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Elderly Play It Safe in Treating Osteoarthritis

Fear of side effects makes them choose less effective remedies

TUESDAY, June 29, 2004 (HealthDayNews) -- Older people would rather be safe than sorry when it comes to treating their arthritic knees, even when safe may also mean ineffective.

A variety of medications are available to relieve pain caused by osteoarthritis, but each varies in its helpfulness and potential side effects.

Results of a new study find older patients with knee osteoarthritis often choose treatments that have fewer side effects rather than ones that may work better.

According to the report, knee osteoarthritis is a major cause of disability in older people. Treatment to improve knee function includes surgery, weight loss, muscle-strengthening exercises and joint protection techniques.

There are also drugs that can decrease pain. These vary greatly in cost and risk of side effects. In their report, Yale University researchers looked at these medication options.

"We were interested in what patients' treatment preferences were for knee osteoarthritis," said lead researcher Dr. Liana Fraenkel, an assistant professor of internal medicine and rheumatology.

Fraenkel and her colleagues wanted to know if patients were informed of all the available alternatives, and if they were, what they would choose given the tradeoffs between the risks and benefits of each of the treatments.

"We looked at a range of things from very safe creams to pills, all having various toxicity profiles," Fraenkel said. "You could have a cream that was very safe but didn't work as well, and you could have pills that were somewhere in the middle and pills that worked better but had more side effects."

The research team interviewed 100 patients with knee osteoarthritis. The patients were an average of 70 years of age, according to the report in the June 28 issue of the Archives of Internal Medicine.

"Surprisingly, patients strongly preferred safer alternatives even when they were less effective," Fraenkel said. "That's really against what many doctors prescribe for the treatment of pain, and even what guidelines say."

Fraenkel noted other studies in cancer patients have found older patients tend to prefer treatments with fewer side effects, even if they are less effective.

Fraenkel said the reasons for this finding included patients being used to their pain after having had it for a long time, and also fear of additional side effects. Many patients, she added, are willing to receive less pain relief rather than contend with side effects that can diminish their quality of life.

"Many times patients may not agree with what physicians would assume," Fraenkel said. "This reinforces the importance of informing patients of everything that is a rational treatment option and figuring out what is best for them," she added.

"It is the physician's responsibility to present all available options, not only what physicians consider the best," Fraenkel said. "We need to discuss with patients what they consider to be important in order to decide what might be the best choice for them."

"These results do not surprise me, and are consistent with what we see as specialists in physical medicine and rehabilitation," said Dr. D. Casey Kerrigan, a professor and chairman of the Department of Physical Medicine and Rehabilitation at the University of Virginia.

"Patients come to us keenly interested in treatments with minimal adverse effect and seek our advice in particular about different types of exercise, and what types of activities they should do or avoid," he added.

More information

The National Institute of Arthritis and Musculoskeletal and Skin Diseases can tell you about osteoarthritis.

SOURCES: Liana Fraenkel, M.D., M.P.H., assistant professor, internal medicine and rheumatology, Yale University, New Haven, Conn.; D. Casey Kerrigan, M.D., professor and chairman, Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville; June 28, 2004, Archives of Internal Medicine
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