Osteoarthritis: Research, Prevention and Treatment. David Hunter, MBBS PhD Osteoarthritis Research Society International Chief of Research, New England Baptist Hospital Associate Professor of Medicine, Tufts University. Disclosure.
David Hunter, MBBS PhD
Osteoarthritis Research Society International
Chief of Research, New England Baptist Hospital
Associate Professor of Medicine, Tufts University
Arthritis Rheum. 1998, Aug;41(8):1343-55.
Osteoarthritis Cartilage. 2009; Sep 2.
Patient education about both the disease and its management
Improvement of function
Alteration of the disease process and its consequences
Patient education Self-management programs Weight loss (if overweight or obese) Aerobic exercise programs Physical therapyMuscle-strengthening exercises Assistive devices for ambulationPatellar tapingAppropriate footwear Medial-wedged insoles (for genu valgum)
BracingOccupational therapyJoint protection and energy conservation Assistive devices for activities of daily living
Therapeutic Advances in Musculoskeletal Diseases 1: 35-47
» Modest effect size of NSAIDs
» Poor short- and long-term relief
» Narrow therapeutic benefit of COXIBs over NSAIDs
» Comorbidities carry enhanced risks of DDI/SAEs
Numerous studies have documented standard clinical practice is focused upon analgesia using pharmacologic agents and when this fails surgery.
These studies document:
inadequate uptake of conservative, non-pharmacologic treatment options such as weight loss and exercise (both important risk factors that are capable of modifying the course of the disease),
inappropriate surgical interventions such as arthroscopic debridement and lavage and the
inappropriate use of imaging.
DeHaan MN, Guzman J, Bayley MT, Bell MJ: Knee osteoarthritis clinical practice guidelines -- how are we doing?Journal of Rheumatology 2007, 34: 2099-2105.
Pencharz JN, Grigoriadis E, Jansz GF, Bombardier C: A critical appraisal of clinical practice guidelines for the treatment of lower-limb osteoarthritis. Arthritis Research 2002, 4: 36-44.
Jawad AS: Analgesics and osteoarthritis: are treatment guidelines reflected in clinical practice?.American Journal of Therapeutics 2005, 12: 98-103.
Glazier RH, et al.: Management of common musculoskeletal problems: a survey of Ontario primary care physicians.CMAJ Canadian Medical Association Journal 1998, 158: 1037-1040.
Of the 125 million Americans with chronic diseases, 48% are estimated to have at least one comorbidity, and 62% of persons over the age of 65 have two or more chronic illnesses.
Persons with OA:
65% are overweight/ obese
40% have hypertension
15% have diabetes
These comorbidities further compound management challenges and are frequently ignored in current management approaches.
Jain RK, McCormick JC: Archives of Internal Medicine 2004, 164: 807.
G, Miller JD, Lee FH, Pettitt D, Russell MW: American Journal of Managed Care 2002, 8: S383-S391.
Messier SP, et al.: Arthritis & Rheumatism 2005, 52: 2026-2032.
According to the US Centers for Disease Control (CDC), arthritis and other rheumatic conditions (AORC) cost the US $128 billion in 2003, a 24% surge since 1997 and an amount equal to 1.2% of the gross domestic product (GDP).
As a result of inadequate care many patients are dissatisfied.
Many are turning to untested and aggressively marketed dietary supplements with little substantive evidence to support their efficacy.
Many patients are turning to the internet for healthcare information but how does the consumer know what is a credible source of information?
Chard J, et al: Rheumatology 2002, 41: 1208-1210.
Rosemann T, et al: BMC Musculoskeletal Disorders 2006, 7: 48.
Burks K:Orthopaedic Nursing 2002, 21: 28-34.
Neville C, et al.: Arthritis Care & Research 1999, 12: 85-95.
Gardiner P, et al: Alternative Therapies in Health & Medicine 2007, 13: 22-29.