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 very 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.
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.
“What we've found in interviewing people is that because they have such a short time in the physician's office, their knee problem is all they'll talk about, when in fact they have problems with other joints that go unaddressed,” she told this newspaper at the meeting, which was sponsored by the European League Against Rheumatism.
Ms. Keenan reported on 16,222 community-dwelling British adults older than 55 years who completed a postal questionnaire about joint problems.
The research, funded by the U.K. Arthritis Research Campaign, was conducted under the auspices of the Leeds West Primary Care Trust. The survey response rate was 86%.
Participants were asked to report joint problems involving pain, swelling, and/or stiffness that lasted more than 6 weeks during the prior 3 months, and to rate the effect 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.
Far more commonly, knee pathology was reported in combination with problems in the hands, feet, back, and other joints.
Individuals with single joint pathology restricted to the knee were 3.7-fold more likely than respondents without joint problems to report significant difficulty in standing and walking.
But individuals with multiple joint 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 hips—a condition with roughly the same prevalence as isolated knee pathology in the survey population—the odds of difficulty in standing and walking shot up to 39-fold greater than in individuals without joint problems.