The finding that reported levels of pain and functional disability increased markedly with time since diagnosis is to be expected, given the progressive nature of the disease. The fact that reports of negative emotions, depression and a negative outlook towards the future (with respect to their pain) also rose following diagnosis is particularly interesting, and may suggest a psychological element to the increased reports of pain. Indeed, a study conducted by Veale

et al.[31] found that patients Trametinib diagnosed with OA reported a significantly reduced quality of life relative to people who fulfilled the criteria for OA, but had not yet been informed of their ‘diagnosis’. This would appear to indicate that psychological factors

play a major role in the pain and disability associated with arthritis, Crizotinib order and highlights the need to address psychosocial health in any effective patient-centric management program. Current management protocols were generally regarded as being of only medium effectiveness, a result that is largely in line with previous studies, and indicative of the current lack of effective management programs and interventions.[31] However, the levels of supplement and over-the-counter (OTC) medication usage were significantly higher than those reported in other studies.[32, 33] It is unclear why this is the case, although it is possible that the higher prevalence of ‘self-diagnosed’ patients within the cohort may lead to an increased reliance on readily obtainable supplements and OTC pain medications. However, the estimates are in line with findings in the US that suggest Avelestat (AZD9668) that between 30% and 47% of older adults with OA use complementary or alternative medicine (CAM).[34,

35] US expenditures for CAM therapies averaged $1127 per year per patient, compared with $1148 for traditional therapies and musculoskeletal conditions account for 16% of CAM use.[36] Concerns about the side-effects associated with prescription medications such as non-steroidal anti-inflammatory drugs (NSAIDs) were also common, resulting in relatively high non-compliance rates, and potentially a move toward supplements and OTC medications that may be erroneously viewed as ‘safer’ within the community. The fact that more patients were using supplements than were undertaking other patient-centric interventions such as weight loss and exercise – that actually have been shown to improve pain and functional disability – highlights the need for increased patient education and information.[10] Two major limitations of this study are common to virtually all online questionnaires. The first is the issue of self-reporting, and the inherent difficulties involved in requiring patients to describe their own conditions, disease states and treatments.