COMPARISON OF GENERAL INTERNISTS, FAMILY PHYSICIANS, AND RHEUMATOLOGISTS MANAGING PATIENTS WITH SYMPTOMS OF OSTEOARTHRITIS OF THE KNEE

Objective. To evaluate the nature, risks, and benefits of osteoarthrit is (OA) management by primary care physicians and rheumatologists. Met hods. Subjects were 419 patients followed for symptoms of knee OA by e ither a specialist in family medicine (FM) or general internal medicin e (GIM) or by a rheumatologist (RH). Management practices were charact erized by in-home documentation by a visiting nurse of drugs taken to relieve OA pain or to prevent gastrointestinal side effects of nonster oidal anti-inflammatory drugs (NSAIDs) and by patient report (self-adm inistered survey) of nonpharmacologic treatments. Changes in outcomes (knee pain and physical function) over 6 months were measured with the Western Ontario and McMaster Universities Osteoarthritis Index. Resul ts. Patients of RHs were 2-3 years older (P = 0.035) and tended to exh ibit greater radiographic severity of OA (P = 0.064) and poorer physic al function (P = 0.076) at baseline than the other 2 groups. In all 3 groups, knee pain and physical function improved slightly over 6 month s; however, between-group difference were not significant. Compared to drug management of knee pain by FMs or RHs, that by the GIMs was dist inguished by greater utilization of acetaminophen and nonacetylated sa licylates (P = 0.008), lower prescribed doses of NSAIDs (P = 0.007), a nd, therefore, lower risk of iatrogenic gastroenteropathy (P < 0.001). In contrast, patients of RHs were more likely than those of FMs and G IMs to report that they had been instructed in use of isometric quadri ceps and range-of-motion exercises (P less than or equal to 0.001), ap plication of heat (P = 0.051) and cold (P < 0.001) packs, and in the p rinciples of joint protection (P < 0.001). Neither physician specialty nor specific management practices accounted for variations in patient outcomes. Conclusion. This observational study identified specialty-r elated variability in key aspects of the management of knee OA in the community (i.e., frequency and dosing of NSAIDs, use of nonpharmacolog ic modalities) that bear strong implications for long-term safely and cost. However, changes in knee pain and function over 6 months were un related to variations in management practices.