Study to Assess the Prescription Pattern and Quality of Life in Osteoarthritis Patients at a Tertiary Care Hospital

Abstract

Introduction: Osteoarthritis (OA) often called wear and tear arthritis is a chronic progressive musculoskeletal joint disease with multifactorial aetiology, affecting millions of people around the world. It is one of the leading causes of morbidity, having major impact on Quality of Life (QoL) of the patient with substantial economic and social burden. OA can have a negative impact on health related QoL and psychological well-being of the individual. Aim: To evaluate the prescribing trends of drugs in the management of OA in a tertiary care teaching hospital and to assess the effect of pharmacotherapy on QoL of OA patients in terms of subjective and functional status using Western Ontario and McMaster Universities Arthritis index scale (WOMAC)-modified Centre for Rheumatic Disease (CRD) Pune version OA patients. Materials and Methods: Prospective observational study conducted among the OA patients in Orthopaedic Department over the period of one year between November 2014-December 2015. Adult patients of either gender diagnosed with OA for minimum period of three months were enrolled for the study. Out of 285 eligible patients, drug therapy of 256 patients’ data were analysed and they were given treatment by the treating orthopaedician. All the patients were asked to personally complete the WOMAC index scale during their first visit. They were followed-up for one month of pharmacotherapy in order to assess change in the WOMAC index scale. Data were analysed using Statistical Package for the Social Sciences (SPSS) software 16.0 version. The p-value <0.05 was considered statistically significant. Results: Among 256 patients who completed the study, the most frequently prescribed drug class was NSAIDs (82.1%). Acelofenac with Paracetamol combination (117) and Diclofenac monotherapy (44) were most commonly prescribed. Statistically significant reduction in the WOMAC (pain, stiffness and physical function) score was observed in the follow-up visit when compared to first visit (p<0.0001) after one month of pharmacotherapy in patients taking Diclofenac and Aceclofenac with Paracetamol combination. Conclusion: This study highlighted the significant improvement in QoL and significant reduction in WOMAC scores with Aceclofenac-Paracetamol combination and Diclofenac monotherapy in OA patients.

Prevalence of Nonsteroidal Antiinflammatory Drugs Prescribed for Osteoarthritis: A Systematic Review and Meta‐Analysis of Observational Studies

“…The pooled estimate of NSAIDs prescribed to patients with hip osteoarthritis (27,32,60) was 34.9% (95% CI 23.8, 47.9; n = 3 studies, I 2 = 0%, high quality of evidence). In contrast, NSAID prescribing to patients with knee osteoarthritis was 46.3% (95% CI 36.9, 55.9; n = 11 studies, I 2 = 28.8%, moderate quality of evidence) (27,29,32,45,47,48,57,59,60,66,67) and for spine osteoarthritis was 66.9% (95% CI 66.6, 67.2; n = 1 study, I 2 = 0%, high quality of evidence) (27). The stratified analyses results are summarized in Table 3 and the forest plot shown in Supplementary Figure 3, available on the Arthritis Care & Research website at https://doi.org/10.1002/acr.25157.…”

“…The pooled prevalence of NSAIDs varied widely across geographical locations. The pooled estimate of NSAIDs prescribing was highest in South Asia at 83.4% (95% CI 74.8, 89.4; n = 4 studies, I 2 = 3.0%, moderate quality of evidence) (37,47,49,57), followed by Latin America and Caribbean at 68.5% (95% CI 66.8, 70.1; n = 1 study, I 2 = 0%, high quality of evidence) (33), East Asia and Pacific at 46.8% (95% CI 35.0, 58.9; n = 10 studies, I 2 = 31.7%, high quality of evidence) (12,25,32,38,40,51,53,58–60), Europe and Central Asia at 40.2% (95% CI 31.8, 49.3; n = 23 studies, I 2 = 12.2%, moderate quality of evidence) (26,27,28,29,39,42,43,45,46,48,50,52,54–56,61–68), Middle East and North Africa at 34.1% (95% CI 33.9, 34.3; n = 1 study, I 2 = 0%, high quality of evidence) (44), and North America at 32.6% (95% CI 16.9, 53.6; n = 12 studies, I 2 = 11.0%, moderate quality of evidence) (11,30,31,34–36,41,69–73). The stratified analyses results are summarized in Table 3 and the forest plot shown in Supplementary Figure 3, available on the Arthritis Care & Research website at https://doi.org/10.1002/acr.25157.…”

“…Studies were from 31 countries across the globe, including South Asia (n = 4 studies) (37,47,49,57), Middle East and North Africa (n = 1 study) (33), East Asia and Pacific (n = 10 studies) (12,25,32,38,40,51,53,58–60), Europe and Central Asia (n = 23 studies) (26–29,39,42,43,45,46,48,50,52,54–56,61–68), Latin America and Caribbean (n = 1 study) (44), and North America (n = 12 studies) (11,30,31,34–36,41,69–73). Most studies (90.2%) were from high‐income countries with 1 study from an upper‐middle income country (44), and 4 studies were from lower‐middle income countries (37,47,49,57). Half the studies (52.9%) were from clinical settings, with 20 studies from primary care (26,28,29,34,39,42,46,48–50,52,54,55,58,60,64,65–68), 7 studies from tertiary care clinics (37,43,44,47,56,57,72), and 5 studies from multiple care (30,31,41,45,62); 18 studies (35%) provided prevalence data from a database (11,12,25,27,32,33,35,36,38,40,51,53,59,63,69–71,73), and 1 was a population‐based study (61).…”

“…Based on WHO income status, the pooled estimate of NSAIDs prescribing in high‐income countries was 40.3% (95% CI 33.6, 47.4; n = 46 studies, I 2 = 8.5%, moderate quality of evidence) (11,12,25–36,38–43,45,46,48,50–56,58–64,65–73), greater in middle‐income, including, respectively, lower‐middle and upper‐middle income countries, 83.4% (95% CI 74.8, 89.4; n = 4 studies, I 2 = 0%, moderate quality of evidence) (37,47,49,57) and 68.5% (95% CI 66.8, 70.1; n = 1 study, I 2 = 0%, high quality of evidence) (44). There were no studies from low‐income countries.…”

“…Twenty‐five studies provided data on the types of NSAIDs prescribed to patients with osteoarthritis. The pooled estimate of COX‐2 selective NSAIDs was 11.0% (95% CI 8.0, 14.8; n = 23 studies, I 2 = 51.8%, moderate quality of evidence) (11,12,27,28,30,31,34–38,46,52,57,59,62,61,65–68,71,73) compared to nonselective NSAIDs at 34.5% (95% CI 27.0, 42.8; n = 23 studies, I 2 = 48.8%, moderate quality of evidence) (12,27,28,30,31,34,36–38,46,48,52,57,59,61,62,63,65–68,71,73). The stratified analyses results are summarized in Table 3 and the forest plot shown in Supplementary Figure 3, available on the Arthritis Care & Research website at https://doi.org/10.1002/acr.25157.…”