A new decision tree for diagnosis of osteoarthritis in primary care: international consensus of experts

Abstract

Background and aims Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. Methods To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA. The IRB used American College of Rheumatology diagnostic criteria. Results Care pathways based on clinical and radiological findings were developed to identify intervention thresholds for GPs/specialists. To optimize usefulness in the primary care setting, the guidelines were formatted as an uncomplicated, but comprehensive one-page decision tree for each topology, highlighting key aspects of the evaluation process and incorporating red flags. In a two-phase validation stage, the draft guidelines were evaluated by rheumatologists and GPs for project execution, content and perceived benefit. The strength of the guidelines lies in their user-friendly diagram and potential for broad application. Such guidelines will allow GPs to make an easy but definite diagnosis of OA and offer clear guidance about situations requiring an expert opinion. The guidelines have potential to improve patient outcomes and reduce the number of unnecessary procedures. Discussion and conclusions This project demonstrated the feasibility of developing easy-to-use and effective visual decision trees to facilitate the diagnosis and management of OA of the hip, knee and hand/finger in primary care. The next step should be to conduct a large impact study of implementation of these recommendations in the diagnostic management of OA in general practice in different areas.

Impact of osteoarthritis on activities of daily living: does joint site matter?

“…Our study therefore lends further credence to the argument that in the clinical setting where the focus of intervention is on the improvement of symptoms, the use of a clinical definition of knee OA, which includes pain, may be more useful than relying on a radiographic diagnosis alone to identify individuals at risk of functional impairment and target resources accordingly. Indeed, the International Rheumatologic Board (IRB) recently proposed guidelines for the diagnosis of OA in primary care which are based on the ACR criteria for clinical OA [23].…”

Disease Burden and Costs in Moderate-to-Severe Chronic Osteoarthritis Pain Refractory to Standard of Care: Ancillary Analysis of the OPIOIDS Real-World Study

“…In routine clinical practice in Spain, patients with moderate-to-severe OA chronic pain refractory to standard analgesic treatment with NSAIDs plus opioids reported modest reduction in pain, while presenting a considerable burden of comorbidities, cognitive impairment, and level of dependency in a relatively short period of treatment Consequently, healthcare costs per patient significantly increased for the NHS, particularly when considering treatments with strong opioids; €2472/year vs. €1380/ year with weak opioids INTRODUCTION Osteoarthritis (OA) is a degenerative joint pathology with prevalence varying depending on the affected joint and the criteria used to define the disease [1,2]. Between 6% and 24% of adults have OA with chronic pain of more than 3 months' duration, with incidence increasing with aging [3][4][5]. In Spain, the study on prevalence of rheumatic diseases (EPISER) showed a prevalence of OA in any joint of 29.4% in persons aged over 40 years [5].…”

Identification of Novel Genes in Osteoarthritic Fibroblast-Like Synoviocytes Using Next-Generation Sequencing and Bioinformatics Approaches

“…The increasing prevalence of OA is likely due to increases in longevity and prevalence of obesity 2,3. Clinically, the diagnosis of OA is mainly based on symptoms and radiographic findings, although discordance between pain and severity of radiographic joint pathology has been reported 4,5. The major histopathological changes in OA joint are the cartilage destruction with hypertrophic differentiation of chondrocytes 6.…”