Nondrug Approaches to Osteoarthritis
Nondrug Approaches to Osteoarthritis
With the promise of a safe and clinically effective disease-modifying osteoarthritis (OA) drug flickering on the immediate horizon, a significant part of the OA discussion at the American College of Rheumatology (ACR) meeting in Boston in November 2014 focused on getting back the basics: How can we modify known OA risk factors? And how can we maximize the effectiveness of nonoperative, nonpharmacologic treatments available for OA?
OA, which affects an estimated 27 million Americans, is a leading cause of disability in the United States. OA accounted for approximately 20.9 million (26.8%) of annual arthritis-related ambulatory medical visits between 2001 and 2005. Risk factors for OA include age; sex; obesity; previous injury; muscle weakness; and genetic factors that affect joint shape, joint stability, and cartilage development.
To address the prevalence, cost, and disability associated with OA, multiple organizations, including the ACR, Osteoarthritis Research Society International, National Institute for Health and Care Excellence,American Academy of Orthopaedic Surgeons,and European League Against Rheumatism have released guidelines to improve OA treatment. Although most agree on the components of the nonoperative treatment paradigm—weight loss, joint protection, education, physical and occupational therapy, orthotics/braces/splints, pharmacotherapy, nutriceuticals, and alternative treatments—the guidelines vary widely on recommendations for individual treatments included in the paradigm.
Because OA is chronic and slowly progressive, and healthcare in the United States can be fragmented, many patients are unable to benefit from treatments that are long term and require multidisciplinary, integrated care. Of note, market research from Peoplemetrics in 2007 suggested although 91% of patients with knee OA did not feel ready for total joint replacement, only 19% are satisfied with their current treatment.
As a result of this disconnect, members of the US Bone and Joint Initiative convened the Chronic Osteoarthritis Management Initiative (COAMI) in May 2012 to perform a systematic review of OA guidelines. Their goal was to change the OA management from late stage intervention to earlier, preventive treatment. Their recommendations for nonoperative, nonpharmacologic treatment included patient education and referral to self-management programs, weight loss for overweight persons, low-impact aerobic exercise, and use of walking aids and assistive devices.
The Quest for Disease Modifiers in Osteoarthritis
With the promise of a safe and clinically effective disease-modifying osteoarthritis (OA) drug flickering on the immediate horizon, a significant part of the OA discussion at the American College of Rheumatology (ACR) meeting in Boston in November 2014 focused on getting back the basics: How can we modify known OA risk factors? And how can we maximize the effectiveness of nonoperative, nonpharmacologic treatments available for OA?
OA, which affects an estimated 27 million Americans, is a leading cause of disability in the United States. OA accounted for approximately 20.9 million (26.8%) of annual arthritis-related ambulatory medical visits between 2001 and 2005. Risk factors for OA include age; sex; obesity; previous injury; muscle weakness; and genetic factors that affect joint shape, joint stability, and cartilage development.
The Guideline/Practice Dilemma
To address the prevalence, cost, and disability associated with OA, multiple organizations, including the ACR, Osteoarthritis Research Society International, National Institute for Health and Care Excellence,American Academy of Orthopaedic Surgeons,and European League Against Rheumatism have released guidelines to improve OA treatment. Although most agree on the components of the nonoperative treatment paradigm—weight loss, joint protection, education, physical and occupational therapy, orthotics/braces/splints, pharmacotherapy, nutriceuticals, and alternative treatments—the guidelines vary widely on recommendations for individual treatments included in the paradigm.
Because OA is chronic and slowly progressive, and healthcare in the United States can be fragmented, many patients are unable to benefit from treatments that are long term and require multidisciplinary, integrated care. Of note, market research from Peoplemetrics in 2007 suggested although 91% of patients with knee OA did not feel ready for total joint replacement, only 19% are satisfied with their current treatment.
As a result of this disconnect, members of the US Bone and Joint Initiative convened the Chronic Osteoarthritis Management Initiative (COAMI) in May 2012 to perform a systematic review of OA guidelines. Their goal was to change the OA management from late stage intervention to earlier, preventive treatment. Their recommendations for nonoperative, nonpharmacologic treatment included patient education and referral to self-management programs, weight loss for overweight persons, low-impact aerobic exercise, and use of walking aids and assistive devices.
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