Muckelt Paul Edward, Roos E M, Stokes M, McDonough S, Grønne D T, Ewings S, Skou S T
School of Health Sciences, University of Southampton, Southampton, UK.
Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK.
J Comorb. 2020 May 14;10:2235042X20920456. doi: 10.1177/2235042X20920456. eCollection 2020 Jan-Dec.
Robust data on the impact of comorbidities on health in people with osteoarthritis (OA) are lacking, despite its potential importance for patient management. Objectives were to determine coexisting conditions in people with OA in primary care and whether more comorbidities were linked with individual health status.
A retrospective analysis of 23,892 patients with knee and hip OA was conducted to determine comorbidities present (number/clusters) and how these linked with pain intensity (0-100), widespread pain (site numbers), medication usage (paracetamol, nonsteroidal anti-inflammatory drugs, opioids), quality of life EuroQol five dimension scale (EQ-5D), and physical function (walking speed) using independent -tests or test.
Sixty-two percent of people with OA treated in primary care had at least one comorbidity; hypertension (37%), heart disease (8%), and diabetes (7%) being most common. Outcome measures worsened with more comorbidities (0-4+ comorbidities); pain intensity [mean (SD)] 46(22)-57(21); number of painful sites 3.7(3.0)-6.3(5.4); quality of life 0.73(0.10)-0.63(0.15); walking speed 1.57 m/s (0.33)-1.24 m/s (0.31), while the proportion of people using pain medication increased from 0 to 2 comorbidities (58-69%; < 0.001), with an increase in opioid use from 4.6% to 19.5% with more comorbidities (0-4+ comorbidities).
Most people with knee or hip OA in primary care have at least one other long-term condition. A greater number of comorbidities is linked with worsening health, highlighting the importance of screening for comorbidities when treating patients with OA. It is important for clinicians to consider how OA treatments will interact and affect other common comorbidities.
尽管合并症对骨关节炎（OA）患者健康的影响可能对患者管理具有重要意义，但目前仍缺乏相关有力数据。本研究旨在确定初级保健中OA患者并存的疾病，以及更多合并症是否与个体健康状况相关。
对23892例膝和髋OA患者进行回顾性分析，以确定存在的合并症（数量/类别），以及这些合并症如何与疼痛强度（0-100）、广泛性疼痛（疼痛部位数量）、药物使用情况（对乙酰氨基酚、非甾体抗炎药、阿片类药物）、欧洲五维健康量表（EQ-5D）生活质量和身体功能（步行速度）相关，采用独立样本t检验或卡方检验。
在初级保健中接受治疗的OA患者中有62%至少患有一种合并症；最常见的是高血压（37%）、心脏病（8%）和糖尿病（7%）。随着合并症数量增加（0-4种及以上合并症），各项结局指标恶化；疼痛强度[均值（标准差）]为46（22）-57（21）；疼痛部位数量为3.7（3.0）-6.3（5.4）；生活质量为0.73（0.10）-0.63（0.15）；步行速度为1.57米/秒（0.33）-1.24米/秒（0.31），而使用止痛药物的患者比例从0种合并症增加到2种合并症时从58%增至69%（P<0.001），随着合并症增多（0-4种及以上合并症），阿片类药物使用比例从4.6%增至19.5%。
在初级保健中，大多数膝或髋OA患者至少患有一种其他慢性病。合并症数量越多，健康状况越差，这凸显了在治疗OA患者时筛查合并症的重要性。临床医生考虑OA治疗如何相互作用并影响其他常见合并症非常重要。
