Background Osteoarthritis (OA) is described as the most prevalent rheumatologic disease in Spain and as first cause of permanent disability, featuring pain, stiffness and severe limitation to the movement of the joints. Expert groups working on OA (OMERACT, EULAR, OARSI) center their efforts on preserving the patients' wellness and quality of life related to health issues.
In 2012 a study to assess these issues took place in our primary health center, detecting an alarming lack of records describing pain control, actual treatment and such. Despite the experts' recommendations to include scales and questionnaires regarding the patients' perception, few doctors actually use them
Objectives evaluate the improvement of the patients diagnosed of hip and/or knee OA's clinical records on the primary Health Center of Las Ciudades, following an intervention directed to the professional health workers
Methods the intervention would take place in two phases. First, a sixty-minute clinical session assessing the latest international recommendations regarding OA; the second would take place six months later, discussing the relevance of the use of such scales in every-day consult. A quasi-experimental before-after study without control group was developed, including all patients registered on the OMI/AP Madrid program with hip and/or knee OA.
Results 761 patients were registered as diagnosed of OA, knee OA or hip OA; by simple random-sampling 248 were chosen, 97 meeting excluding criteria. Out of the 151 selected patients, in those diagnosed of knee OA (127), the most frequently registered symptom was pain (70.9%), followed by hypertrophy (15.7%), crepitus (13.4%) and stiffness (9.4%). In the 27 cases diagnosed of hip OA, pain (29.6%) and limitation to internal rotation (2.6%) were the primary symptoms. Of all revised records, only 8 (5.3%) described signs and symptoms following Altman's criteria to diagnose a patient of OA. In these patients, the most frequent signs were, in decreasing order, pain, hypertrophy, stiffness and crepitus. In 33.8% of the records, no registration of the actual or previous treatment was found. Few clinical histories mentioned a non-medical treatment for symptoms control. Finally, none of the revised clinical records used the recommended scales to evaluate the impact on a patient's life.
Conclusions There is a need for international standardization of the diagnostic criteria and of the degree of affection regarding the OA for validated protocols to be created in the areas. The diagnosis-coding system used is confusing and other ostheomuscular pathologies usually end up labelled as OA by mistake. A registering effective tool to evaluate and follow OA patients is demanded.
EULAR evidence based recommendationas for the management of knee osteoarthritis. (ESCISIT). Ann Rheum Dis 2003;62:12:1145
P.G. Conaghan, D.J. Hunter, J.F. Maillefert, W.M. Reichmann, E. Losina. Summary and recommendations of the OARSI FDA osteoarthritis Assessment of Structural Change Working Group. Osteoarthritis and Cartilage 19 (2011)
Benito P. Artrosis. Fisiopatología, diagnόstico y tratamiento. Sociedad Española de Reumatología. Manual SER de las Enfermedades Reumáticas. En: Blanco García F (ed.) 4° ed. Madrid: Ed. Panamericana, 2010
Disclosure of Interest None declared