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Ann Rheum Dis. 2004 Apr; 63(4): 408–414.
PMCID: PMC1754944

Clinical comorbidity in patients with osteoarthritis: a case-control study of general practice consulters in England and Wales


Objectives: To determine patterns of clinical comorbidity in general practice consulters with OA and compare them with comorbidity in consulters without OA.

Methods: A case-control study nested in a one-year prevalence survey of consultations in 60 general practices in England and Wales. Cases were 11 375 subjects aged 50 and over who had consulted with OA during the study year. Controls were 11 780 subjects matched for age and sex who had consulted during the study year, but not for OA. Morbidity outcomes were based on a standard clinical classification system.

Results: After adjusting for age, sex, and social class, cases were significantly more likely to have high levels of comorbidity than controls (2.35; 2.16 to 2.55). Significant OA comorbid associations with other musculoskeletal conditions included arthropathies (OR 2.26; 99% CI 1.50 to 3.41), upper limb sprain (2.04; 1.38 to 3.00), synovial and tendon disorders (2.03; 1.54 to 2.68), and other joint disorders (2.00; 1.71 to 2.32). OA non-musculoskeletal associations were with obesity (2.25; 1.73 to 2.92), gastritis (1.98; 1.46 to 2.68), phlebitis (1.80; 1.28 to 2.52), diaphragmatic hernia (1.80; 1.29 to 2.51), ischaemic heart disease (1.73; 1.13 to 2.66) and intestinal diverticula (1.63; 1.20 to 2.23).

Conclusions: Comorbidity for OA was extensive, with musculoskeletal as well as non-musculoskeletal conditions. Age, sex, and social class did not explain this comorbidity but propensity to consult may be a part explanation. An important question remains as to whether comorbidity in general practice significantly adds to the disability or further impairs the health of patients with OA.

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Selected References

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  • Hippisley-Cox J, Pringle M, Crown N, Meal A, Wynn A. Sex inequalities in ischaemic heart disease in general practice: cross sectional survey. BMJ. 2001 Apr 7;322(7290):832–832. [PMC free article] [PubMed]
  • Morris AD, Boyle DI, MacAlpine R, Emslie-Smith A, Jung RT, Newton RW, MacDonald TM. The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration. BMJ. 1997 Aug 30;315(7107):524–528. [PMC free article] [PubMed]
  • Schellevis FG, van der Velden J, van de Lisdonk E, van Eijk JT, van Weel C. Comorbidity of chronic diseases in general practice. J Clin Epidemiol. 1993 May;46(5):469–473. [PubMed]
  • Schellevis FG, Van de Lisdonk EH, Van der Velden J, Hoogbergen SH, Van Eijk JT, Van Weel C. Consultation rates and incidence of intercurrent morbidity among patients with chronic disease in general practice. Br J Gen Pract. 1994 Jun;44(383):259–262. [PMC free article] [PubMed]
  • Lawrence RC, Hochberg MC, Kelsey JL, McDuffie FC, Medsger TA, Jr, Felts WR, Shulman LE. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol. 1989 Apr;16(4):427–441. [PubMed]
  • March LM, Bachmeier CJ. Economics of osteoarthritis: a global perspective. Baillieres Clin Rheumatol. 1997 Nov;11(4):817–834. [PubMed]
  • Frankel S, Eachus J, Pearson N, Greenwood R, Chan P, Peters TJ, Donovan J, Smith GD, Dieppe P. Population requirement for primary hip-replacement surgery: a cross-sectional study. Lancet. 1999 Apr 17;353(9161):1304–1309. [PubMed]
  • Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001 Feb;60(2):91–97. [PMC free article] [PubMed]
  • Hungin AP, Kean WF. Nonsteroidal anti-inflammatory drugs: overused or underused in osteoarthritis? Am J Med. 2001 Jan 8;110(1A):8S–11S. [PubMed]
  • Ettinger WH, Davis MA, Neuhaus JM, Mallon KP. Long-term physical functioning in persons with knee osteoarthritis from NHANES. I: Effects of comorbid medical conditions. J Clin Epidemiol. 1994 Jul;47(7):809–815. [PubMed]
  • Carr-Hill RA, Rice N, Roland M. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. BMJ. 1996 Apr 20;312(7037):1008–1012. [PMC free article] [PubMed]
  • McNiece R, Majeed A. Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort study. BMJ. 1999 Jul 3;319(7201):26–28. [PMC free article] [PubMed]
  • Hansell A, Hollowell J, Nichols T, McNiece R, Strachan D. Use of the General Practice Research Database (GPRD) for respiratory epidemiology: a comparison with the 4th Morbidity Survey in General Practice (MSGP4). Thorax. 1999 May;54(5):413–419. [PMC free article] [PubMed]
  • Vedsted Peter, Christensen Morten Bondo, Sørensen Henrik Toft, Fink Per, Olesen Frede. Special status consultation for frequent attenders. Who are the candidates? J Public Health Med. 2002 Mar;24(1):53–57. [PubMed]
  • Cushnaghan J, Dieppe P. Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites. Ann Rheum Dis. 1991 Jan;50(1):8–13. [PMC free article] [PubMed]
  • Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000 Oct 17;133(8):635–646. [PubMed]
  • Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997 Jul 15;127(2):97–104. [PubMed]
  • Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. 1999 May;25(2):283–vi. [PubMed]
  • Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA. 1989 May 12;261(18):2663–2668. [PubMed]
  • Spector TD, Hochberg MC. Methodological problems in the epidemiological study of osteoarthritis. Ann Rheum Dis. 1994 Feb;53(2):143–146. [PMC free article] [PubMed]
  • Gabriel SE, Crowson CS, O'Fallon WM. Comorbidity in arthritis. J Rheumatol. 1999 Nov;26(11):2475–2479. [PubMed]
  • Philbin EF, Groff GD, Ries MD, Miller TE. Cardiovascular fitness and health in patients with end-stage osteoarthritis. Arthritis Rheum. 1995 Jun;38(6):799–805. [PubMed]
  • Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum. 1990 Dec;20(3 Suppl 1):34–41. [PubMed]
  • Von Korff M, Simon G. The relationship between pain and depression. Br J Psychiatry Suppl. 1996 Jun;(30):101–108. [PubMed]
  • Creamer P, Hochberg MC. Osteoarthritis. Lancet. 1997 Aug 16;350(9076):503–508. [PubMed]
  • Scaife B, Gill P, Heywood P, Neal R. Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data. Fam Pract. 2000 Aug;17(4):298–304. [PubMed]
  • McBeth J, Macfarlane GJ, Benjamin S, Silman AJ. Features of somatization predict the onset of chronic widespread pain: results of a large population-based study. Arthritis Rheum. 2001 Apr;44(4):940–946. [PubMed]

Figures and Tables

Figure 1
An illustration of the Read code hierarchy using the example of "Musculoskeletal and connective tissue disorders" chapter.

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