Knee osteoarthritis (OA) is a leading cause of disability in the elderly

Jun 29 2004

Many older patients with knee osteoarthritis prefer treatments with lower risks of adverse side effects, even if those treatments were not the most effective, according to an article in the June 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

Knee osteoarthritis (OA) is a leading cause of disability in the elderly, according to information in the article. Treatment for knee OA, which includes surgery, weight loss, muscle-strengthening exercise, and joint protection techniques, is aimed at improving or maintaining knee function, and targeting symptoms. Medication options provide modest effectiveness for decreasing pain associated with knee OA, and vary greatly with respect to their cost and risk of toxicity.

Liana Fraenkel, M.D., M.P.H., from Yale University, New Haven, Conn., and colleagues interviewed 100 consecutive patients with symptomatic knee osteoarthritis (79 percent female; 92 percent white; average age, 70 years) about their OA medication preferences. The researchers surveyed the importance of specific medication characteristics-including type of drug (prescription or over-the-counter), administration (dose and method), time to benefit, response rate, common adverse effects, risk of ulcer, and monthly copayments-and then measured the impact of these characteristics on the percentage of patients preferring the following treatments: non-selective non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors (cox-2 inhibitors), glucosamine and/or chondroitin sulfate, opioid derivatives, and/or capsaicin.

Despite being described as less effective than the other drug treatments, capsaicin-a topical agent that has been used in treating pain-was preferred by 44 percent of participants, assuming the patient was responsible for full cost of the medication. Of the medication traits studied, risk of common adverse side effects and gastrointestinal ulcer had the greatest impact on patients' choice, each accounting for approximately 19 percent of total relative importance. Non-selective NSAIDs, the most widely prescribed medication for arthritis patients, was found to be the least-preferred option across almost all circumstances.

"We conclude that many older patients with knee OA might be willing to accept less effective treatments in exchange for a lower risk of adverse effects," the authors write. "The magnitude of the discrepancy between patient preferences in this study and the widespread use of nonselective NSAIDs raises important questions about how patient preferences are elicited and how treatment decisions for OA are made in clinical practice."