VIENNA — Multiple joint problems are the rule, not the exception, in individuals with joint pathology, Anne-Maree Keenan reported at the annual European congress of rheumatology.
She presented the results of a large British primary care practice survey showing that the prevalence of one or more chronic joint problems was high in individuals older than 55 years—and that the median number of such problems in affected individuals was four.
Moreover, the degree of associated functional impairment in activities of daily living rose exponentially rather than additively as the number of joint problems increased, said Ms. Keenan, a podiatrist and research fellow in the academic unit of musculoskeletal disease and rehabilitation, University of Leeds, England, at the meeting sponsored by the European League Against Rheumatism.
These findings highlight the drawbacks of the typical assessment and treatment algorithms for joint pathology. Busy physicians often focus on a single major joint, thereby ignoring the true extent of the patient's problems.
Ms. Keenan reported on 16,222 community-dwelling British adults older than 55 years who completed a postal questionnaire about joint problems sent to them by their primary care physician. The research, funded by the U.K. Arthritis Research Campaign, was conducted under the auspices of the Leeds West Primary Care Trust. The response rate was 86%, which American researchers would consider excellent for a mailed questionnaire.
Participants were asked to report any joint problems involving pain, swelling, and/or stiffness that lasted more than 6 weeks during the prior 3 months, and to rate the effect of such problems on activities of daily living.
The knee was the joint most frequently involved, with a prevalence of 220 per 1,000 population. However, the knee was the sole joint involved in only 1 of 11 affected individuals. More commonly, knee pathology was reported in combination with other joint problems.
Individuals with single joint pathology restricted to the knee were 3.7-fold more likely than respondents without problems to report significant difficulty in standing and walking. But individuals with multiple problems involving the knees and feet were 14.5-fold more likely to have difficulty in standing and walking. And in those with problems affecting the knee, back, feet, and hip, the odds of difficulty in standing and walking shot up to 39-fold greater than in individuals without joint problems.