A new study has determined that the treatment of patients with osteoarthritis (OA) don’t usually follow the current medical evidence’s standard care guide.
The researchers found that physicians were prescribing medications for pain and inflammation, or opting for surgical interventions instead of recommending exercise or weight loss plans programs to OA patients. The study’s findings were published in the January 2011 issue of Arthritis Care & Research.
In 2002 a report by the World Health Organization (WHO) estimated OA was the fourth leading cause of years lost due to disease (YLD) worldwide. Disability caused by osteoarthritis is quickly becoming a major public health concern. Experts estimate that in 2020 the number of people with OA will double primarily because of increasing rates of obesity and the aging of the “baby boomer” generation.
Arthritis and other joint conditions, according to the Centers for Disease Control and Prevention (CDC), cost the U.S. $128 billion in 2003-a 24% increase since 1997. Much of the cost burden in arthritis care can be attributed to osteoarthritis which is the cause of the large volume of joint surgeries including total joint replacements.
Researchers at the University of Sydney in Australia, led by Dr. David Hunter, and New England Baptist Hospital in Boston, Massachusetts and colleagues reviewed how standard clinical practice diverges from evidence-based recommendations in the management of OA. “We present a potential roadmap for optimizing the quality of OA healthcare for those developing and enforcing policy decisions, and for clinicians on the frontlines of OA management to enact practice change,” commented Dr. Hunter.
The researchers determined that current medical practice doesn’t reflect recommendations based upon medical evidence. The authors report that treatment interventions usually focus on reducing pain and improving joint function by using therapies that target symptoms, but don’t help with improving joint structure or long-term betterment of the disease.
Usually doctors don’t recommend conservative non-pharmacologic management therapies which leads to unnecessary diagnostic imaging and inappropriate referrals to orthopedic surgeons.
Often people with osteoarthritis are overweight. The authors support medical evidence which recommend a conservative non-drug based treatment for these patients. “Weight management and exercise programs tend to be overlooked by clinicians,” said Dr. Hunter. “These conservative approaches are beneficial to patients who adhere to weight-loss and exercise programs.”
The researchers also suggest that surgery be resisted when symptoms can be well managed by other treatment methods. The typical indications for a surgical approach in treating OA are debilitating pain and major limitation of functions such as walking, working, or sleeping.
But earlier studies have determined that up to 30% of some surgeries are not necessary and recent recommendations suggest routine arthroscopy for knee OA management should be avoided, but continues in clinical practice.
The study team also noted there is an overuse of inappropriate diagnostic imaging instead of clinical diagnosis based on history and physical examination. Based on current guidelines imaging should be reserved for instances where a diagnosis is unclear and radiography could rule out other diseases that may produce similar symptoms.
Research studies estimate there are 95 million high-tech scans (CT, MRI, PET) conducted every year in the United States, a $100 billion industry, of which $14 billion has been shouldered by Medicare-and that approximately 20% to 50% of these scans were unnecessary, because the findings did not help with the diagnosis or treatment of the patient’s symptom.
“Eliminating unproven procedures and reducing needless costs is necessary to improve the quality and lower the cost of healthcare in the U.S.,” concluded Dr. Hunter. “The management of OA should focus on a patient-centered and provider integrated approach that improves quality and reduces cost by following evidence-based recommendations.”