Therapeutic strategies distinguish community based primary care physicians from rheumatologists in the management of osteoarthritis.

Using an osteoarthritis (OA) case study, we described the drug therapy that primary care physicians prescribe for uncomplicated OA of the hip, and for OA complicated by a history of gastropathy or renal insufficiency. To produce "gold standard" criteria against which to interpret previous results, the same instrument was administered to 126 rheumatologists selected at random from the membership of the American College of Rheumatology. Virtually all rheumatologists prescribed nonsteroidal antiinflammatory drugs (NSAID); 76% specified doses large enough to have significant antiinflammatory effects. In contrast, 65% of the primary care physicians recommended NSAID therapy in a suboptimal antiinflammatory dose (p = 0.055 for the rheumatologist-primary care physician difference). For OA complicated by a history of either gastropathy or renal insufficiency, rheumatologists were more likely than primary care physicians to adopt a therapeutic strategy that did not inhibit prostaglandin synthesis (p < 0.001 for both). Differences also were noted in the ancillary therapies employed by the 2 groups for managing uncomplicated OA. Educational interactions between rheumatologists and primary care physicians could benefit by recognition of the differing perspectives on NSAID dosing, the avoidance of NSAID induced side effects, and ancillary therapies that appear to differentiate subspecialists and generalists.