Health care providers from more than 20 leading professional societies are proposing a significant change in the management of Osteoarthritis (OA), the most common form of arthritis and a leading cause of disability in the United States, to treating it like other chronic diseases, according to conclusions released by the United States Bone and Joint Initiative (USBJI).
The Chronic Osteoarthritis Management Initiative (COAMI) Work Group, which met earlier this year to assess current practice in the management of osteoarthritis, is proposing seven priority actions in view of scientific advances made in recent years. Osteoarthritis affects 27 million Americans or over 10 percent of adults. Many factors — some more modifiable than others — contribute to an increased risk of developing OA; these include obesity, genetics, aging, and the consequences of joint injuries and trauma (for example, from sports injuries).
As OA progresses, it can cause enough pain and disability that it interferes with work and daily activities, including the ability to be physically active. Lack of regular physical activity can lead to even more health consequences, since many people with OA also have been diagnosed with other chronic conditions, such as diabetes, whose treatment and management often require greater levels of physical activity and weight loss.
Even though OA could be viewed as a chronic condition, it's not usually approached that way. For example, the standard for other chronic conditions (such as diabetes or heart disease) now involves screening for risk factors, prevention-oriented interventions, ongoing monitoring, and comprehensive care models. Instead of this emphasis on early intervention and prevention, OA interventions tend to start later in the disease process. Many patients and health care providers tolerate and expect joint pain as an anticipated consequence of aging, and joint replacement as an inevitable endpoint of OA.
"Paying attention to patients' symptoms, starting with asking about them in various settings, asking about a family history of joint replacement, following up both proactively and longitudinally, and applying the principles of integrated, multi-specialty systems of care all would improve outcomes for the millions of people with OA," said Joanne M. Jordan, MD, MPH, Director of the University of North Carolina's Thurston Arthritis Research Center and Chair of the COAMI. "Importantly, many of these changes could be implemented now."
The Work Group members (who include primary care physicians; orthopaedic nurses and surgeons; specialists in rheumatology, rehabilitation and sports medicine; osteopathic physicians; physical therapists; and athletic trainers) identified seven priority actions to undertake, with the help of partners in other organizations who share COAMI's goals for improved patient outcomes.
The priority actions include:
developing a Call to Action geared specifically to health care professionals who treat patients with OA, as well as policy makers and the public;
convening a larger conference that leads to further recommendations that would build agreement across disciplines and specialties within the health care system, so that current inconsistencies in approach could be resolved, and models of care developed;
reaching out to other partners beyond the Work Group members (both existing and new) to include them in future COAMI work;
exploring standardized screening tools and indicators of OA to make early diagnosis both more consistent and more likely;
developing tools and prompts that promote patient engagement in learning about and managing OA (especially before symptoms become debilitating);
lending COAMI's support to existing advocacy and awareness efforts that are already underway; and
developing and supporting an OA-specific research agenda that would fill gaps in evidence and practice.
