Decision Trees For Differential Diagnosis Pdf Printer

• Decision Trees For Differential Diagnosis Pdf Printers

Osteoarthritis (OA) is the most common form of arthritis and a leading cause of pain and disability worldwide [1, 2, 3]. The most frequently affected peripheral joints are the hip, knee and hand/finger [4]. Risk factors for OA include sex, previous joint injury, obesity and metabolic syndrome, genetic predisposition, mechanical factors such as malalignment or abnormal joint shape, and advancing age [5, 6]. Long regarded as a “degenerative wear and tear” condition, OA is increasingly being recognised as a dynamic joint pathological process caused by destruction and repair for which treatment interventions can be applied.

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In 2012, the World Health Organization (WHO) reported that OA is the single most common cause of disability in older adults [7]. Worldwide, an estimated 10% of men and 18% of women over 60 years of age have symptomatic OA; approximately 80% of these have movement limitations and 25% are unable to perform major activities of daily living. With the global increase in the older population, the prevalence of diseases such as OA will also increase. Indeed, by the year 2050, the WHO estimates that 130 million people will have OA and 40 million will be severely disabled by OA [7].

OA is a frequent cause of healthcare consultations. In France, for example, on an annual basis, OA is responsible for approximately 9 million consultations, 14 million prescriptions and 300,000 radiological examinations [http://www.stop-arthrose.org]. In 2010, the total direct costs for treating all patients with OA in France was estimated at about €3 billion per year [8], which emphasizes the burden of the disease to healthcare systems and to society in general. The burden of OA includes not only physical impairment [9] and its associated costs but also psychological impairment (e.g., distress, devalued self-worth) [4]. OA plays a prominent role in multimorbidity, which has been shown to reduce quality of life [10] and to increase work disability, treatment burden and healthcare costs [11]. The disease is also associated with a higher risk of mortality, estimated to be increased by 1.5 in hip and knee OA [12, 13].

Despite the availability of evidence-based treatment guidelines for OA [14], large gaps remain in the overall quality of care. According to patients, pain is generally insufficiently considered and managed [15, 16]. Diagnostic procedures are often inconsistent, and behavioural and rehabilitative strategies to prevent and treat OA are generally underutilized [3]. Uptake of core non-pharmacological measures such as weight loss and exercise programmes tends to be low, especially in older patients (> 65 years of age) even if these treatment modalities have no severe side effects [17].

Besides experiencing pain and loss of function, patients may be frustrated because their disease is not being taken seriously [3, 18, 19]. A Cochrane systematic review suggested that interventions such as improving general practitioner (GP) training regarding OA pain and use of influential physicians may increase guideline-consistent behaviour and improve patient outcomes [20].

Therefore, we need to establish guidelines for the diagnosis of OA in the primary care setting, taking into account barriers to implementing the guidelines as well as possible solutions to overcome these barriers [21, 22, 23]. Surprisingly, the OA scientific community had developed several guidelines for OA treatment before establishing clear recommendations for OA diagnosis. This paradox must be changed.

Decision Trees For Differential Diagnosis Pdf Printers

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