Treating osteoarthritis in practice--the TOP Study

This study consisted of two nationwide surveys. The first involved 209 general practitioners (GPs) from 22 sampling points in England, Scotland and Wales, and the second involved 510 patients with osteoarthritis (OA) (aged 60 years and above), rheumatoid arthritis (RA) or unspecified arthritis, who had visited their GP for treatment. The results showed that OA has a significant negative impact on patients' quality of life; 79% of patients stated that their condition limited their quality of life. Only 15% of GPs reported prescribing a conventional non-steroidal anti-inflammatory drug (NSAID) as first-line treatment for patients with arthritis. More than half (57%) stated that they would prescribe a simple analgesic or a compound analgesic before trying an NSAID. Forty four per cent of GPs stated that their main therapeutic objective when prescribing an NSAID was to minimise GI side-effects, and therefore start at a low dose. This implies that many patients are likely to be receiving sub-optimal doses. Experiencing breakthrough pain and GI side-effects were common reasons cited for patients re-presenting to GPs. GPs reported their expectation to prescribe GI protectants to a fifth (21%) of their patients on NSAIDs and estimated one in six patients (17%) take OTC products to relieve GI symptoms. This research demonstrates that there is considerable dissatisfaction with currently used treatment regimens for osteoarthritis, from both the GP and patient perspectives.