PRAGUE — Nonpharmacologic therapies remain less commonly prescribed than are pharmacologic therapies for the treatment of knee and hand osteoarthritis—and this trend has been noted both for primary care physicians and rheumatologists, according to two studies presented at the 2006 World Congress on Osteoarthritis.
When it comes to primary care physicians (PCPs) treating knee osteoarthritis (OA), nonpharmacologic treatments are “insufficiently prescribed and, when initiated, are rarely continued over the long term,” reported Dr. Bernard Mazières of Rangueil University Hospital, in Toulouse, France. However, first-line pharmacologic treatment with acetaminophen was initiated in 96% of patients, Dr. Mazières reported at the meeting, which was sponsored by the Osteoarthritis Research Society International.
Dr. Mazières' observational, prospective, multicenter, 1-year cohort study included a total of 933 knee OA patients from 383 randomly selected PCPs in France and Spain. Information on the EULAR recommendations for treating knee OA was provided to the PCPs at the start of the study.
While 99% of the patients were prescribed acetaminophen during the study period, only 47% (437) were prescribed a treatment strictly following the EULAR recommendations. Among those who received nonpharmacologic therapy, the most common prescription was rehabilitation (40%), followed by weight loss (24%), and education (20%). The study concluded that under these therapeutic conditions patients were satisfied with their OA treatment and “improvement in pain, stiffness, and clinical signs of inflammation was clinically relevant.”
In a separate oral presentation at the meeting, Dr. Emmanuel Maheu reported that, when compared with PCPs, rheumatologists are no better at prescribing nonpharmacologic therapy—at least when it comes to the treatment of hand osteoarthritis.
His prospective cross-sectional study included 169 French rheumatologists and PCPs treating 316 hand OA patients. The study found that, when compared with rheumatologists, PCPs prescribed more analgesics (93% vs. 73%), more nonsteroidal anti-inflammatories (62% vs. 43%), and “surprisingly” more physical therapy (19% vs. 3%), said Dr. Maheu, of St. Antoine Hospital, Paris.
Rheumatologists prescribed more splints (30% vs. 13%) and more intra-articular steroid injections (16% vs. 5%).