Abstract
IntroductionUnderstanding the relationship between patient-reported osteoarthritis (OA) severity and other patient-reported outcomes in the real-world clinical setting can provide a basis for appropriate patient management. The objective of this study was to determine how patient-reported OA severity correlates with patient-reported outcomes including pain, function and productivity.MethodsWe used the Adelphi Disease Specific Programme (DSP) for OA, a database aggregated from large, multinational, observational studies for specific chronic diseases. Data were obtained based on a 0 to 100 mm pain visual analogue scale (VAS) and a series of questions including functioning (that is, activities of daily living) and work productivity. OA severity was rated by the patients based on the question "How bad would you say your arthritis is now?" with potential responses of "mild," "moderate," and "severe." Regression models and chi-square analyses were used to evaluate the relationships between self-reported OA severity and other outcomes.ResultsOf 998 subjects in the OA DSP U.S. database, 714 (72.5%) agreed to participate. This sample was predominantly female (61.7%) with a mean age of 63.8 ± 12.9 years. Increased OA severity was associated with an older population (P < 0.05). With increasing OA severity (mild, moderate, severe), statistically significant differences (P < 0.05) were observed in increased pain VAS scores (23.5, 50.2, 70.8, respectively), lower functioning outcomes, and a higher percent of overall work impairment due to OA (17%, 37%, 48%, respectively). The increased work impairment at greater severity levels also resulted in higher costs related to lost work productivity, with annual costs due to lost productivity estimated at $6,096, $13,2510, and $17,214 per patient for self-reported mild, moderate, and severe OA, respectively (P < 0.05 for pairwise comparisons).ConclusionsIn the clinical practice setting, patient-reported OA severity was associated with other key patient-reported outcomes and thus may provide an accurate and tangible assessment of patients' perceptions of their disease. Identifying OA patients by their perceived severity level may be of benefit to patients and health-care providers when choosing treatment options aimed at reducing pain, and improving function and productivity.
Highlights
Understanding the relationship between patient-reported osteoarthritis (OA) severity and other patient-reported outcomes in the real-world clinical setting can provide a basis for appropriate patient management
Time since first diagnosis increased with increasing OA severity: 4.6 years (95% confidence interval (CI): 3.8 to 5.3) for mild OA, 5.9 years for moderate OA, and 7.2 years for severe OA (P < 0.05 for each pairwise comparison adjusted for age and gender)
After adjustment for age and gender, mean scores on pain severity increased as OA severity increased: 23.5 for mild OA, 50.2 for moderate OA, and 70.8 (67.2, 74.4) for severe OA (P < 0.0001 for each pairwise comparison)
Summary
Understanding the relationship between patient-reported osteoarthritis (OA) severity and other patient-reported outcomes in the real-world clinical setting can provide a basis for appropriate patient management. Osteoarthritis (OA) is a degenerative joint disease that is characterized pathologically by loss of articular cartilage and concomitant development of osteophytes at the joint margins, and characterized clinically by pain, stiffness, fatigue, and functional impairment. These characteristics result in the substantial disability and reduced quality of life reported by patients with OA [1,2]. A variety of pharmacologic options are available for managing OA-related pain such as simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, opioids, and injectables including corticosteroids and viscosupplementation with hyaluronan Choosing among these medications is often determined by disease severity. Johnson et al [12] showed that selfreported improvement did not correlate with clinicopathologic findings including range of motion, disease activity, and radiographic grade
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