6This educational package focuses on the non-pharmacological and pharmacological management of hip and knee osteoarthritis, the most commonly encountered pathological joint affliction. It complements the Hip and Knee Book (Williams et al 2009) which is the patient self-help guide. Hip and knee pain poses significant challenges to both NHS Wales in terms of its clinical management and also the Welsh Government in terms of the financial implications of this chronic disease. By 2020, the prediction is that increases in life expectancy and an ageing population are expected to make osteoarthritis (OA) the fourth leading cause of disability (Woolf et al 2003).

It is also estimated that 30-34% of adults aged 40 to 75 in the UK have ‘metabolic syndrome’ (Khunti et al 2010), a chronic condition characterised by patients living with co-morbid diabetes, cardiovascular disease or respiratory disease, 70% of which report limited activity as a consequence of their arthritic pain. The sedentary lifestyle that leads to metabolic syndrome puts patients at a higher risk of all-cause mortality (Slater et al 2011). Therefore primary care clinicians need to view treatment of OA as essential in improving a patient’s pain and disability, especially in those with co-morbid chronic illnesses.

By reading this module, you will have updated your knowledge and skills in:

  • Diagnosing and managing patients presenting with acute hip and knee pain;
  • Reviewing the evidence for the pharmacological and non-pharmacological interventions used in the treatment of OA;
  • Understanding shared decision making and how it can be used to help manage patients with hip and knee OA.

Although there are a variety of options to reduce OA pain and disability, despite clinicians ‘best intentions,’ the reality is that treating the painful hip and knee usually consists of an anti-inflammatory prescription and waiting for a hip or knee replacement. One of the key messages contained within this module is that general practitioners need to take a more proactive approach to reduce patients’ pain and improve function using multiple approaches. The following review of treatments demonstrates that no single treatment option will be effective when used in isolation, and that the successful management of OA relies on the successful adoption of several key lifestyle changes at its core, combined with evidence based therapies.

It is of interest that the NNT’s (i.e. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial) used for the treatment of osteoarthritis are larger for pharmacological therapies than some of the non-pharmacological therapies offered. This gives added importance to ‘selling’ lifestyle changes rather than on the over-simplification and reliance on a single pharmacological treatment.

 

This module was created November 2012 and updated June 2018

 

References
Khunti K, Taub N, Tringham J et al 2010. Screening for the metabolic syndrome using simple arthropometric measurements in south Asian ans white Europeans: A population-based screening study.The Leicester Ethnic Athersclerosis and Diabetes Risk (LEADER) Study. Primary Care Diabetes 4(1): 25-32
Slater M, Perruccio AV, Badley EM 2011. Musculoskeletal comorbidities in cardiovascular disease, diabetes and respiratory disease: the impact on activity limitations; a representative population-based study. BMC Public Health 11: 77-84.
Woolf AD, Pflger B 2003. Burden of major musculoskeletal conditions. Bull World Health Organ 81(9): 646-56