Challenges exist even among providers who are aware of OA because multidisciplinary treatment approaches are not standardized and there is no consistent set of recommendations and measurements for pain management, according to the COAMI report. This is especially true for patients with moderate symptoms for continuous time periods.
Identifying the best treatment is further complicated because of subgroups in the disease structure, says orthopedic surgeon Nizar Mahomed, MD, professor in the surgery department at the University of Toronto. For example, some types of OA are inflammatory while others are not.
“We need to come together and start to understand and agree upon defining different groupings so that we can have meaningful progress in terms of dealing with this disease,” says Dr. Mahomed. “The reality is if it were simple, it would have been done.”
A better understanding of the disease would allow doctors to tailor treatment more appropriately instead of the current algorithm, which is more or less a shotgun approach of exercise, weight loss, medication, physical therapy, and surgical management, says Dr. Mahomed.
“There are different responder patterns to this disease,” says Dr. Mahomed. “It’s all linked to the fact that we have to understand better what the fundamental disease is so that we can then try to identify better treatment strategies.”
Screening Tools
To enable practitioners to better screen for OA so that they can intervene sooner, providers need basic, standardized tools to gauge patient risk, disability, pain, and loss of function. That requires agreement across disciplines on which screening tools work best. One way to achieve consensus on optimal screening tools is through high-quality, cross-disciplinary research studies, according to Norelee Kennedy, a physical therapist and OA researcher at Ireland’s University of Limerick.
“Notwithstanding that there will always be discussion on the ideal screening tool for any condition, the evidence is clear that there is a strong need for a more coordinated approach to chronic disease and OA management,” notes Kennedy.
The coalition intends to compile information about such tools as validated questionnaires and other methods used to diagnose and assess the disease, says Dr. Iversen. Its next meeting will focus on synthesizing literature to develop a compendium of OA screening tools available to general medical professionals.
Risk Factors
Also in the works is a public relations campaign to raise the profile of OA, better educate the public about risk factors, and lend support to existing advocacy groups, says Dr. Iversen.
