First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence

L Denoeud1, B Mazieres2, C Payen-Champenois3 and P Ravaud1

1 Bichat Claude Bernard Hospital, Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Paris, France
2 Paul Sabatier University and Department of Rheumatology, University Hospital of Rangueil, Toulouse, France
3 Bristol-Myers Squibb, Medical Department, Rueil-Malmaison, France

Correspondence to:
Dr Philippe Ravaud
Departement dEpidemiologie, Biostatistique et Recherche Clinique, Hopital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France;

Objectives: To document adherence to two parts of the EULAR 2000 recommendations for knee osteoarthritis, concerning non-pharmacological and pharmacological first line management; and to identify factors influencing adherence to the recommendations.

Methods: In a prospective study, 1030 randomly selected French general practitioners completed questionnaires about three unselected outpatients with osteoarthritis, and about their own practice, knowledge, and agreement with the EULAR 2000 recommendations. Percentages of adherence of their prescriptions to both parts of the recommendation were calculated, and probabilities of non-adherence analysed in relation to patient and physician related characteristics, using multilevel logistic regression analysis.

Results: Data were obtained from 967 physicians and 2430 patients. The EULAR 2000 recommendations were familiar to 79% of the GPs; 99% agreed with the non-pharmacological part and 97% with the pharmacological part. Adherence to the two parts was 74.8% and 73.6%, but 54.2% for both together. Factors increasing adherence to the non-pharmacological recommendation were patient body mass index >35 kg/m2 (odds ratio 0.11 (95% confidence interval, 0.06 to 0.21)), patients stated preference for a treatment (OR 0.43 (0.55 to 0.97)), and physicians regular continuance of medical education (OR 0.76 (0.59 to 0.98)); patients age and duration of symptoms decreased adherence. Factors increasing adherence to the pharmacological recommendation were gastrointestinal disease (OR 0.50 (0.35 to 0.72)) and physicians knowledge of the EULAR recommendations (OR 0.75 (0.60 to 0.93)).

Conclusions: Although most physicians agreed with the EULAR 2000 recommendations, adherence was only approximately 75% for each of the non-pharmacological and pharmacological recommendations and 54% for both together.