Do Physicians Treat Symptomatic Osteoarthritis Patients Properly? Results of the AMICA Experience

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Objective

The main objective of the AMICA project was to photograph the Italian scenario of osteoarthritis (OA) and its treatment in general and specialty practice. The study was designed to evaluate their prescription modalities to determine whether they matched the recently proposed treatment guidelines for OA (ACR 2000; EULAR 2000; APS 2002).

Methods

The study involved 2764 general practitioners (GPs) and 316 specialists who enrolled a total of 25,589 patients with OA of the hand, knee, and hip.

Results

Pharmacological treatment alone was prescribed to 55% of the patients seen by GPs, 25% of those seen by rheumatologists, 8% of those seen by orthopedic surgeons, and 17% of those seen by physical medicine specialists (GPs versus specialists, P < 0.001). Specialists often prescribed a combined pharmacological and nonpharmacological approach (rheumatologists 51%, orthopedic surgeons 66%, physical medicine specialists 76%). Concomitant comorbidities and their treatment do not seem to influence OA prescription modalities except for peptic ulcer and anticoagulant therapy. The presence of peptic ulcer was associated with a reduction in NSAID prescriptions (OR 0.61, CI 0.53 to 0.69) and more frequent use of Coxibs (OR 1.15, CI 1.03 to 1.28) and simple analgesics (OR 1.42; CI 1.26 to 1.61), as well as physical therapy. NSAIDs and Coxibs also were less frequently prescribed if patients were receiving anticoagulant therapy (NSAIDs OR 0.86, CI 0.70 to 1.06; Coxibs: OR 0.77; CI 0.64 to 0.93). Gastroprotective therapy was more frequently used in patients treated with NSAIDs, Coxibs, and analgesics. There was no significant difference in therapies prescribed for patients with hypertension or cardiac disease (myocardial infarction and/or angina pectoris).

Conclusions

The published guidelines appear to be properly used by most of the physicians in terms of the pharmacological approach; however, the increased use of Coxibs has not reduced the amount of prescribed gastroprotection. No specific precautions were observed in the treatment of patients with hypertension or cardiac problems. Nonpharmacological treatments are mainly used in conjunction with medications and did not take into account the findings of evidence-based medicine. Continuing education of GPs and specialists caring for OA patients is essential.

Section snippets

Do Family Practitioners Follow the Recommended Guidelines for the Treatment of OA Patients Properly?

Our study only partially answers this question because of its cross-sectional design. GPs used analgesic treatment in 18% of patients, traditional NSAIDs in 45%, and Coxibs in 55%. The most frequent physical therapies prescribed by GPs were ultrasound (10%) and magnetotherapy (7%). Exercises and other passive or active rehabilitation strategies were prescribed for only 13% of the patients seen by GPs. Education, particularly the use of patient-centered options such as exercise, was not

Discussion

A number of recent guidelines have been developed for the management of knee and hip OA. The American College of Rheumatology (ACR) recommendations published in 2000 are an update of previous guidelines for hip and knee OA published in 1995 (12), which represented the consensus opinion of 8 experts who suggested a specific algorithm for OA management (4, 5). The 2000 recommendations not only refer to trials undertaken in the interim period but differ from the 1995 guidelines insofar as the

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