Imaging, opioids and exercise: a call to action on best management of OA

Avoiding unnecessary imaging and getting back to the basics such as exercise and weight loss would do much to alleviate the ‘huge individual and societal impact’ of osteoarthritis.

Speaking at the APLAR-ARA meeting, Professor David Hunter said there needs to be much more implementation of the National Osteoarthritis Strategy.

He said osteoarthritis prevention such as through the reduction of sports injuries has to date been a ‘huge missed opportunity’.

In the management of osteoarthritis, he said patients were extremely unsatisfied and the use of placebos masquerading as therapies was rife.

Therefore the priority should be encouraging patients back to the strategies that do work, through the prescription of diet and lifestyle interventions and multidisciplinary coordinated care.

Professor Hunter said the evidence that a 10% reduction in bodyweight through diet and exercise over 18 months could lead to a 50% improvement in symptoms of knee osteoarthritis could not be beaten.

“There are no other treatments that do this as effectively and safely,” he said.

However there was some concern that research demonstrating the effectiveness of exercise for osteoarthritis was often not sufficiently described to allow for replication in clinical practice.

He reminded delegates that opioids had no place in the management of osteoarthritis but were associated with a huge risk of harm.

Guidelines recommended against viscosupplemention injections and, as reported earlier this year in the limbic, intra-articular corticosteroid injections may have short- term benefit but repeated treatment predisposes to cartilage and joint damage.

Professor Hunter, from the University of Sydney’s Institute of Bone and Joint Research, said patients without a locked knee did not require arthroscopy, which had substantial costs and a real risk of harm.

He said imaging had ‘terrible consequences for our patients’ – with research in progress showing that patients referred for MRI have substantially increased rates of arthroscopic intervention.

“We don’t need imaging to make this diagnosis confidently. A history and physical examination are usually sufficient when diagnosing osteoarthritis.’”

Total joint replacement was a wonderful procedure – only in the right patient at the right time, and after referral to allied health professionals.

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