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Osteoarthritis

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

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Osteoarthritis

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  1. Osteoarthritis

  2. Mr. P • 45y • Plumber • BL knee pains • OA diagnosed on XR

  3. What next?? • Impact of OA • Occupation • ADL • Family • Hobbies • Lifestyle • Sleeping Any adjustments to home or workplace

  4. What other assessment?? • I.C.E./understanding • Support/social • Mood • Pain severity • Other MSK pains • Co-morbidities

  5. Shared management… • Agreement with patient • Education • Risks vs. benefits • Regular follow up Core Treatments Patient Self-Management

  6. Core treatments?? • Access to information • Education • Footwear • Activity and exercise • Strengthening • Aerobic • Assistance with weight loss

  7. Patient Self-Management?? • Exercise • Weight loss • Suitable footwear • Heat or cold packs pain sites • TENS for pain relief

  8. What if this is not enough?? • Adjuncts Pharmacological Non - Pharmacological

  9. Pharmacological… • Paracetamol • Topical NSAIDs – knee/hand OA • Oral NSAIDs/COX-2 inhibitors • Opioid based drugs • Topical capsaicin • Intra-articular corticosteroid injection

  10. Things not to prescribe… • Rubefacients • Intra-articular hyaluronan injections • Electro-acupuncture5 • Chondroitin / glucosamine

  11. 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

  12. What if this is not helping? Refer to surgery?

  13. When can you refer?? Offered all core treatments Impact on QOL History of mechanical locking (Arthroscopic lavage & debridement) Joint symptoms (pain/stiffness/reduced function)

  14. But don’t… • Use current scoring tools for prioritisation (QOL, WOMAC) • Be biased by patient factors • Age • Gender • Smoking • Obesity • Co-morbidities

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