Background:Knee osteoarthritis (OA) is a leading cause of disability among older adults. Recently, evidence-based guidelines for the comprehensive management of osteoarthritis (OA) were developed by the American College of Rheumatology (ACR).Objectives:The aim of this study was to assess compliance of doctors with ACR 2019 clinical practice guidelines for the management of knee OA.Methods:We conducted a prospective study including rheumatologists and general practitioners. The doctors were invited to answer a structured questionnaire via Google Form. The outcomes of interest concerned the medical management of knee OA as well as alternative medicine.Results:The study included 100 doctors: 75 rheumatologists and 25 general practitioners. Almost half of them (49%) have been practicing medicine for more than 10 years. Forty four percent of doctors see between 10 to 20 patients with knee OA per month and 47% of them declared seeing more than 20 patients. Regarding the pharmacological treatment of knee OA flares, oral Non-steroidal Anti-inflammatory drug (NSAIDs) was the initial molecule of choice (91%) followed by grade I analgesics (86 %) and topical NSAIDs (68%). Tramadol and non-Tramadol opioids as well as intraarticular glucocorticoid injections were prescribed respectively in 41% and 46 % of cases. Glucosamine and chondroitin sulfate were prescribed in 49% and 54% of cases respectively and as a combination in 20% of cases. The reasons for non-prescribing these molecules were non-affordable prices (n=19), a lack of efficacy (n=6) and potential sides effects (n=1). Seventy three percent of doctors prescribe hyaluronic acid injections, with a frequency of three weekly injections in 38.7 % of cases and according to the response to the first injection in 61.3% of cases. The combination of both corticosteroids and hyaluronic acid injection was preferred in 38% of cases. The majority of doctors (84%) referred their patients to physical therapy as a first-line prescription (82.1%) or after medical treatment failure (17.9%). The use of alternative medicine was at follows: acupuncture (42.7%), prolotherapy (28.1%) and platelet-rich plasma injections (16.7%). Thirty eight doctors recommended against alternative medicine.Conclusion:Our study showed a poor compliance to guidelines regarding the use of intra-articular injections and alternative medicine. Even though, these guidelines provide direction for clinicians, doctors and patients should engage in shared decision-making that accounts for patients’ values, preferences, and susceptibilities.Disclosure of Interests:None declared.
The attitudes and beliefs of general practitioners towards clinical practice guidelines: a qualitative study in Al Ain, United Arab Emirates
