Published 11/1/2012
Maureen Leahy

Changing the Paradigm for Diagnosing and Treating Arthritis

USBJI work group issues a call to action

Osteoarthritis (OA) affects approximately 27 million Americans—and one in four Americans older than age 60 experiences significant pain and disability due to OA. Yet, despite its chronic, progressive, and debilitating effects, OA is not treated in the same way as other chronic diseases.

“Patients with OA might be better served by changing the practice paradigm from the current episodic and reactive approach to one that is similar to other chronic diseases. Such an approach would include longitudinal, early, and proactive management; public and patient education; and coordinated multi- and interdisciplinary interventions,” explained Kimberly Templeton, MD, president of the United States Bone and Joint Initiative (USBJI).

To address this shift, the USBJI recently coordinated the first work group meeting of the Chronic OA Management Initiative (COAMI). Held May 10–11, 2012, in Rosemont, Ill., the meeting brought together representatives from more than 20 professional medical societies to address OA management, with the goal of reshaping the current practice paradigm for OA to improve patient outcomes.

A multidisciplinary approach
The COAMI work group included orthopaedic surgeons; primary care physicians; specialists in rheumatology, rehabilitation, and sports medicine; pediatricians; osteopathic physicians; nurses; physical therapists; and athletic trainers. Chaired by Joanne M. Jordan, MD, MPH, director of the University of North Carolina’s Thurston Arthritis Research Center, the work group focused on the following issues:

  • the current situation and the clinical rationale for changes
  • elements of a new vision for OA treatment and prevention
  • barriers and obstacles to achieving that vision
  • opportunities for change

“It was wonderful to see representatives from all the different specialties in one venue and to hear their perspectives on OA,” said Thomas C. Barber, MD, the AAOS representative. “Together we are looking for ways to better manage OA from start to finish.”

OA has multiple risk factors, including genetics, aging, and the consequences of injury and trauma. Using these factors to identify those at higher risk for OA would enable these patients to be screened and treated earlier. Because half of OA patients are seen in primary care settings, where they may not report—or be asked about—their joint pain, COAMI called for a multidisciplinary approach to identify and treat the condition.

During the 2-day meeting, participants explored ways to increase the visibility of OA among healthcare providers and to encourage providers to take better advantage of opportunities to screen and treat patients at risk of OA. One of their main discussions focused on finding the right tools, such as a “joint health score” or genetic markers, to enable clinicians to identify patients with OA and develop a strategy for dealing with it across multiple specialties.

“Currently, no laboratory test exists to diagnose OA,” said Dr. Barber. “With the right marker—whether it is a radiograph, a list of symptoms, or a score sheet—OA patients can be identified and treated in a systematic fashion. Treatment options are plentiful and may include anti-inflammatory drugs, other types of pain medications, injections, activity modification, physical therapy, or surgery.”

Increasing visibility
Misconceptions and lack of awareness about the prevalence, symptoms, and impact of OA make it more difficult to prevent and treat, noted work group members. All too often, symptoms are ignored until they become so severe that quality of life is affected. Greater awareness, earlier screening, and evidence-based treatment and interventions would help address this issue, noted participants.

In addition to exploring standardized screening tools and indicators of OA, the work group proposed the following priority actions:

  • Convene an OA management conference that would build agreement across healthcare disciplines and specialties, eliminate current inconsistencies in approach, and propose models of care
  • Recruit additional partners—such as federal agencies involved in prevention, associations representing other chronic diseases, payers and insurers, and midlevel providers—to participate in future COAMI efforts
  • Develop tools and prompts that promote patient engagement in learning about and managing OA
  • Lend COAMI’s support to existing OA advocacy and awareness efforts
  • Develop and support an OA-specific research agenda to fill gaps in evidence and practice data

Although COAMI itself is not designed to develop an evidence-based guideline for OA, the AAOS currently has two clinical practice guidelines focused on the treatment of OA—one for knee OA and the other for glenohumeral joint OA. Appropriate use criteria on nonsurgical treatment of knee OA are currently under development.

“Changing the paradigm of OA management is a great concept, but it needs to be further refined,” said Dr. Barber. “We are hopeful that future meetings will enable us to agree on a unified strategy.”

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org

COAMI work group participants
American Academy of Family Physicians
American Academy of Nurse Practitioners
American Academy of Orthopaedic Surgeons
American Academy of Pediatrics
American Academy of Physical Medicine and Rehabilitation
American Academy of Physician Assistants
American College of Physicians
American College of Sports Medicine
Arthritis Foundation
American Medical Society for Sports Medicine
American Medical Women’s Association
American Physical Therapy Association
American Orthopaedic Society for Sports Medicine
American Osteopathic Association
American College of Osteopathic Family Physicians
Institute of Pediatric Nursing
National Association of Orthopaedic Nurses
National Athletic Trainers’ Association
National Hispanic Medical Association
National Medical Association
Osteoarthritis Research Society International
United States Bone and Joint Initiative

Did you know…?

  • Patients with OA can expect to spend twice as much as an average patient on total direct medical charges.
  • More than half of patients with diagnosed diabetes also have OA.
  • Approximately 25 percent of primary care visits are related to OA.
  • Knee OA alone is estimated to affect 10.9 million Americans.