The State of the Science in the Prevention and Management of Osteoarthritis

Abstract

Overview: In July 2011 a symposium on osteoarthritis convened experts in many areas—nursing, epidemiology, rheumatology, public policy, geriatrics, pharmacotherapy, physical therapy, and complementary modalities—to discuss the importance of nurses in reducing the disability caused by osteoarthritis. The planning committee included representatives from AJN, the National Association of Orthopaedic Nurses, and the Hospital for Special Surgery. Symposium attendees recommended ways in which nurses could take on greater leadership roles in research, policy, education, and clinical practice for the early diagnosis and management of this prevalent condition. The Centers for Disease Control and Prevention (CDC) reported in 2006 that arthritis affects 46 million adults in the United States and is our nation’s most common cause of disability.1 While there are more than 100 different forms of arthritis, rheumatoid arthritis and osteoarthritis (OA) are the two most common forms that affect adults. Rheumatoid arthritis is an autoimmune disease resulting in inflammation of the joints, which leads to pain and destruction of joints and organs. OA is characterized by a breakdown of cartilage, the cushion between the ends of bones, and can also damage ligaments, menisci, and muscles. OA is the most common form of arthritis; it represents an enormous public health burden in terms of health care costs, disability, lost earnings, and reduced quality of life. In 2005 the National Arthritis Data Workgroup estimated that 27 million U.S. adults—more than 10% of the adult population— had OA,2 and it has also been estimated that by 2030, 67 million U.S. adults will have arthritis.3 In 2009 almost 1 million people were hospitalized for OA; it is also the main underlying cause of joint replacement, for which the 2009 costs were $42.3 billion.4 In 2003 arthritis and other rheumatoid conditions resulted in $128 billion in total medical costs and lost earnings.5 In 2010 the CDC and the Arthritis Foundation published A National Public Health Agenda for Osteoarthritis (www.cdc.gov/arthritis/docs/oaagenda.pdf), a major call to action. It lays out how successfully employing novel approaches to the prevention, early detection, and treatment of OA can affect the financial, societal, and personal burden of this chronic disease. Though this groundbreaking report placed a spotlight on many clinical and advocacy groups, the largest group of health care providers—nurses—was notably absent. Nurses have ranked at the top of Gallup’s annual “honesty and ethical standards” poll for many years,6 and as educators nurses can have great influence on public perceptions of disease processes and care. In the primary care setting, studies have shown, nurses’ assessment and coordination of care, as well as their education of patients about disease processes and prevention of complications, are invaluable.7–9 Fig. 1 Symposium planning committee, left to right: Maureen Shawn Kennedy, Patricia Quinlan, Marjorie G. Kulesa, Laura Robbins, Basia Belza, and Elizabeth Schlenk. Photo courtesy of the Hospital for Special Surgery Although articles about OA have been published in nursing journals, we question whether nurses are missing opportunities to teach patients about screening, prevention, complementary therapies, and pain management, perhaps because of the misperception that OA is part of the aging process and less important to treat than diabetes or cardiovascular disease. This question led us to other questions. Are enough nurses being trained in OA management? Are assessment tools for monitoring both disease progression and complications widely available in all primary and acute care settings, physicians’ offices, clinics, and community health care centers? Do assessment and monitoring tools pay adequate attention to patients’ level of health literacy, language, age, gender, race, culture, ethnicity, and socioeconomic factors? To answer these questions and determine the level of awareness and knowledge of OA among nurses, AJN, the Hospital for Special Surgery, and the National Association of Orthopaedic Nurses developed a collaborative project—the State of the Science in the Prevention and Management of Osteoarthritis. The objectives were to identify gaps in the science and barriers to the early identification of OA and the implementation of interventions that promote mobility, decrease pain, and slow progression. describe the state of the science of current interventions for preventing immobility and managing the effects of OA. achieve consensus on the priorities for developing the best nursing practices—in the clinical, educational, research, and policy arenas—in order to meet the needs of diverse populations with OA in a variety of settings. disseminate the analysis and recommendations to clinicians, nurse leaders, educators, researchers, specialty nursing organizations, other health care professionals, policymakers, consumer advocacy groups, and the general public.