Cimmino Marco A, Sarzi-Puttini Piercarlo, Scarpa Raffaele, Caporali Roberto, Parazzini Fabio, Zaninelli Augusto, Marcolongo Roberto
Rheumatology, University of Genoa, Genoa, Italy.
Semin Arthritis Rheum. 2005 Aug;35(1 Suppl 1):17-23. doi: 10.1016/j.semarthrit.2005.01.015.
To assess the clinical characteristics and determinants of pain observed by general practitioners (GPs) in Italian patients with osteoarthritis (OA) of the hand, hip, and knee.
The 2764 GPs participating in the study were asked to enroll 10 consecutive patients with OA diagnosed according to the American College of Rheumatology (ACR) clinical criteria. To standardize the diagnosis, the GPs received ad hoc training from musculoskeletal system specialists. A questionnaire evaluating demographic data, the clinical characteristics of OA, and previous diagnostic and therapeutic interventions was administered by the GPs.
25,589 evaluable patients were enrolled during a mean period of 2.8 weeks by the GPs: 17,567 women (69%) and 7878 men (31%). The most painful OA joints were the knee in 12,827 patients (54%), the hip in 5645 patients (24%), and the hand in 5467 patients (23%)--percentages calculated on the 23,939 patients for whom this information was available. The weekly incidence of referrals to GPs for OA was higher for women and for knee OA. The median age of the patients was 70 years (range 50 to 104 years) and disease duration was 8.3 +/- 7.10 years. The most frequent comorbidities were hypertension (53%), obesity (22%), osteoporosis (21%), type II diabetes mellitus (15%), and chronic obstructive pulmonary disease (13%). The median pain visual analog scale (VAS) score was higher for women than for men, for hip OA, and for generalized OA (GOA) than for knee and hand OA (P < 0.0001). Intense pain, defined as VAS readings of >60 mm, was increased in women only in the knee (OR = 1.24; 95% CI 1.15 to 1.34) and in GOA (OR = 1.17; 95% CI 1.03 to 1.33). It was also significantly increased in patients older than 70 years (OR = 1.46; 95% CI 1.39 to 1.54), those with a low educational level (OR = 1.44; 95% CI 1.36 to 1.5), a BMI of > or =30 (OR = 1.52; 95% CI 1.42 to 1.61), a disease duration of more than 7 years (OR = 1.60; 95% CI 1.52 to 1.68), comorbidities (OR = 1.61; 95% CI 1.5 to 1.73), and GOA (OR = 2.05; 95% CI 1.91 to 2.19). Manual occupations were associated with highly intense pain only in men.
The results of this study underscore the major impact of OA on care in general practice, the high frequency of OA-associated comorbidities, and the role of different risk factors in OA pain.
评估意大利手部、髋部和膝部骨关节炎（OA）患者中，全科医生（GP）观察到的疼痛的临床特征及决定因素。
邀请参与研究的2764名全科医生，让他们连续纳入10名根据美国风湿病学会（ACR）临床标准确诊为OA的患者。为使诊断标准化，全科医生接受了肌肉骨骼系统专家的专门培训。全科医生发放了一份调查问卷，评估人口统计学数据、OA的临床特征以及既往诊断和治疗干预情况。
全科医生在平均2.8周的时间里共纳入25589名可评估患者：女性17567名（69%），男性7878名（31%）。在有疼痛的OA关节中，膝部有12827名患者（54%），髋部有5645名患者（24%），手部有5467名患者（23%）——这些百分比是根据有此信息的23939名患者计算得出的。女性和膝部OA患者因OA转诊至全科医生处的周发病率更高。患者的中位年龄为70岁（范围50至104岁），病程为8.3±7.10年。最常见的合并症为高血压（53%）、肥胖（22%）、骨质疏松（21%）、II型糖尿病（15%）和慢性阻塞性肺疾病（13%）。女性、髋部OA以及全身型OA（GOA）患者的疼痛视觉模拟量表（VAS）评分中位数高于男性、膝部和手部OA患者（P<0.0001）。定义为VAS读数>60mm的剧烈疼痛，仅在女性的膝部（OR = 1.24；95%CI 1.15至1.34）和GOA（OR = 1.17；95%CI 1.03至1.33）中增加。在70岁以上患者（OR = 1.46；95%CI 1.39至1.54）、教育程度低的患者（OR = 1.44；95%CI 1.36至1.5）、BMI≥30的患者（OR = 1.52；95%CI 1.42至1.61）、病程超过7年的患者（OR = 1.60；95%CI 1.52至1.68）、合并症患者（OR = 1.61；95%CI 1.5至1.73）以及GOA患者（OR = 2.05；95%CI 1.91至2.19）中也显著增加。体力劳动职业仅与男性的剧烈疼痛相关。
本研究结果强调了OA对全科医疗护理的重大影响、OA相关合并症的高发生率以及不同风险因素在OA疼痛中的作用。
