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