A naturalistic study of the determinants of health related quality of life improvement in osteoarthritic patients treated with non-specific non-steroidal antiinflammatory drugs
[en] OBJECTIVES: To capture changes in the quality of life (QoL) occurring in patients with osteoarthritis (OA) during treatment with non-specific non-steroidal anti-inflammatory drugs (NSAIDs) and to identify factors that predict such changes. METHODS: A naturalistic, prospective follow up of 783 patients with OA in whom primary care physicians decided to start treatment with non-selective NSAIDs. Short Form-36 (SF-36) and the Western Ontario and McMaster Universities OA index (WOMAC) were assessed at baseline and after 3 months. Baseline results were compared with QoL values in 4800 subjects randomly selected from the general population. Multiple regression analysis was performed to identify determinants of QoL at baseline and measures influencing changes in SF-36 or WOMAC during follow up. RESULTS: All QoL dimensions were significantly (p<0.01) decreased in patients with OA compared with controls. Significant improvement (p<0.05) in four dimensions of the SF-36 (vitality, role emotional, role physical, bodily pain) and in all components of the WOMAC was seen between baseline and month 3. Older age, female sex, longer duration of OA, and a higher number of comorbidities were the major determinants of a poor QoL at baseline. Maximal benefit from non-specific NSAIDs was seen in patients with the most severe impairment in QoL and the shortest duration of OA. CONCLUSION: OA negatively impacts all dimensions of the QoL. Non-specific NSAIDs improve the QoL in patients with OA treated in a "real life setting". The profile of patients receiving maximal benefit from such treatment may be of interest for health providers, enabling them to decide who should preferentially be given cytoprotective treatments or coxibs.
Disciplines :
Rheumatology
Author, co-author :
Rabenda, Véronique ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Burlet, N.
Ethgen, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Raeman, F.
Belaiche, Jacques ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Language :
English
Title :
A naturalistic study of the determinants of health related quality of life improvement in osteoarthritic patients treated with non-specific non-steroidal antiinflammatory drugs
Reginster J-Y. The prevalence and burden of arthritis. Rheumatology (Oxford) 2002;41(suppl 1):3-6.
Sharma L, Cahue S, Song J, Hayes K, Pai YC, Dunlop D. Physical functioning over three years in knee osteoarthritis: role of psychosocial, local, mechanical, and neuromuscular factors. Arthitis Rheum 2003;48:3359-70.
Jette AM, Haley SM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, et al. Late life function and disability instrument (FDI). J Gerontol A Biol Sci Med Sci 2002;57:M209-10.
Briggs A, Scott E, Steele K. Impact of osteoarthritis and analgesic treatment on quality of life of an elderly population. Ann Pharmacother 1999;33:1154-9.
Hopman-Rock M, Kraaimaat FW, Bijlsma JW. Quality of life in elderly subjects with pain in the hip or knee. Qual Life Res 1997;6:67-76.
Hill CL, Parsons J, Taylor A, Leach G. Health-related quality of life in a population sample with arthritis. J Rheumatol 1999;26:2029-35.
Wiklund I. Quality of life in arthritis patients using nonsteroidal anti-inflammatory drugs. Can J Gastroenterol 1999;13:129-33.
de Bock GH, Kaptein AA, Touw-Otten F, Mulder JD. Health-related quality of life in patients with osteoarthritis in a family practice setting. Arthritis Care Res 1995;8:88-93.
Zhao SZ, Dedhiya SD, Bocanegra TS, Fort JG, Kuss ME, Rush SM. Health-related quality of life effects of oxaprozin and nabumetone in patients with osteoarthritis of the knee. Clin Ther 1999;21:205-17.
Yeomans N, Wilson I, Langstrom G, Hawkey C, Naesdal J, Walan A, et al. Quality of life in chronic NSAID users: a comparison of the effects of omeprazole and misoprostol. Scand J Rheumatol 2001;30:328-34.
Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form Health Status Survey (SF-36): conceptual framework and item selection. Med Care 1992;30:473-83.
Ware JE. The SF-36 Health Survey. In: Spilker B, ed. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia, PA: Lippincott-Raven, 1996:337-45.
McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994;32:40-66.
Razavi D, Gandek B. Testing Dutch and French translations of the SF-36 Health Survey among Belgian angina patients. J Clin Epidemiol 1998;51:975-81.
Leplege A, Ecosse E, Verdier A, Perneger TV. The French SF-36 Health Survey, translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 1998;51:1013-23.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15:1833-40.
Ethgen O, Tellier V, Ben Sedrine W, De Maessener J, Gosset C, Reginster J-Y. Health-related quality of life and cost ambulatory care in osteoporosis: how may such outcome measures be valuable information to health decision makers and payers? Bone 2003;32:718-24.
Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, ramdomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162:2113-23.
Schnitzer TJ. Means, responders, and meaning: evaluation of clinical trials in osteoarthritis. Arthritis Rheum 2003;48:3001-3.
McKenna F, Borenstein D, Wendt H, Wallemark C, Lefkowith JB, Geis GS. Celocoxib versus diclofenac in the management of osteoarthritis of the knee: a placebo-controlled, randomised, double-blind comparison. Scand J Rheumatol 2001;30:11-8.
Yocum D, Fleischmann R, Dalgin P, Caldwell J, Hall D, Roszko P. Safety and efficacy of meloxicam in the treatment of osteoarthritis: a 12-week, double blind, multiple-dose, placebo-controlled trial. Arch Intern Med 2000;160:2947-54.
Langman M, Kahler KH, Kong SX, Zhang Q, Finch E, Bentkover JD, et al. Drug switching patterns among patients taking non-steroidal anti-inflammatory drugs: a retrospective cohort study of a general practitioners database in the United Kingdom. Pharmacoepidemiol Drug Safety 2001;10:517-24.
Bradley J D, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med 1991;325:87-91.
Lin J, Zhang W, Jones A, Doherty M. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials. BMJ 2004;329:324-6.
La Montagna G, Tirri G, Cacace E, Perpignano G, Covelli M, Pipitone V, et al. Quality of life assessment during six months of NSAID treatment: Gonarthrosis and Quality Of Life (GOAL) study. Clin Exp Rheumatol 1998;16:49-54.
Samsa G, Edelman D, Rothman LM, Williams R, Lipscomb J, Matchar D. Determining clinically important differences in health status measures. A general approach with illustration to the health utilities index mark II. Pharmacoeconomics 1999;15:141-55.
Bindman AB, Keane D, Lurie N. Measuring health changes among severely ill patients. The floor phenomenon. Med Care 1990;28:1142-51.
Chambless LE, Roeback JR. Methods for assessing difference between groups in change when initial measurement is subject to intra-individual variation. Stat Med 1993;12:1213-37.
Bruyère O, Honore A, Rovati LC, Giacovelli G, Henrotin YE, Seidel L, et al. Radiologic features poorly predict clinical outcomes in knee osteoarthritis. Scand J Rheumatol 2002;31:13-16.
Rabenda V, Belaiche J, Raeman F, Haim M, Reginster J-Y. Use of healthcare resources related to gastrointestinal toxicity of NSAIDs [abstract]. Osteoporos Int 2003;14(suppl 7):S14.