Osteoarthritis (OA) had a substantially higher disease burden than rheumatoid arthritis (RA) — a fact that, if not surprising, has never fully taken hold in clinician and patient perception of both conditions, according to researchers, in Arthritis & Rheumatology.
“The composite evidence confirms previous findings that, as groups, OA and RA patients have similar disease burden at presentation to rheumatologists at this time,” the study’s first author Jacquelin Chua, MD, of Rush University Medical Center in Chicago, and colleagues, writes. “After treatment, OA is associated with a higher mean burden of disease than RA.”
Researchers analyzed data from 149 patients with OA and 203 with RA, measuring disease burden with scores from the Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data (MDHAQ/RAPID3). RA patients were divided into two groups: those who had previously taken disease-modifying anti-rheumatic drugs (DMARDs) and those who had not. Scoring occurred at initial and six-month follow-up visits. OA patients were older and had greater body mass index and disease duration than those with RA.
Median disease duration was 3.4 (1.0-5.5) years in OA patients, 3.2 (0.6-8.6) years in prior-DMARD RA, and 1.0 (0.4-3.0) years in the DMARD-naive group.
All three sets of RAPID3 scores varied significantly: the most substantial differences emerged at six-month follow-up, when burdens for OA patients became substantially greater than for RA patients. Scoring changes from initial to follow-up for all three groups were 15.0 to 13.3 in OA patients, 15.8 to 10.8 in prior-DMARD RA, and 15.7 to 10.3 in DMARD-naive RA (P=0.78).
Pincus and colleagues found significant differences in adjusted RAPID3 scores between OA and all RA patients (3.3) and OA and DMARD-naive RA patients (4.0), but not between OA and prior-DMARD RA patients (2.6), a media release from MedPage Today explains.
Initially, no significant differences existed in scores for symptom checklist, RA disease activity index self-report painful joint count, or fatigue visual analogue scale for OA patients, prior-DMARD RA patients, or DMARD-naive RA patients. The baseline self-reported painful joint count was 6.9 for OA patients, 7.9 in prior-DMARD RA patients, and 7.7 in DMARD-naive RA patients. However, differences again emerged at the six-month mark in fatigue visual analogues scale scores between DMARD-naive RA and prior-DMARD RA patients, although not in OA patients.
“There is a perception among most doctors, the general public, and even patients that people who have RA have a far greater disease burden than people who have OA,” study co-author Theodore Pincus, MD, of Rush University Medical Center, says, in MedPage Today.
“Therefore, the key finding of similarity at first visit and greater disease burden in OA patients compared to RA patients six months later is likely to be surprising to many readers.”
While acknowledging that many of the study findings may not surprise clinicians and scientists, Pincus said a key objective of the research was to reaffirm the evidence of OA’s disease burden compared with RA — and potentially spark new conversation over perceptions of the disease from a diagnostic and treatment standpoint.
“In some senses, the primary goal of our study may be regarded as an alert to health policy planners, the public health community, and granting agencies to recognize the importance of osteoarthritis,” Pincus writes. “As a condition that is the most common or second-most common (to hypertension) in the population, OA is a serious disease that has been relatively neglected for many years and needs attention for better understanding of pathogenesis and treatment.”
Care can be improved, experts argued, by educating clinicians in various fields on the needs of OA patients and treating or referring them accordingly. According to Pincus, rheumatologists and primary care physicians could both benefit by understanding what all stakeholders bring to the table, the release continues.
“Some rheumatology programs have suggested that people with OA are not candidates for rheumatology care,” Pincus wrote. “An emphasis on RA and other inflammatory rheumatic diseases is correct … However, most non-rheumatologists have even less to offer patients with OA than rheumatologists, particularly with non-pharmacologic therapy — including exercise therapy, physical therapy, occupational therapy, aides and devices, self-management of pain, and other approaches that can be very helpful to some patients.”
According to Angela Botto-van Bemden, PhD, director of OA programs for the Arthritis Foundation, earlier diagnosis is a key starting point for any care strategy.
“We’ve come a long way for RA but for OA we need earlier diagnosis,” Botto-van Bemden states. “We’re still not diagnosing early enough.”
Botto-van Bemden and Pincus agree that a more patient-centered approach to OA diagnosis and treatment could help reduce disease burden.
“People say OA is just the body wearing down, but it’s not just something you have to accept because you’re aging,” Botto-van Bemden concludes. “We need better integration and patient engagement. We need to know what patients prefer. We need to help patients better make sure it’s shared clinical decision-making and outcomes-focused. What is working and why?”
[Source: MedPage Today]