Objective. Although there is a strong relationship between depression, chronic pain, and physical activity, there are few findings regarding the prevalence and predictors of depression in patients with osteoarthritis (OA). The goal of the present study was to assess the prevalence and severity of depression in a large sample of patients with OA and to reveal predictors of depression. Methods. Patients were approached consecutively in 75 general practices. Of 1,250 distributed questionnaires, 1,021 were returned and analyzed. Besides sociodemographic data, medication and comorbidities, depression, and arthritis were assessed using the Patient Health Questionnaire (PHQ-9) and the Arthritis Impact Measurement Scale. A stepwise multiple linear regression analysis with the PHQ-9 score as the dependent variable was performed. Results. On the PHQ-9, 19.76% of men and 19.16% of women achieved a score of >15, indicating at least a moderately severe depression. Significant sex differences could not be revealed. The strongest predictor for depression severity was perceived pain (␤ ‫؍‬ 0.243, P < 0.001) and few social contacts (␤ ‫؍‬ 0.218, P < 0.001). Further predictors were physical limitation of the lower body (␤ ‫؍‬ 0.157, P < 0.001) and upper body (␤ ‫؍‬ 0.163, P < 0.001), age (␤ ‫؍‬ ؊0.168, P < 0.001), and body mass index (␤ ‫؍‬ 0.080, P ‫؍‬ 0.020). Conclusion. These findings suggest an increased prevalence of depression among patients with OA and emphasize the need for recognition and appropriate treatment. Most of the revealed predictors are influenceable and should be potential targets in a comprehensive treatment of OA to interrupt the vicious circle of pain, physical limitation, and depression.

Background: Due to technological progress and improvements in medical care and health policy the average age of patients in primary care is continuously growing. In equal measure, an increasing proportion of mostly elderly primary care patients presents with multiple coexisting medical conditions. To properly assess the current situation of co-and multimorbidity, valid scientific data based on an appropriate data structure are indispensable. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) is an ambitious project in Germany to establish a system for adequate record keeping and analysis in primary care based on episodes of care. An episode is defined as health problem from its first presentation by a patient to a doctor until the completion of the last encounter for it. The study aims to describe co-and multimorbidity as well as health care utilization based on episodes of care for the study population of the first participating general practices.

A large prospective study of steroid withdrawal was performed within the framework of the Collaborative Transplant Study to analyze long-term graft and patient outcome in renal and heart transplant recipients. Steroids were withdrawn no earlier than 6 months posttransplantation. A comparison of 7-year outcomes in renal transplant recipients (94% receiving cyclosporine; 97% Caucasian) showed a benefit of steroid withdrawal versus steroid continuation in retrospectively matched controls, for graft survival (81.9% ± 1.8% vs. 75.3% ± 1.2%, p = 0.0001), patient survival (88.8% ± 1.5% vs. 84.3 ± 1.0%; p = 0.0016) and death-censored graft survival (91.8% ± 1.3% vs. 87.9% ± 1.0%: p = 0.0091). Steroid withdrawal was associated with improved graft survival in heart recipients also (76.2% ± 2.4% vs. 66.9% ± 1.7%, p = 0.0008). A total of 58.6% of renal recipients and 44.3% of heart recipients never required steroids during follow up. Rates of acute rejection and renal dysfunction did not differ between steroid-free and steroid-continuation groups. Steroid withdrawal was associated with significantly improved cardiovascular risk factors compared with steroid continuation. Rates of the development of osteoporosis and cataracts did not differ in the entire patient cohort, but were strikingly lower in patients taken off steroids during the first posttransplant year.

The PACIC 5A is a reliable and valid instrument to assess the congruency of care to the chronic care model of OA patients. Its use is encouraged in quality improvement projects but also in further research.