A thousand patient voices: knowledge, impact, and experiences of living with osteoarthritis of the knee

Abstract

Purpose: To examine patient attitudes and understanding of osteoarthritis of the knee (OAK), the effect it has on their overall health, limitations in function and social participation caused by OAK, and treatment experiences. Methods: An online survey was conducted by Harris Poll among US adults in June 2019. Eligibility criteria included age ≥40 years, physician-diagnosed OAK, and receiving current or prior treatment for OAK. Patients with prior knee replacement surgery, participation in a clinical trial, or treatment with intra-articular extended-release corticosteroid were excluded. Assessment of impact of OAK reported as percentage agreement (“strongly agree” or “agree”) with various statements. Results: The survey included 1041 participants; mean age was 63 years; 68% were female and 79% were white. A majority (87%) had at least high school-level education; 38% were employed, 44% retired, and 12% were unable to work because of illness or disability. On average patients had been bothered by OAK pain for more than 11 years. Patients’ OAK was managed by primary care physicians (53%), specialists (39%), and others (8%). Patient comorbid conditions included hypertension (55%), high cholesterol (51%), obesity (26%), depression (24%), and type 2 diabetes (18%). A large proportion (82%) felt knowledgeable about their OAK; however, 60% agreed that “osteoarthritis of the knee is just a natural part of aging. I just have to live with it.” Patients did not always recognize conditions in which OAK has a role in developing or worsening: obesity (47%), depression (39%), high blood pressure (22%), type 2 diabetes (11%), and heart disease (11%). Approximately 67% of patients indicated that they were concerned about their health, and 37% reported that OAK made it difficult for them to manage other health issues. In patients with OAK and type 2 diabetes, 33% noted that OAK treatments made it more difficult to manage blood glucose levels. More than half cited OAK contributing to poor quality of sleep (63%) and difficulty in managing their weight (51%). Among respondents, 35% agreed OAK was “one of the worst things they are dealing with in their life” which has substantial impact on their day-to-day functioning. Nearly all patients (95%) reported that OAK had a negative impact on their quality of life, and 39% rated the negative impact as “a great deal” or “a lot.” About half (48%) acknowledged OAK pain sometimes so severe that they struggled to get through the day. Most patients (88%) felt that OAK had forced them to give up or negatively impacted one or more physical activities; particularly exercise or sport activities (85%). Patients acknowledged social and emotional consequences of OAK: 31% noted their self-esteem worsened, 29% reported feeling confined to their home, 24% noted feeling isolated from friends and family, 21% responded that OAK made it difficult for them to maintain healthy relationships (Figure). Many patients reported feeling like they suffered from their OAK pain in silence (56%) and that other people don’t understand how their OAK pain impacts their daily life (56%). A substantial proportion (41%) of patients identified one or more changes in work activity or hiring household help because of OAK pain. Currently employed patients missed 3 days of work on average in the prior year because of symptoms of OAK and 2 days for medical appointments or treatment for OAK. Patients used many OAK treatments within the last year including over-the-counter analgesics (79%), topical creams (41%), intra-articular injections (33%), prescription NSAIDs (25%), and opioid analgesics (21%). A third (33%) of the patients had used opioids in the past to manage OAK pain, and 73% of those continued opioid use in the year before the survey. Conclusions: This recent survey of real-world patients with OAK identifies new gaps and confirms the substantial burden of this condition. Patients’ common perception that OAK represents normal aging may delay seeking care for their knee OA. The low recognition of OAK interactions with other comorbidities may reduce patient motivation to manage their OAK. Patients reported that OAK negatively impacts their ability to perform activities of daily living, reduces quality of sleep, and reduces physical activities of sport and exercise, which may exacerbate comorbid conditions. OAK pain also predisposes to social isolation and lowers self-esteem. Work-related physical limitations and absenteeism may interfere with their livelihood and productivity. There is a substantial use of opioid analgesics in this population. These findings indicate opportunities for patient education about self-management and other treatment approaches and underscore a large unmet need for effective nonopioid therapies to manage OAK pain and functional impact. Sponsor: This study was funded by Flexion Therapeutics (Burlington, MA, USA)