From Our 2011 Archives
Arthritis Doctors Too Often Opt for Drugs, Surgery
Study: Many Osteoarthritis Patients Would Benefit From More Conservative Treatments Such as Weight Loss, Exercise Programs
Reviewed By Laura J. Martin, MD
Jan. 7, 2011 -- Many doctors who treat people with osteoarthritis are prescribing medications or choosing surgical options instead of recommending more conservative treatments such as weight loss and exercise programs.
That's the main conclusion of a new analysis published in the January 2011 issue of Arthritis Care & Research.
Researchers who reviewed standard clinical practices say therapeutic options aimed mostly at reducing pain and improving joint function are still first-line treatments.
But such treatments do little to improve joint structure or point toward long-term improvement of disease symptoms, according to the analysis by David Hunter, MD, of the University of Sydney in Australia.
Doctors Need to Change Recommendations
Hunter says in a news release that many doctors do not adhere to the latest evidence-based guidelines for treatment of osteoarthritis.
The study says doctors too often fail to try conservative, non-pharmacological treatments, which can lead to unnecessary diagnostic imaging and inappropriate referrals to orthopaedic specialists.
The study authors say they support recommendations of nondrug treatments, when possible, and point out that many people with osteoarthritis are overweight or obese.
"Weight management and exercise programs tend to be overlooked by clinicians," Hunter says. "These conservative approaches are beneficial to patients who adhere to weight loss and exercise programs."
Surgery Should Be a Last-Ditch Approach
In addition, the researchers say, surgery should be avoided as a way to treat pain when symptoms can be managed by other forms of treatment.
Typically, reasons for turning to surgery include debilitating pain and major limitations of everyday abilities, such as walking, working, or sleeping.
Some previous studies have shown that up to 30% of surgeries are inappropriate. The study team also reports an overuse of inappropriate diagnostic imaging instead of clinical diagnosis made on the basis of physical examinations and patient history.
According to current guidelines, imaging should be reserved for cases in which diagnosis is unclear, and when radiography could rule out other diseases that might be producing symptoms.
The study says 95 million CT, MRI, or PET scans are performed annually in the United States, at a cost of $100 billion. The researchers say 20% and possibly 50% of such scans are not necessary, and that results of many procedures failed to help doctors diagnose or treat patients' symptoms.
"Eliminating unproven procedures and reducing needless costs is necessary to improve the quality and lower the cost of health care in the U.S.," Hunter says. "The management of [osteoarthritis] should focus on a patient-centered and provider integrated approach that improves quality and reduces cost by following evidence-based recommendations."
Knee Osteoarthritis Very Common
Knee osteoarthritis occurs in 13% of people 60 and older, the report says. The risk of mobility disability from knee osteoarthritis is greater than any other medical condition that occurs in people 65 and older.
The researchers conclude that new ways need to be found to guide and quantify treatment of osteoarthritis symptoms.
"Quality indicators can be developed from evidence-based clinical recommendations," the authors write. "They are the next logical step in the clinical quality improvement cycle after guideline development."
SOURCES: News release, Arthritis Care & Research.Hunter, D. Arthritis Care & Research, January 2011; vol 63: pp 31-38.
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