The patient journey in knee osteoarthritis-variations in diagnosis, patient characteristics, and treatment by physician specialty

Purpose: Knee osteoarthritis (OA), a leading cause of chronic pain and disability, affects an estimated 32.5 million adults in the United States. OA patients receive care from various physician specialties, including orthopedists (OS), rheumatologists (RH), sports medicine (SM) physicians, specialists (PS). Current treatments for knee target symptoms with conservative lifestyle measures pharmacological treatments, such as over-the-counter (OTC) or prescription (Rx) nonsteroidal anti-inflammatory drugs (NSAIDs) intra-articular corticosteroids (IA CS) hyaluronic acid HA). Finally, severely painful late-stage disease often leads to surgical intervention, total replacement (TKR). Organizational guidelines provide treatment recommendations patients; however, these are idealized settings, there is limited documentation on real-world decisions among practitioners. The purpose this study was assess patient characteristics across four specialties interest: RH, OS, SM, PS. Methods: Board-certified physicians ≥ 2 years practice who were seeing 10 per week participated chart review. Data their two most recent (structured questions answers medical records) collected March April 2019. Demographics, comorbidities, (time treatment, line discontinuations, etc.) captured. As no patient-identifying information included, project exempt IRB review HIPAA consent. Because designed effect modifications, confidence level 90% used. Results: Patient Characteristics: included 854 visited RH (n=250), OS (n=352), SM (n=152), PS (n=100). Within cohort, mean age 65.2 years, BMI 30.7, 51% female. Mean significantly higher (33), (31.6) versus (30.2), (29.8) patients. saw more female (58%) than (47%). Significantly unemployed (73%) due limitations function that impacted ability perform work (15%) those visiting other (OS, 57% 5%, respectively; 60% 7%; 52% 5%). time patient-reported symptom onset diagnosis 3.4 whereas previous TKR 5.3 years. number comorbidities 2.6, (2.6), (2.8), (3.2) (2.3). common interest hypertension (57%), obesity (38%), hyperlipidemia (33%). In addition, reported back (38%) SM; 17%, 19%, 24%, respectively) well anxiety/depression (28%) (17%) (16%). at last visit 5.6 (0-10 NRS), had greater (6.5) specialists. Treatments: OTC NSAIDs acetaminophen (APAP) first-line over patients’ charts (Figure 1). IA CS used approximately 20% patients, HA 10% usage similar specialties. Second-line rank ordered CS>OTC/Rx NSAIDs/APAP>IA HA, third-line HA>IA NSAIDs/APAP. Reasons discontinuation lack efficacy/worsening symptoms, adverse event (AE)/safety concerns, formulary/cost issues (Table demonstrated highest rate (82.4%) shortest duration (1.4 years), although reasons unknown 48% Prescription antidepressants (25%), (27%), APAP (28.5%) lowest rates. Rx longest (3.7 followed by opioids (3.2 years). Lack efficacy reason greatest receiving single-injection (61%). AE/safety concerns primary (51%) second COX-2 inhibitors. Limitations potential selection bias, confounding risk factors, small sample size, missing data. Conclusions: Despite some differences strategies largely similar. Among US population, syndromes BMIs, RA rheumatic diseases. likely use NSAIDs/APAP less NSAIDs. A drove changes, particularly case HA. These observations suggest need additional therapeutic options treat light high proportions existing lost presented safety concerns.View Large Image Figure ViewerDownload Hi-res image Download (PPT)