title: Management of knee osteoarthritis in primary care: pain and depression are the major obstacles.
abstract: OBJECTIVE
  Osteoarthritis (OA) management is a challenge, as OA consists of a spectrum of pathologies requiring a multifaceted treatment approach. Patient education programmes (PEP) are attractive, as they may be cost effective and potentially efficacious. The goals of the study were to determine what may hinder the efficacy of a PEP for knee OA by determining the relevance of depression, pain, disease knowledge and physical ability in patients to their response to a PEP.
  
  
  METHODS
  Clinical and demographic data relating to 170 patients who completed a trial of a PEP were analysed to determine how they interrelate during patient management.
  
  
  RESULTS
  All patients showed a progressive decrease in mental health over the duration of the study (P<.001). Greater pain was associated with reduced coping, increased depression and reduced physical ability (P<.05). Women were more likely to experience disability (P<.05). Disability was associated with reduced ability to cope, increased depression and the experience of more pain (P<.05). Subjects with a Caucasian background were significantly (P<.05) more likely to possess knowledge of OA than other ethnic groups. The lowest knowledge group experienced more pain; the highest knowledge group was coping better and had less depression (P<.05).
  
  
  CONCLUSIONS
  A complex interrelationship between depression, pain, disease knowledge, and physical ability in patients with knee OA has been demonstrated. Specifically, the treatment of depression and pain may be paramount to the successful treatment of knee OA, and these factors should be considered in each patient and management priorities made.
authors.affiliation: The Sir Joseph Hotung Centre for Musculoskeletal Disorders, Chair Clinical Rheumatology, St Georges University of London & Hospital, Cranmer Terrace, London. ccooper@sgul.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Axford
authors.forename: Christine
authors.initials: C
authors.lastname: Heron
authors.forename: Fiona
authors.initials: F
authors.lastname: Ross
authors.forename: Christina R
authors.initials: CR
authors.lastname: Victor
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D012720:Severity of Illness Index
chemical_list: D000700:Analgesics; D000928:Antidepressive Agents