
This observational, prospective, national survey was carried out among a national representative sample of GPs (n = 808) and RHs (n = 134). Each physician completed a medical questionnaire for the 2 most recent patients fulfilling the ACR criteria for knee OA.
GPs and RHs included 1,570 and 251 patients, respectively. Mean pain level of the knee (on a VAS, 0-100 mm) was greater for GP patients than for RH patients (49.8 ± 16.3 vs. 46.2 ± 17.1 mm, respectively; p < 0.01). As compared with patients of RHs, those of GPs more frequently had another joint affected by OA: 71.2% vs. 63.7% (p < 0.0001) and more often had hypertension and diabetes mellitus (p < 0.05).
As compared with RHs, GPs more frequently prescribed low-dose NSAIDs (p < 0.0001), oral NSAIDs (p < 0.05), and topical NSAIDs (p < 0.0001) but less frequently symptomatic slow-acting drugs for OA (p < 0.01). Moreover, GPs more frequently recommended rehabilitation (p < 0.01) and loss of weight (p < 0.0001). Logistic regression analysis revealed an association of low-dose NSAIDs prescription and prescription by GPs, prescription of topical NSAIDs, no prescription of oral NSAIDs or coxibs and no intra-articular injection of steroids.
This study identified speciality-related variability in some aspects of the management of knee OA. The clinical profile of patients with knee OA differed between GPs and RHs.