Osteoarthritis

This tool provides information to facilitate the management of osteoarthritis (general) in adults.

Focused examination

1. Patient History 

  • Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider.

  • Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.

  • Address prognostic factors that may delay recovery.

Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):

  • History of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot, swollen joint, history of malignancy, vertebral infection, osteoporotic fractures, traumatic fracture, myelopathy, brain haemmorrhage/mass lesion, inflammatory arthritis

Examples of other conditions/co-morbidities:

  • Physical conditions: back pain, headache

  • Psychological symptoms: depression, anxiety

  • Co-morbidities: diabetes, heart disease

Examples of prognostic factors that may delay recovery:

  • Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization

2. Physical Examination

  • Assess levels of concern regarding major structural or other pathologies.​

  • Diagnose osteoarthritis clinically without investigations if a person is over 45 years of age AND has activity-related joint pain AND has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.

3. Management 

  • Offer information on nature, management, and the course of osteoarthritis.

  • Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.

Patient Handouts

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Non-pharmacological management of osteoarthritis 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider local muscle strengthening and general aerobic exercise

  • Consider heat/cold 

  • Consider manipulation and stretching (particularly for osteoarthritis of the hip)

  • Consider interventions to achieve weight loss for those who are overweight or obese

  • Consider transcutaneous electrical nerve stimulation (TENS) for pain relief 

  • Consider appropriate footwear with shock-absorbing properties

  • Consider assessment for bracing/joint supports/insoles

  • Consider assistive devices (e.g., walking sticks and tap turners)

  • Do not offer acupuncture 

  • Do not offer glucosamine or chondrotin products

Pharmacological management of osteoarthritis

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider oral analgesics 

  • Consider topical treatments 

  • Consider non-steroidal anti-inflammatory drugs and highly selective COX-2 inhibitors

  • Consider intra-articular injections

  • Do not offer intra-articular hyaluronan injections

Invasive management of osteoarthritis 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice):

  • Do not refer for arthroscopic lavage and debridement unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose bodies)

*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.

Care Pathway for the management of osteoarthritis

(click here for French version)

Clinician Handout_Osteoarthritis_Page_3.

4. Reevaluation and Discharge

  • Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.

  • Monitor for any emerging factors that may delay recovery.

5. Referrals and Collaboration

  • Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms or new physical or psychological symptoms.

Additional Resources

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