ABSTRACT
OBJECTIVES: To evaluate if the rheumatologic clinical criteria established for the diagnosis of knee osteoarthritis are valid in primary care and if it is possible to do without the laboratory and radiologic criteria. DESIGN: Descriptive study of the agreement between the diagnosis exclusively clinical and the clinical, laboratory and radiologic diagnosis according the American Rheumatism Association (ARA) criteria. SETTING: Population of the health area of Talavera de la Reina (Toledo). PATIENTS: People with one or both knees non referred pain during the previous month, in spite of their characteristics, length or periodicity. MEASUREMENTS AND RESULTS: The ARA and R.D. Altman clinical diagnosis criteria of knee osteoarthritis were applied to the sample and they were compared with the diagnosis obtained with the clinical, laboratory and radiological criteria (reference diagnosis). The clinical diagnosis of knee osteoarthritis was established according the ARA criteria in 93% cases, according Altman in 86% and according the reference diagnosis in 87%. The sensibility and positive predictive value obtained using both clinical criteria are high, but the specificity is very low. CONCLUSIONS: The clinical criteria can be used in primary care, although they have a low specificity. It could be necessary to establish new criteria to ameliorate the specificity and the handling of these patients in primary care, to avoid unnecessary explorations.
Subject(s)
Osteoarthritis, Knee/diagnosis , Primary Health Care/methods , Adult , Aged , Aged, 80 and over , Arthralgia/diagnosis , Confidence Intervals , Female , Humans , Knee Joint/diagnostic imaging , Male , Middle Aged , Physical Examination , Radiography , Sensitivity and Specificity , Synovial Fluid/cytologyABSTRACT
OBJECTIVE: To study the feasibility of local infiltration in primary care consultations. DESIGN: Before-and-after intervention study. SETTING: Two clinics at an urban health centre. PARTICIPANTS: Patients diagnosed with pathology of tender areas and treated with corticosteroid infiltration between May 1997 and May 1998. INTERVENTION: Corticoid infiltration plus local anaesthetic. Weekly check-up. Analysis of the variables: sex, age, diagnosis, time elapsed between indication and start of treatment, subjective assessment of pain before and after treatment (VRS scale), number of infiltrations per patient, side-effects. Evaluation of overall and individual effectiveness. RESULTS: 41 patients were infiltrated. Average age was 58. Most common pathologies were: rotary joint tendinitis (48.7%), anserine bursitis (24.4%), plantar fasciitis (7.3%). Average number of infiltrations per pathology: 1.3. Mean waiting time: 3.5 days. Comparison of pain by means of VRS (range 0-5) before and after treatment used the Wilcoxon test, with a statistically significant difference and p < 0.001 (z = -5.5109). For 35 patients (85.4%), pain was solved very well (values 0 and 1 on the VRS). For 3 patients (7.3%), improvement was moderate; and for 3 (7.3%) there was no improvement. CONCLUSIONS: 1. Treatment with local infiltration of corticosteroids is effective in dealing with pain, and is an alternative to treatment with NSAIDs. 2. It is feasible in primary care, and there are many advantages if the general practitioner employs this therapeutic technique.
