Osteoarthritis

Mr. P

• 45y

• Plumber

• BL knee pains

• OA diagnosed on XR

What next??

• Impact of OA– Occupation– ADL– Family– Hobbies– Lifestyle– Sleeping

Any adjustments to home or workplace

What other assessment??

• I.C.E./understanding

• Support/social

• Mood

• Pain severity

• Other MSK pains

• Co-morbidities

Shared management…

• Agreement with patient

• Education

• Risks vs. benefits

• Regular follow up

Core Treatments

Patient Self-Management

Core treatments??

• Access to information– Education– Footwear

• Activity and exercise– Strengthening– Aerobic

• Assistance with weight loss

Patient Self-Management??

• Exercise

• Weight loss

• Suitable footwear

• Heat or cold packs pain sites

• TENS for pain relief

What if this is not enough??

• Adjuncts

Pharmacological

Non - Pharmacological

Pharmacological…

• Paracetamol

• Topical NSAIDs – knee/hand OA

• Oral NSAIDs/COX-2 inhibitors

• Opioid based drugs

• Topical capsaicin

• Intra-articular corticosteroid injection

Things not to prescribe…

• Rubefacients

• Intra-articular hyaluronan injections

• Electro-acupuncture5

• Chondroitin / glucosamine

Non-Pharmacological…

• Heat or cold packs• TENS• Manipulation and stretching

– Hip osteoarthritis

• Bracing/joint supports/insoles– Biomechanical joint pain or instability

• Assistive devices – Walking sticks – Tap turners– OT/PT

What if this is not helping?

Refer to surgery?

When can you refer??

Offered all core treatments

Joint symptoms (pain/stiffness/reduced function)

Impact on QOL

History of mechanical locking(Arthroscopic lavage & debridement)

But don’t…

• Use current scoring tools for prioritisation (QOL, WOMAC)

• Be biased by patient factors – Age– Gender– Smoking– Obesity– Co-morbidities