Osteoarthritis Management
After high blood pressure, depression and diabetes, osteoarthritis is the fourth most common chronic condition managed by GPs. The prevalence of osteoarthritis is also increasing rapidly in the last couple of decades with increased life expectancy, increased levels of obesity and also with people increasingly turning to sport and deliberate exercise as a pathway to weight loss and longevity. Australian Bureau of Statistics data indicated that in 2014/15 there were about 2 million Australians living with osteoarthritis in at least one joint.
At our practice we recognise the impact that osteoarthritis can have on the daily functioning and life of our patients. We offer a holistic approach to the management of osteoarthritis and offer a variety of strategies other than pain medicine and joint replacement.
About Osteoarthritis. Osteoarthritis is not just a simple process of wearing out of the joint cartilage through repetitive activity. There are many different tissue types that make up a joint and participate in unison to its normal functioning including:
- Bone
- Cartilage
- Fibrocartilage (also know as meniscus or labrum depending on the joint)
- Ligaments
- Tendons
- Muscles
- Joint capsule (Synovium)
- Synovial fluid
There are also different cell types at a microscopic level within a joint. Joints are constantly going through a process of inflammation and repair to allow for the joint to be used to bear the forces for which it evolved while maintaining the health of the joint. Osteoarthritis occurs when a complex interplay of trauma, excessive forces through the joint, general overall health and genetic predisposition contribute to a tipping of this balance towards inflammation which then becomes chronic and inhibits and overtakes the repair process. It is at this cellular level that the process of osteoarthritis begins. Unfortunately, by the time it becomes symptomatic to the point of impacting on a patient’s daily functioning, there has often been significant damage to the joint.
Management approaches employed through our doctors include a multifactorial approach that addresses the cause, the symptoms and the progression. These approaches include:
- Lifestyle changes
- Loss of weight
- Paced exercises and strengthening program
- Good nutrition and hydration
- Pain relief
- Active measures – paced activity, daily mild exercise, relaxation, mindfulness, isometric exercises
- Passive measures – medication, steroid injections
- Inclusion of allied health colleagues (which can be referred through a GP Management Plan)
- Physiotherapy – maintain range of movement, strengthening around the joint, assessment of the biomechanical chain that impacts on the joint, strapping and active pain management activities
- Exercise Physiology – full physical assessment and development of an appropriate and realistic exercise program
- Dieticians – health eating habits for loss of weight and/or healthy tissues
- Occupational Therapy – identify and manage any occupational or recreational triggers to exacerbation of osteoarthritis
- Regenerative Therapies
- Restore the balance of repair and inflammation to improve functioning and reduce pain
- See section on Regenerative Medicine for more information
- Referral to Specialists
- For cases that have been refractive to all conservative measures and where the level of disability has become unacceptable to the patient we have a close relationship with local orthopaedic surgeons to who we refer.
- Dr Archer and Dr Munroe both work regularly as surgical assistants for orthopaedic surgeons and are often participating in operations on their patients. This provides an insight not available to most GPs and assists greatly in both post surgical management of patients and in the level of advice that can be provided to all patients.