Comparative study of patients knowledge on osteoarthritis treatment options to ACR guidelines

Purpose: Portuguese population is growing older, according to national data in 2011 the aging index was 129. The number of elderly population is higher than the younger; average life expectancy is 79,2 years (1). Because knee Osteoarthritis increases with age, and according to WHO 80% of these subjects will have some degree of impairment and 25% will not be able to do their daily living activities (2), OA has a big impact on the sustainability of both health and social care as populations grow older. Our goalwas to compare current guidelines of managing knee OA, to the degree of information each patient has about their treatment options. Methods: 94 subjects (72,3% female; 27.7% male), of four different general physicians of the region of Algarve were studied. All subjects had knee Osteoarthritis according to American College of Rheumatology clinical and radiological criteria. Subjects were accessed randomly after visiting their GP, and the Osteoarthritis Quality Indicator (OA-QI) Questionnaire (3), was applied. Results: The education level of Portuguese elderly population is very low, what is reflected in this sample, 66% only have 4years of formal education (primary school) and 19,9% have less than 4 years or has never learned how to read or write. The prevalence of OA increases, in subjects who are overweighted (OW) or obese. In this random sample 69 in 94 were OW or obese (mean BMI was 29 (±5 sd)), 37,9% of OW, 77,8% of obese I (OI), 88,9% of obese II (OII) and 100% of obese III(OIII) were advised to lose weight but only 3,4% OW; 29,6%OI; 22,2% OII and 50% OIII say they have been referred for a specific diet consultation. When asked about exercise only 92 subject answer, of these 79,3% admit have been told of the benefits of exercise, but only 33,8% admit during exercise regularly. Regarding pharmacological treatment options, only 61,7% say that Paracetamol is their first option to treat pain, 93,5% admit to take anti-inflammatory drugs and 20% of these say they have never been informed of the effects or possible side effects of this medicine. Because of the deterioration of their symptoms 26,6% of the subjects say that a corticosteroid injection has been considered and 33% has been referred for operation (joint replacement). Conclusions: Comparing to the American College of Rheumatology recommendations, we expected to find higher number of subjects mentioning to have been informed of non-pharmacological treatment options such as weight lose and exercise. We also did not expect that the impact of this knowledge on patients, namely by the low percentage of subject doing regular exercise, even after admitting to have been informed of the beneficial effect of exercise. We also did not expect to find that the number of subjects that say have been referred for operation to be higher than the number that say have been referred to a dietician. Subjects taking paracetamol for first medication to treat pain was lower than the number actually taking anti-inflammatory drugs. The sample of this study is preliminary study will have to be increased, but results seem to confirm the necessity to reinforce information on treatment guidelines to GP's and education and life style programs targeted to OA patients. In our opinion, the very low education level of the population should be taken into account for these programs.