Therapieprinzipien von Hausärzten und Rheumatologen in Süddeutschland bei rheumatoider Arthritis und Gonarthrose (Therapeutic approaches of general practitioners and rheumatologists in treating rheumatoid arthritis and osteoarthritis of the knee)

Abstract

Using "paper patients" we compared the therapeutic approaches of general practitioners and rheumatologists to rheumatoid arthritis and to osteoarthritis of the knee. The mailed survey contained a mild, a moderate and a severe case of rheumatoid arthritis (RA) and a case of osteoarthritis (OA) of the knee. 111 out of 252 general practitioners and 78 out of 132 rheumatologists selected at random participated in the study. We found that rheumatologists would choose more non-steroidal anti-inflammatory drugs (NSAID), disease modifying antirheumatic drugs (DMARD), steroids and physical therapy. In case 4 (OA of the knee) rheumatologists would more frequently recommend analgesics, local steroids, occupational therapy, surgery and ortheses. Primary care physicians on the other hand prescribed more chondroprotective agents. Patients with RA and OA of the knee would be treated differently by primary care physicians and rheumatologists. In order to develop a more uniform therapeutical concept and therefore to reach a better management of the rheumatic patient, a close co-operation of the two physician groups is needed.

The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review

“…Within the 18 studies investigating behaviour of GPs regarding exercise for CKP/KOA, eight presented information on "reported behaviours" of GPs [4,24-27,30,31,33]. The remaining 10 studies detailed "actual" behaviour using; patient questionnaires (n = 3) [34,38,39], patient interviews (n = 3) [32,37,40], case-note review (n = 3) [23,35,41] and patient questionnaires and interviews (n = 1) [36].…”

“…Although 99% of GPs reported ever providing advice or referring to a physiotherapist [31], the frequency of actual provision of exercise advice or physiotherapy referral was lower. Estimates of provision of exercise advice and physiotherapy referral were generally higher for vignette-based studies (exercise advice 9%-89% [4,24-27,30];physiotherapy referral 44%-77% [27,30,33]) than reviews of actual practice (exercise advice 5%-52% [23,32,36,40-42]; physiotherapy referral 13-63% [23,34,35,37-40]). Of the studies specifically concentrating on CKP, 18-40% patients had received or been referred for physiotherapy [35,38,40], 44-54% of GPs stated they would refer to physiotherapy and 59-76% stated they would advise on knee joint exercises for such patients [30].…”