Preferences in the management of osteoarthritis of the hip and knee: Results of a survey of community-based rheumatologists in the United States

Objective. To determine rheumatologists' preferences in the medical management of osteoarthritis (OA) of the hip and knee, and examine possible variations in these preferences. Methods. A stratified random sample of 1,001 rheumatologists in community-based practice in the United States was surveyed by mail. Results. Responses were obtained from 594 subjects (529 white, 499 male, mean ± SD age 47.4 ± 8.1 years). Over 80% used acetaminophen or nonaspirin, nonsteroidal antiinflammatory drugs (NSAIDs) either always or frequently for the management of OA of the hip and knee. A majority used the following non-pharmacologic methods either always or frequently: weight loss, cane or crutch, physical and/or occupational therapy referral, and exercise. Variation in practice preferences was noted by age (<47 versus ≥47 years), sex, board certification in rheumatology, and number of patients seen per month. Respondents felt that severe pain and limitation of function were the most important factors in recommending total join arthroplasty for patients. Conclusion. These data demonstrate that practicing rheumatologists most often use either acetaminophen and/or NSAIDs in combination with non-pharmacologic methods in the medical management of OA of the hip and knee. The existence of variation in practice preferences has policy implications.