Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation.

Osteoarthritis (OA) is a complex musculoskeletal disease and a leading cause of pain and disability worldwide. Hip and knee OA alone are major contributors to global disability, having notable effects on individual well-being, increasing the reliance of individuals on health-care services and contributing to a rise in the socioeconomic burden. Consistent, coordinated and tailored approaches are important for providing appropriate care to all people with OA, but despite the scale of the challenge many individuals are still not offered the safe, best-evidence treatments recommended for OA care. This Review discusses the core priority treatments for OA, including exercise and physical activity, weight-loss, education and support for self-management. Additional physical or psychological evidence-based adjunctive therapies and combined therapies that can be used to tailor individual programmes are also discussed. These options include cognitive behavioural therapy, heat therapy, walking aids and splints, manual therapies and transcutaneous electrical nerve stimulation. International examples of OA treatment options, models of care and resources available are also given. Many challenges still need to be addressed to advance the uptake of these conditions, including further discussion around the risks and costs involved with all treatments.

Multisite peripheral joint pain: a cross-sectional study of prevalence and impact on general health, quality of life, pain intensity and consultation behaviour.

BACKGROUND: Research into musculoskeletal conditions often focusses on pain at single sites, such as the knee, yet several studies have previously reported the high prevalence of multiple sites of musculoskeletal pain. The most common form of musculoskeletal condition is arthritis, with osteoarthritis (OA) the most common cause of joint pain in adults 45 years and over. However, there is limited recognition of the prevalence of multisite peripheral joint pain in those either living with or at risk of OA, therefore this study set out to estimate the prevalence of multisite peripheral joint pain in adults 45 years and older, and its impact on several dimensions of health. METHODS: A cross-sectional population survey was mailed to adults (n = 28,443) aged 45 years and over from eight general practices in the North West Midlands, United Kingdom (UK). Prevalence rates were established for multisite peripheral joint pain (pain in two or more sites; hands, hips, knees, feet). Impact was measured for general health (SF-12 MCS & PCS), QoL (EQ-5D), pain intensity (0-10 numerical ratings scale) and the number of consultations with a range of health care professionals. RESULTS: Of 15,083 responders (53%), multisite peripheral joint pain was reported by 54%. Peripheral joint pain was present in n = 11,928, of which 68% reported pain in multiple sites. Multisite peripheral joint pain was shown to be significantly associated with reduced physical (Mean difference = -5.9 95% CI -6.3,-5.5) and mental (-2.8 95% CI -3.2,-2.4) components of the SF-12, reduced QoL (-0.14 95% CI -0.15, -0.13), increased pain (+0.70 95% CI 0.62, 0.79) and increased odds of consultations with GPs (OR 2.4 95% CI 2.2, 2.6) and practice nurses (OR 2.6 (95% CI 2.1, 3.2) when compared to single site pain. CONCLUSIONS: Multisite peripheral joint pain is prevalent in the population in adults 45 years and over and has a significant negative impact on several dimensions of health. Health care professionals should consider joint pain beyond the index site in order to address holistic management.

Patients' perceptions of the treatment and management of hand osteoarthritis: a focus group enquiry.

PURPOSE: Osteoarthritis (OA) is the commonest reason for a musculoskeletal consultation in primary care in older adults. There is evidence that appropriate advice and management is sub-optimal. The aim of this study was to explore perceptions and experiences of the treatment and management of hand OA in older adults. METHODS: Four focus groups were conducted with primary (n = 15) and secondary (n = 14) care participants aged 50-84 years (mean age 64.9 years; 3 males, 14 females) with a clinical diagnosis of hand OA. Data were tape-recorded, transcribed and analysed using thematic analysis and constant comparison method. RESULTS: Participants described a lack of help and information with regards to management of their hand OA and also a perceived lack of understanding of the impact of hand OA on the individual. Some received contradictory advice about its management. Beliefs about treatment efficacy were balanced against perceived and actual side-effects and tolerance, and such perceptions appeared to influence the use of alternative therapies. CONCLUSIONS: The study identified a perceived unmet need in people with hand OA presenting in primary and secondary care. This may be due to the clinical uncertainty of treatment, lack of high-quality randomised controlled trials evaluating therapeutic options, and the limited written information available incorporating the patient experience. The study emphasised the need to understand patient illness and treatment beliefs. A better understanding of illness and treatment beliefs will facilitate the use of evidence-based approaches in the management of hand OA.