Getting Osteoarthritis on Nurses’ Radar

Osteoarthritis of the left knee. Image via Wikipedia

By Shawn Kennedy, AJN editor-in-chief—Louise Murphy, an epidemiologist at the Centers for Disease Control and Prevention (CDC) gave these stunning statistics to an audience gathered in the conference center at the Hospital for Special Surgery in New York City last week:

• Twenty-seven million U.S. adults (pdf) suffer from osteoarthritis (OA), mostly in the hands, hips, and knees.
• Data from the National Ambulatory Medical Care Survey 2006–2007 showed that OA was the reason for 12.3 million visits to primary care providers, 85 thousand ED visits, and 921 thousand hospitalizations in 2009.
• In 1997, there were 400,000 total knee or total hip replacements; that number had increased to 900,000 by 2009.
• One study put lifetime risk by age 85 at one in two for knee arthritis (two in three for obese individuals), and one in four for arthritis of the hip.

The audience included over 45 nurses, physicians, physical therapists, and other health professionals. We met July 14 and 15 to identify what keeps patients from accessing health services and from getting evidence-based care for OA. This ‘state of the science” project is a collaboration among AJN, the Hospital for Special Surgery, and the National Association of Orthopaedic Nurses.

The missing nursing perspective. In 2010, the CDC and the Arthritis Foundation published “A National Public Health Agenda for Osteoarthritis,” which details a three-year plan to reduce the disease burden of OA by promoting evidence-based treatment to delay onset or reduce progression of the disease. What became apparent was the absence of nursing participation in this effort. While there are many nurses who do provide care for patients with arthritis, that care is usually at the point where patients are having joint replacement surgery, or it’s incidental to other care patients are seeking.

Arthritis is often overlooked because other comorbidities, like diabetes or heart disease, are given a higher priority. Many providers and patients alike feel arthritis is inevitable and there’s nothing that can be done aside from taking pain medication—but that’s wrong. There are measures that can slow progression and make joint replacement a less inevitable outcome. The key is getting patients on regimens early on, before there is significant damage in the joint.

Nurses should be asking questions about pain and stiffness in all patients at risk, and in all settings.

Our “State of the Science on the Prevention and Management of OA” project hopes to increase awareness among nurses about the need for early recognition and treatment for patients with OA.

AJN will publish the papers and proceedings from this meeting, which include papers on

• assessing for risk and progression of OA.
• interventions to relieve pain and disability.
• promoting self-management.
• examining issues nurses may have around implementing best practices.

Meanwhile, you can check your own risk for developing OA with an interactive tool at FightArthritisPain.org. The tool, which was previewed at the meeting by Patience White, chief public health officer of the Arthritis Foundation, is evidence based.