Osteoarthritis (OA) is a chronic, disabling disease and one of the most common comorbidities in older adults. Community health centres are the optimal setting for delivering long-term, personalized health management to OA patients and those with multiple comorbidities. Conducting surveys within these centres can determine the current state of health management and treatment for individuals with OA. Currently, research on the comorbidity characteristics and diagnostic and therapeutic status of OA patients remains inadequate.

To describe the comorbidity patterns and current treatment status of patients with OA in community health centres in Beijing, for informing future strategies for managing OA in the context of multimorbidity.

A purposive sampling method was used in this cross-sectional study used to select four community health centres in Beijing, each provided over 50 000 consultations per year. Electronic medical records of patients diagnosed with OA between June 2020 and June 2024 were retrieved. Patient data were merged using unique patient identifiers. Key variables included gender, age, occupation, diagnoses, number of visits, and treatments. Patients were grouped by comorbidity status, and the differences in clinical characteristics and treatment status between patients with single disease and comorbidities were analyzed.

A total of 10 552 OA patients were included, representing 31.1% of all outpatients. The average age was (65.1±14.2) years, 4 293 patients (40.7%) were males and 6 259 patients (59.3%) were females. On average, patients had (10.5±13.1) visits during the study period and (3.9±2.1) diagnoses. In total, 860 patients (8.2%) had OA only, while 4 320 (40.9%) had 1-2 other chronic conditions. The most frequent comorbidities were cardiovascular diseases (52.4%), endocrine and metabolic conditions (35.6%), respiratory diseases (35.2%), musculoskeletal conditions (34.1%), and digestive system disorders (27.3%). Hypertension (24.4%), coronary heart disease (20.8%), dyslipidemia (15.2%), osteoporosis (11.9%), and type 2 diabetes (11.7%)were the most prevalent diagnoses. A total of 5 013 patients (47.5%) received OA-related treatment, with an average of (3.92±2.31 ) treatment types. Treatment patterns included oral medications (73.2%), topical agents (24.6%), and external traditional Chinese therapies (2.3%). The most frequently used oral medications were Chinese herbal medicines or prepared Chinese medicines (43.2%), followed by anti-inflammatory drugs (18.7%), anti-osteoporotic agents (6.3%), and anxiolytics (5.0%). Older patients had a higher prevalence of comorbidities (93.0%), comparing with younger patient (88.7%), and the proportion with more than 10 comorbidities rose from 1.0 % of younger patients to 2.1 % of older patient. Patients had other chronic conditions had significantly more visits (P<0.01) and received more treatment approaches (P<0.001). Regression analysis identified age, comorbidity status, and number of visits as independent predictors of treatment diversity (P<0.01).

Over 90 % of OA patients in Beijing community health centres present with at least one chronic comorbidity, most commonly cardiovascular diseases (hypertension, coronary heart disease) and metabolic diseases (dyslipidemia, osteoporosis and type 2 diabetes). Compared to patients with OA only, those had other chronic conditions require more frequent visits and more complex treatment. Community-based OA management predominantly involves oral medications, particularly Chinese traditional and anti-inflammatory drugs.

骨关节炎（OA）是一类慢性致残性疾病，亦是老年人常见的共病类型。社区卫生服务机构可为OA及老年共病患者提供长期、个体化的健康管理服务，能够客观反映该类人群的健康管理水平与临床诊疗现状。目前，针对OA患者共病特征及诊治现状的研究尚显不足。

了解北京地区社区卫生服务机构OA患者的共病特征和治疗现状，为OA共病研究及防治提供依据。

采用目的抽样方法选取北京市年门诊量超过5万人次且愿意参加本研究的社区卫生服务机构为研究现场，筛选2020年6月—2024年6月在样本机构就诊且符合研究要求的OA患者为调查对象。从医疗机构的诊疗系统中调取这些患者的日常诊疗数据，根据门诊号整合同一患者的就诊信息并纳入统计分析，提取性别、年龄、职业、诊断、就诊次数、治疗方法等资料，分析OA患者的临床特征、共病情况和接受治疗情况。根据患者共病情况进行分组，分析OA单病、共病患者间的临床特征和治疗现状差异。

共纳入OA患者10 552例，占社区卫生服务机构就诊患者总数的31.1%，其中男4 293例（40.7%），女6 259例（59.3%）。患者平均年龄为（65.1±14.2）岁，调查期间平均在参与研究的社区卫生服务机构就诊（10.5±13.1）次。平均诊断条目（3.9±2.1）种，其中仅诊断出OA的患者共计860例，占8.2%；存在其他诊断的患者以同时被诊断1~2种疾病的情况最多，占比40.9%。共计52.4%的患者同时被诊断了循环系统疾病，是最常见的慢性共病类别，其次为内分泌和营养代谢疾病（35.6%）、呼吸系统疾病（35.2%）、肌肉骨骼系统疾病（34.1%）和消化系统疾病（27.3%）；最常见的慢性疾病诊断为高血压，占比24.4%，其次为冠心病（20.8%）、血脂异常（15.2%）、骨质疏松症（11.9%）和2型糖尿病（11.7%）。共计5 013例（47.5%）接受了OA相关治疗，平均接受治疗（3.92±2.31）种，治疗方法包括口服药物（73.2%）、外用药物（24.6%）和中医外治法（2.3%）；口服药物以中草药和中成药为主，占比43.2%，其次为抗炎镇痛药物（18.7%）、抗骨质疏松药物（6.3%）和抗焦虑药物（5.0%）。统计不同年龄段的共病分布情况发现，随着年龄增加，共病患者占比从88.7%上升至93.0%，而共病超10种的患者从约1.0%上升至2.1%。根据是否存在共病情况分组发现，共病患者的复诊次数更多（P<0.01），接受治疗种类更多（P<0.001）。对接受治疗患者进行治疗种类的多因素线性回归分析发现，年龄、共病情况、就诊次数是接受治疗种类的独立影响因素（P<0.01）。

本研究调查的北京地区4家社区卫生服务机构就诊的OA患者的共病诊出率超过90%。慢性共病以循环系统疾病多见，代表性共病疾病主要有高血压、冠心病、血脂异常、骨质疏松症和2型糖尿病。社区卫生服务机构治疗OA以口服药物为主，其中中草药、中成药和抗炎镇痛类药物的使用率较高。相比单病种患者，共病患者的就诊次数更多，接受治疗种类更多，情况更加复杂。