Clinical Presentation of Osteoarthritis in General Practice: Determinants of Pain in Italian Patients in the AMICA Study

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Objective

To assess the clinical characteristics and determinants of pain observed by general practitioners (GPs) in Italian patients with osteoarthritis (OA) of the hand, hip, and knee.

Methods

The 2764 GPs participating in the study were asked to enroll 10 consecutive patients with OA diagnosed according to the American College of Rheumatology (ACR) clinical criteria. To standardize the diagnosis, the GPs received ad hoc training from musculoskeletal system specialists. A questionnaire evaluating demographic data, the clinical characteristics of OA, and previous diagnostic and therapeutic interventions was administered by the GPs.

Results

25,589 evaluable patients were enrolled during a mean period of 2.8 weeks by the GPs: 17,567 women (69%) and 7878 men (31%). The most painful OA joints were the knee in 12,827 patients (54%), the hip in 5645 patients (24%), and the hand in 5467 patients (23%)—percentages calculated on the 23,939 patients for whom this information was available. The weekly incidence of referrals to GPs for OA was higher for women and for knee OA. The median age of the patients was 70 years (range 50 to 104 years) and disease duration was 8.3 ± 7.10 years. The most frequent comorbidities were hypertension (53%), obesity (22%), osteoporosis (21%), type II diabetes mellitus (15%), and chronic obstructive pulmonary disease (13%). The median pain visual analog scale (VAS) score was higher for women than for men, for hip OA, and for generalized OA (GOA) than for knee and hand OA (P < 0.0001). Intense pain, defined as VAS readings of >60 mm, was increased in women only in the knee (OR = 1.24; 95% CI 1.15 to 1.34) and in GOA (OR = 1.17; 95% CI 1.03 to 1.33). It was also significantly increased in patients older than 70 years (OR = 1.46; 95% CI 1.39 to 1.54), those with a low educational level (OR = 1.44; 95% CI 1.36 to 1.5), a BMI of ≥30 (OR = 1.52; 95% CI 1.42 to 1.61), a disease duration of more than 7 years (OR = 1.60; 95% CI 1.52 to 1.68), comorbidities (OR = 1.61; 95% CI 1.5 to 1.73), and GOA (OR = 2.05; 95% CI 1.91 to 2.19). Manual occupations were associated with highly intense pain only in men.

Conclusions

The results of this study underscore the major impact of OA on care in general practice, the high frequency of OA-associated comorbidities, and the role of different risk factors in OA pain.

Section snippets

Patients and Methods

The general framework of AMICA and a number of its descriptive results are described in an accompanying article (6). The data reported here relate to 2764 general practitioners (GPs) who were asked to enroll 10 consecutive patients each with OA of the hand, hip, and knee diagnosed according to the American College of Rheumatology (ACR) clinical criteria (7, 8, 9).

Results

The median age of the patient population as a whole was 70 years (range 50 to 104 years): 70 years (range 50 to 104 years) for women and 70 years (range 50 to 97 years) for men. Figure 1 shows the age and sex distribution by OA location. The mean disease duration was 8.3 ± 7.10 years, and the median age at symptom onset was 60 years (range 20 to 95 years).

Discussion

This study involved a very large number of patients seen by GPs for pain associated with OA at different locations. In Italy, each GP cares for a limited number of National Health Care subjects (generally 1000 to 1500). Virtually every resident of Italy is registered with a GP, who has no right to select patients (10), thus making our sample representative of Italian OA patients seeking a GP's help. This group is obviously not representative of the general population of OA patients, because

References (26)

  • R.D. Altman et al.

    The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand

    Arthritis Rheum

    (1990)
  • R.D. Altman et al.

    Development of criteria for the classification and reporting of osteoarthritisClassification of osteoarthritis of the knee

    Arthritis Rheum

    (1986)
  • R.D. Altman et al.

    The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip

    Arthritis Rheum

    (1991)
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