Osteoarthritis Patients Still Waiting on Better Treatments

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Osteoarthritis and rheumatoid arthritis patients report having similar pain levels in the beginning, but by six months, osteoarthritis patients say their pain is worse. This suggests a need for more effective osteoarthritis treatments, say researchers writing in Arthritis & Rheumatology.

In this Q&A, the study’s lead author, Theodore Pincus, M.D., of Rush University Medical Center in Chicago, addresses the significance of the findings.

Q: Why examine the differences in disease burden between osteoarthritis and rheumatoid arthritis patients?

A: I’ve been collecting data on every patient I’ve seen since 1982. Some earlier data from the 1990s suggested that the general perception that osteoarthritis isn’t as severe a condition as rheumatoid arthritis was not correct. About three years ago, colleagues in Australia, Drs. Carlos el Haddad and Kathryn Gibson and I recognized that patients with osteoarthritis had similar MDHAQ/RAPID3 ((multidimensional health assessment questionnaire/routine assessment of patient index data) scores to those with rheumatoid arthritis. Therefore, the disease burden appeared similar in both groups of patients, recognizing that individual patients within each group had more or less severe burdens. 

That observation involved a “convenience sample” of patients seen in the clinic, and could be explained entirel

by better treatments for rheumatoid arthritis, who had considerably poorer status at their first visit.  However, patients were similar at first visit, and after six months, the osteoarthritis patients were a little better, but the rheumatoid arthritis patients were much better. This finding highlights that we have much better treatments for rheumatoid arthritis patients than we do for people with osteoarthritis. Osteoarthritis treatment may be considered to a large extent at the level treatments seen for rheumatoid arthritis 30-50 years ago.

Q: What are the most significant findings from this study?

A: Overall, I think one of the most significant findings from this study is that more research into possibly preventing the onset, as well as the progression, of osteoarthritis is needed. There remain some people who think osteoarthritis is just a process seen in aging. But, it’s not really. One way to express that is to consider a patient who needs one knee replacement, but the other knee is fine. Osteoarthritis is clearly not a simple matter of aging alone.

For this study, it’s important to note that the MDHAQ and RAPID3 scores were similar at the initial rheumatology visit for both osteoarthritis and rheumatoid arthritis patients. But, the scores were higher for osteoarthritis patients after six months, although improved in both groups. Osteoarthritis is severe when patients first come to rheumatologists, and their scores improve less over time. Consequently, the difference between osteoarthritis and rheumatoid arthritis is much greater later.

These findings indicated that treatments for rheumatoid arthritis are superior to those currently available for osteoarthritis. It highlights that there’s a need to developing therapies that can better prevent and manage osteoarthritis symptoms.

The results also indicate the value of MDHAQ/RAPID3 to be informative on all rheumatic diseases in which it has been studied. Therefore, disease burden can be compared in patients with different diseases, which is not possible using disease-specific questionnaires.

Q: Were any results surprising?

A: Yes. Our initial observation three years ago that osteoarthritis patients and rheumatoid arthritis patients report similar pain, fatigue, and functional problems was somewhat surprising, but the similarity to rheumatoid arthritis patients was anticipated.

We were surprised to learn that the likelihood of referral to a rheumatologist was similar for osteoarthritis to rheumatoid arthritis, as a general perception exists that osteoarthritis patients are more likely to be self-referred than rheumatoid arthritis patients.

Q: What is the clinical significance and importance of your study?

A: Ultimately, the goal of the study is that people would take the patients with osteoarthritis as seriously as they take rheumatoid arthritis patients. This includes all health professionals-primary care physicians, orthopedists, rheumatologists, physical therapists, occupational therapists, pharmacists, and others. Osteoarthritis is a major public health problem, and these findings indicate a clear need for developing therapies that can better prevent and manage symptoms of the condition.

From an overall clinical perspective, it’s also important to note that the MDHAQ can provide information about all rheumatic diseases and can be used to compare different disease burdens effectively. Approaches like this can be used in any clinical setting for disease burden recognition in individual patients in clinics, patient groups for clinical research, and to inform public health policies.

REFERENCES

Chua JR, Jamal S, Riad M, Castrejon I, Malfait AM, Block JA, Pincus T. "Disease burden in osteoarthritis (OA) is similar to rheumatoid arthritis (RA) at initial rheumatology visit and significantly greater 6-months later." Arthritis Rheumatol. 2019 Mar 20. doi: 10.1002/art.40869. [Epub ahead of print]