How do co-morbidities affect your patients with OA?

Knee and hip osteoarthritis (OA) is a common cause of pain and disability, because of this, the condition is commonplace in physiotherapy practice. The presentation of the disease can be diverse and a number of different factors has been associated with the disease. It has been suggested that severity and prognosis of OA can be affected by the presence of co-morbidities however there hasn’t been conclusive proof of this idea.

This is was Calders & Van Ginckel set out to prove. They did this through a systematic review and meta analysis using PRISMA guidance and studies registered in PROSPERO. The search terms they used included: (i) osteoarthritis, knee and/or hip, (ii) comorbidity, and (iii) clinical symptoms of pain and/or physical dysfunction. After subsequent analysis of quality of studies found as well as other considerations, 17 studies were included within the SR.

The results showed that a greater co-morbidity count was associated with  higher levels of pain as well as a deterioration of physical ability in patients with OA. Other findings include:

  • Those patients with another source of msk pain have higher levels of pain in their OA affected joint
  • OA Patients with hypertension or cardiac disease go on to have higher levels of physical disability
  • The presence of diabetes exacerbates the level of OA-related joint pain
  • There was not a link between depression and deterioration of symptoms

Clinical Lessons Learned

This review shows that people with knee +/- hip osteoarthritis who have a least one co-morbidity go on to have greater levels of pain and lower levels of physical performance. Therefore be mindful when assessing these patients. Pay attention to past medical history and set realistic expectations early on in your assessment. Take this into account and consider how the co-morbidity may aggravate symptoms particularly when prescribing exercise.

Want to learn more about the knee? Why not try our Introduction to the Knee course on PP+?