Original articleImpact of osteoarthritis: results of a nationwide survey of 10,000 patients consulting for OA
Introduction
Osteoarthritis (OA), caused by cartilage and subchondral bone degeneration, is the most common of the joint diseases. Its prevalence increases with age. Because it is heterogeneous and lacks any consensual definition, its epidemiology is complex [1], [2]. Prevalence estimates vary widely, since some authors focus on radiological OA and others on symptomatic disease [3]. Up to half the adult population may have signs of OA on systematic radiography [4], [5], but only 40% of those with Kellgren and Lawrence stage II OA and 60% of those with stage III OA appear to have clinical symptoms of the disease [6], [7]. Moreover, the prevalence of symptomatic OA varies widely according to age and the joints involved: from 10% of those aged 40–49 years to 80% of those older than 70 years for hand OA; from 2% to 10% of those 55 or older for hip OA; from 15% of those older than 45 years to 40% of those older than 75 for knee OA [6], [8], [9].
Behind these statistics, the human impact of OA at a population level is difficult to estimate. Although often considered a non-serious disease, it has a major impact on patients and their families. In a British survey, more than 90% of OA patients reported functional limitations in their activities of daily living, a percentage very close to that observed in a population of patients with rheumatoid arthritis [10]. Because of the disability that it can induce, OA generates substantial costs to society, especially with respect to the elderly, who are the most likely to become dependent and socially isolated when affected by such a disease [11], [12]. At the population level, the economic burden of OA has been evaluated at seven times that of rheumatoid arthritis [13].
The objective of this study was to gather information about the medical and human reality of OA in a large sample of patients, identified during a nationwide survey of more than 5,000 physicians. We addressed three principal questions: Who seeks care for OA? What are the consequences of this degenerative joint disease in their daily lives? Are OA patients substantially more limited than age- and sex-matched controls? To answer the latter question, we compared the functional limitation rates observed in the sample of OA patients with those obtained from a national survey of a representative sample of the French general population in 1999 [14].
Section snippets
Material and method
The survey was designed to gather information about people with OA, its effect on their lives, and the treatment they receive for it (Fig. 1).
MD sample
More than 5000 physicians (response rate: 65%) agreed to participate in the survey: 90.3% were general practitioners and 9.7% rheumatologists (Fig. 1). Their mean age was 46.4 years, comparable to that for French physicians as a whole (Table 1). Most were in private practice, and only 6% also practiced in a hospital. Our sample differed in several respects from the French physician population: it had fewer women (16.1% in our sample, 25.9% in France) and more non-urban physicians (50.1% vs.
Discussion
This cross-sectional study shows the substantial functional impact of OA, especially in comparison to age- and sex-matched controls from the general population. It also confirms the great frequency of multifocal forms of the disease, as shown in previous studies [15], [16]. It has several strengths. First, all OA patients were diagnosed by a physician, on the basis of clinical signs and/or radiographs (except for some cases of hand OA). The diagnostic reliability of this study is thus superior
Acknowledgments
Grant support: Laboratoire Pharmasciences, Courbevoie, France. B Fautrel is a post-doctoral fellow of the French Society for Rheumatology (Institutional support).
The authors wish to thank Bernard Savarieau, MD, and Chantal Rousseau, MD, for their support in organising the survey, Jean-François Chastang, PhD, for his help in analyzing the HID data, and Florence Tubach, MD, for her thoughtful comments and advice.
The authors’ also thank the INSEE division “Enquêtes et études démographiques”,
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