Therapeutic approaches of German and Turkish physicians to rheumatoid arthritis and to osteoarthritis of the knee

Abstract

Our objective was to compare the therapeutic approaches of German and Turkish physicians to rheumatoid arthritis (RA) and to osteoarthritis (OA) of the knee, by means of a mailed survey. The survey contained four case histories representing a mild, a moderate and a severe case of RA and a case of OA of the knee. One hundred and thirty-two physicians from Germany (internal medicine based (IR) and orthopaedics based (OR) rheumatologists) and thirty-three from Turkey (rheumatologists and physical medicine and rehabilitation specialists (PT)) participated in the study. German respondents would give more disease-modifying drugs (DMARD) in early RA (48.7% vs 18.2%, p < 0.05), whereas their Turkish colleagues would prescribe more analgesics, ultrasound and kryotherapy in OA of the knee (63.6% vs 22.1%, 30.3% vs 6.5% and 24.2% vs 0.0% respectively p < 0.05). German physicians chose more exercise, physical and occupational therapy, radiation synovectomy and surgery in all cases. In OA of the knee German OR's would recommend less analgesics, but more local steroids, chondroprotective agents and surgery than the other groups. We may conclude that clinical practice of RA and OA of the knee differs considerably in Germany and Turkey. Cultural, social, educational and economic factors could influence the decisions of the physicians.