Outcomes of osteoarthritis treatment – results of an 8-year follow-up study

Dražen Bedeković, Ivica Bošnjak, Damir Kirner,Višnja Prus, Srđan Novak

Introduction: Osteoarthritis (OA ) is the most common chronic joint disease. It is characterized by chronic pain, joint deformation and loss of function. The treatment of OA is complex and long-term, includes non-pharmacological, pharmacological and surgical methods, and for optimal results a combination of several forms of treatment is required. Participants and methods: The research was conducted as a prospective clinical observational cohort study in the period from 2008 to 2017 on 77 participants from Eastern Croatia suffering from OA who were treated at University Hospital Centre Osijek. All participants underwent screening, the initial inclusion round and the final round according to a pre-prepared protocol. During the follow-up, data were collected on any change in health status, medication therapy or surgical procedure. The aim of the study was to assess the OA treatment outcomes during long-term followup, and it was especially focused on comparing outcomes of combined conservative and surgical methods, and conservative treatment methods alone. Results: Out of the 77 participants who were included after screening, 55 completed the study, 22 died or refused further participation. Subjective assessment of the state of the disease in relation to the beginning of the study was: extremely worsened 10.9%, significantly worsened 36.36%, slightly worsened 25.45%, equal 10.9%, slightly improved 7.27%, significantly improved 9.09%. At the beginning of the study, the average HA Q score (Health Assessment Questionnaire) was 1.37 (0–2.25), the average chronic pain score on the visual-analogue scale (VAS ) was 55.55 (0–100), the average overall health assessment was 43.45 (0–100). At the end of the study: 9 participants underwent total knee arthroplasty (16.36%), and 15 participants underwent total hip arthroplasty (27.27%), average HA Q score 1.53 (0–2.28), average chronic pain score on VAS 50.18 (0–100), average overall health assessment 40.38 (0–90). Conclusion: The effect of OA treatment in this study was unsatisfactory according to subjective and objective indicators, for both conservative and surgical treatment methods. The use of medications should be rationalized and complementary to physical therapy, while surgical treatment methods should be reserved as a method of last but timely choice of treatment.

Uvod: Osteoartritis (OA ) je najčešća kronična bolest zglobova; karakterizirana je kroničnom boli, deformacijom i gubitkom funkcije zgloba. Liječenje OA je složeno i dugotrajno, obuhvaća nefarmakološki, medikamentozni i kirurški pristup, a za optimalni rezultat potrebno je kombinirati više oblika liječenja. Ispitanici i metode: Istraživanje je prospektivna klinička opservacijska kohortna studija provedena u razdoblju od 2008. do 2017. godine na 77 ispitanika oboljelih od OA s područja istočne Hrvatske, liječenih u Kliničkome bolničkom centru Osijek. Svi su ispitanici prošli probir, prvu vizitu i završnu vizitu prema unaprijed pripremljenom protokolu. Tijekom praćenja prikupljeni su podatci o svakoj promjeni zdravstvenog stanja, promjeni u medikamentoznoj terapiji ili operacijskom zahvatu. Cilj istraživanja je procjena ishoda liječenja OA tijekom dugotrajnog praćenja, osobito usporedba ishoda kod kombiniranih konzervativnih i operativnih metoda i samo konzervativnih metoda liječenja. Rezultati: Od 77 ispitanika koji su nakon probira uključeni, 55 je završilo istraživanje, 22 je preminulo ili odbilo daljnje sudjelovanje. Subjektivna ocjena stanja bolesti u odnosu na početak istraživanja bila je: izuzetno pogoršano 10,9%, značajno pogoršano 36,36%, blago pogoršano 25,45%, jednako 10,9%, blago poboljšano 7,27%, značajno poboljšano 9,09%. Na početku istraživanja prosječni HA Q skor (engl. Health Assesment Questionare) bio je 1,37 (0 – 2,25), prosječni skor kronične boli na vizualno-analognoj skali (VAS ) 55,55 (0 – 100), prosječna ukupna procjena zdravstvenog stanja 43,45 (0 – 100). Na završetku istraživanja: devet ispitanika je imalo ugradnju totalne endoproteze koljena (16,36%) i petnaest ispitanika je imalo ugradnju totalne endoproteze kuka (27,27%), prosječni HA Q skor 1,53 (0 – 2,28), prosječni skor kronične boli na VAS 50,18 (0 – 100), prosječna ukupna procjena zdravstvenog stanja 40,38 (0 – 90). Zaključak: Učinak liječenja OA u ovom istraživanju bio je nezadovoljavajući prema subjektivnim i objektivnim pokazateljima primjenom konzervativnih i operativnih metoda liječenja. Upotreba lijekova treba biti racionalizirana i komplementarna s fizikalnom terapijom, dok kirurške metode liječenja trebaju biti rezervirane kao metoda posljednjeg, ali pravovremenog izbora liječenja.