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 Joint symptoms (pain/stiffness/reduced function) Impact on QOL History of mechanical locking (Arthroscopic lavage & debridement)

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