Osteoarthritis (OA) is the most common type of arthritis and is estimated to affect around >40 million people across Europe.¹ The condition has a lifetime risk of 45% for knee OA and 25% for hip OA.¹ OA is the fastest growing cause of disability world-wide¹, and with increased life expectancy and rising levels of obesity across Europe⁴, the condition is predicted to become the fourth leading cause of disability worldwide by 2020.¹

What Is Osteoarthritis?

Osteoarthritis is a long-term chronic disease involving the thinning of cartilage in joints which results in bones rubbing together, creating stiffness, pain, and impaired movement.² The joints most affected are the hands, knees, hips and spine. It is more prevalent with advancing age particularly if there is a family history.² Women are also at a higher risk of getting the illness compared with men. Other risk factors include obesity, lack of exercise, joint injury and joint overuse (e.g. when participating in certain sports).²

The Role of Pharmacists

Pharmacists are frontline and accessible healthcare professionals who have access to patients five times more frequently than family physicians.² Community pharmacists have proven they can address gaps in OA patient care.² There is evidence to suggest that pharmacists administering a simple screening questionnaire can identify >80% of patients with knee pain who have undiagnosed knee OA.³Many people with OA are not diagnosed and are not referred for treatment. Pharmacists are ideally placed to screen for OA and make treatment recommendations, as they are often consulted about the choice of over-the-counter (OTC) analgesics to manage OA pain.¹

Experts in the pharmacy profession recently compiled some recommendations based on a number of osteoarthritis management guidelines as they apply to pharmacists. Some key aspects from the recommendations are summarised below:

Screen for OA²

• Guidelines suggest that OA can be diagnosed clinically, without further diagnostic or imaging tests, if the patient meets all of the following criteria:

  • Age 45 years or older

  • Activity-related joint pain

  • No morning joint-related stiffness or morning stiffness that lasts <30 minutes

  • Patients who do not meet these criteria may be referred by their primary care providers for imaging to rule out other serious joint conditions.

  • OA typically presents as a deep aching pain in a joint. There may be morning joint stiffness, typically lasting <30 minutes. Joints may also exhibit crepitus, enlargement, deformity and limited range of motion. Patients may present with a local inflammatory response, resulting in a tender, red, swollen and hot joint.

For patients who screen positive for OA²:

• Provide arthritis education

  • Provide counselling on the signs and symptoms of OA

  • Provide OA information handouts and pamphlets

• Provide a medication review and treatment recommendations in accordance with current OA guidelines

  • Conduct reviews of the patient’s prescription and OTC medications

  • Counsel patients on risks, benefits and appropriate use of medications to achieve maximum therapeutic benefit

• Refer to allied health professionals as appropriate

  • Patients may benefit from referral to physiotherapists, dietitians and/or occupational therapists.

Management Options

The goal of therapy is to relieve symptoms of pain, improve joint function and mobility and improve quality of life while minimizing medication-related adverse events.²

In addition, pharmacists can educate patients and caregivers to help them understand their condition and work with both the patients and their primary health care provider to choose an appropriate therapy.²

Choice of treatment for OA is typically based on risk versus benefit, cost and patient preference. Pharmacological treatment options should always be used in combination with nonpharmacological options.²

Nonpharmacological management focuses on pharmacists recognizing the need for referral to other healthcare professionals to ensure the patient has access to appropriate specialized care. Non-pharmacological therapies with the most evidence for benefit and with consensus from guidelines include²:

• patient education for self-management

• land and water-based exercise and weight loss 

• corrective footwear (particularly for those with knee OA)

• assistive walking devices such as canes or walkers

• transcutaneous electrical nerve stimulation (TENS) devices 

• heat ,cold and massage (may reduce pain and stiffness in those with knee OA).

Pharmacists are in a unique position to be able to support patients with OA. Management guidelines highlighting pharmacist based interventions should equip the profession to support and improve the lives of those affected by the condition.²

References:

1. Kingsbury SR, Osteoarthritis in Europe: impact on health status, work productivity and use of pharmacotherapies in five European countries, Rheumatology, Volume 53, Issue 5, 1 May 2014, Pages 937–947, accessed from: https://academic.oup.com/rheumatology/article/53/5/937/1798271 on 18/11/17

2. Kielly J, Davies, EM, Practice guidelines for pharmacists: The management of osteoarthritis, Can Pharm J (Ott). 2017 May-Jun; 150(3): 156–168. Accessed from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415069/ on 18/11/17

3. Marra CA, Cibere J et al, Improving osteoarthritis detection in the community: pharmacist identification of new, diagnostically confirmed osteoarthritis,  Arthritis Rheum. 2007 Oct 15;57(7):1238-44, accessed from: https://www.ncbi.nlm.nih.gov/pubmed/17907209 on 18/11/17

Date of Preparation: March 2018

PP-GEP-GBR-1008