Background/Purpose: A growing body of evidence shows that generalized osteoarthritis (GOA) is fairly common, however research and clinical practice recommendations are mainly focused on a specific localization of osteoarthritis (OA). As a consequence the clinical burden of GOA is largely unknown. More insight into the clinical burden of GOA is needed in order to improve its management and to develop treatment tailored to the patients’ needs and problems. Therefore the aim of this study was to determine the clinical burden of GOA in terms of activity limitations and health related quality of life (HRQoL).

Methods: Baseline data from a randomized controlled trial (RCT) comparing two non-pharmacological treatment programmes for patients with GOA were used. GOA was defined as having musculoskeletal complaints in >2 joint groups and having >1 objective signs of OA in >1 joint. In addition, patients had to be limited in performing daily activities (HAQ-DI score > 0.5). Patients clinically diagnosed with GOA by a rheumatologist and referred to multidisciplinary treatment completed self-reported questionnaires to assess socio-demographics, joint involvement (self-report and objective), activity limitations (HAQ-DI) and HRQoL (SF-36 physical (PCS) and mental component summary (MCS) norm based scores). Patients were asked to report the three most important activity limitations due to GOA and to rate its severity on a visual analogue scale. Reported activity limitations were linked to the International Classification of Functioning, Disability and Health (ICF) using established linking rules. 

Results:  In total, 147 patients (85% female) participated in this study with a mean (SD) age of 60 (8) years. Hundred-fifteen patients (78%) reported musculoskeletal complaints in ≥ 4 joint areas. Self-reported and objective signs of OA were most common in the hands (n = 125; 85%) and knees (n = 121; 82%). Patients with GOA were moderately to severely limited in performing daily activities reflected by a mean (SD) HAQ-DI score of 1.27 (0.50). “Much difficulty” with activities such as shopping or doing chores were reported by more than half of the patients. Patients with GOA experience a markedly reduced HRQoL on the physical domain reflected by a mean (SD) PCS score of 32 (8), which is comparable with the impact of Rheumatoid Arthritis on HRQoL. Activities concerning mobility and domestic life were most frequently reported as being important activity limitations, in particular walking (Table 1).

Conclusion:  The results of this study suggest a high clinical burden at least in selected patients with GOA in terms of activity limitations and HRQoL. According to the results it is conceivable that non-pharmacological treatment targets for patients with GOA may focus especially on the physical domain of HRQoL and on mobility limitations (walking in particular) as these activities are the most important for patients.

 

Table 1. The ten most frequently reported, self-perceived activity problems with corresponding ICF codes and corresponding mean (SD) severity scores in 147 patients with Generalized Osteoarthritis (GOA).
ICF code	Activity	N (%)	Mean (SD) severity (0-10)
d450	Walking	71 (48)	6.7 (2.1)
d415	Maintaining a body position	46 (31)	6.4 (2.4)
d410	Changing basic body position	41 (28)	7.1 (1.8)
d640	Doing housework	35 (24)	6.9 (1.7)
d455	Moving around (climbing stairs)	35 (24)	6.5 (2.0)
d430	Lifting and carrying objects	30 (20)	6.1 (2.0)
d440	Fine hand use	25 (17)	6.5 (2.0)
d650	Caring for household objects	24 (16)	7.3 (1.7)
d920	Recreation and leisure	22 (15)	6.1 (2.2)
d475	Driving	20 (14)	6.2 (2.9)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-clinical-burden-of-generalized-osteoarthritis-represented-by-activity-limitations-and-health-related-quality-of-life-a-cross-sectional-study/