The characteristics of synptomatic osteoarthritis in general and specialist practice in Italy : design and methods of the AMICA study

OBJECTIVE: The diagnostic and clinical approach to osteoarthritis (OA) of the hand, knee, and hip in general practice and specialist practice in Italy as determined by the AMICA project. METHODS: Eligible subjects were identified among patients aged <50 years consecutively observed by their general practitioner (GP) or a specialist during the study period for diagnosis or treatment of symptomatic OA of the hand, knee, or hip. OA was diagnosed according to the American College of Rheumatology clinical criteria. The general characteristics and symptoms of all eligible subjects were evaluated. Data were also collected on diagnostic work-up and treatment. All subjects were also asked to quantify the intensity of their OA-related pain according to a 100-mm visual analog scale (VAS) where 0 = no pain and 100 = the worst pain. RESULTS: A total of 2764 GP and 331 specialists (98 rheumatologists, 166 orthopedic surgeons, and 67 other specialists) participated in the study. The area of residence was largely similar for both GPs and specialists and covered all of Italy. A total of 25,589 valuable subjects with OA were identified by the GPs, while 3543 were identified by the specialists. Among the latter, 1777 were identified by orthopedic surgeons, 1067 by rheumatologists, and 699 by other specialists (specialists in physical medicine and internal medicine, geriatricians, etc). The median age of patients identified by GPs was 70 years; the corresponding value was 66 years for the patients identified by the orthopedic surgeons, 69 years by the rheumatologists, and 68 years by other specialists. Overall, 69% of patients were women: this proportion was similar among patients identified by the GPs, the orthopedic surgeons, and other specialists, but patients identified by the rheumatologists were women in 80% of cases. Patients observed by the specialists had a higher level of education than those observed by GPs (P < 0.05). This finding was partially explained by the younger age of the patients observed by the specialists. CONCLUSIONS: This large data set reveals the attitudes of Italian GPs and specialists toward the diagnosis and treatment of OA of the hand, knee, and hip.