Encouraging Healthy Habits in Patients with Osteoarthritis

Osteoarthritis is the most common type of arthritis, affecting nearly 54 million people. The condition causes a great deal of pain and distress, as well as limitations in daily activities and mobility, says Marcy O’Koon, senior director of Consumer Health at the Arthritis Foundation.

While opioids might seem to be an obvious solution, O’Koon says opioids are now discouraged-not just because of the nation’s opioid crisis and tightening access, but because there is a new recognition that they don’t work all that well. “Staying physically active and losing weight, if needed, are at the top of the list,” O’Koon says.

O’Koon recommends taking a 5- to 10-minute walk throughout the week and incrementally increasing the time and/or pace. Endurance will increase and the pain may recede over time. 

It’s also helpful to look at risks in groups. O’Koon points to CDC population surveys that have found that 50% of adults with heart disease and 50% of adults with diabetes have arthritis. “Those groups have double reason to be physically active. If they are over- weight and sedentary too, then overall health suffers.”

Pharmacists can help older adults who have osteoarthritis as well as heart disease. A major concern is that many of these individuals may be taking a lot of over-the-counter NSAIDs without their doctors’ knowledge.

A new study recently published in Arthritis Care & Research suggests there is a great need for improvement for man- aging older patients with arthritis. The study examined 2,297 physician visits for knee osteoarthritis and found rates for visits to orthopedists and physical ther- apists declined from 2007 to 2015. At the same time, prescriptions for NSAIDS and narcotics or opioids increased.

Lead author Samannaaz Khoja, PT, PhD, research assistant professor at the University of Pittsburgh School of Health and Rehabilitation Sciences’ Department of Physical Therapy says physicians tend to be more focused on helping patients manage their pain with medications, without considering the long-term benefits of exercise for mitigating declines in physical health. “Pain control should be just one aspect of treatment. The focus is mainly on pain medications; there should be greater emphasis on nonpharmacological approaches,” Khoja says.

Tom Bateman, PharmD, clinical assistant professor Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey, New Brunswick, says because acetaminophen has a favorable safety profile when compared to alternatives like NSAIDs or opioid analgesics, it is considered the gold standard for treatment of osteoarthritis. The general principle of “start low, go slow” when dosing should be applied when recommending acetaminophen, says Bateman.

“If patients require additional pain control or if high doses of acetaminophen are not appropriate due to reduced hepatic function or alcohol use, then multimodal pain strategies can be used,” Bateman says. “Some would consider cannabis as a newer therapy. “

The Arthritis Foundation recently released the first CBD guidance for adults with arthritis. While there are no established clinical guidelines for CBD use, medical experts who worked in partnership with the Arthritis Foundation agree that CBD may help with arthritis-related symptoms; however, this has not been confirmed in clinical studies.