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PATIENT CARE PROCESS

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Patient Care Process for the Management of Osteoarthritis

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Collect

  • Patient characteristics (e.g., age, weight, height, race, sex, pregnant)

  • Patient history (past medical, family, social, and alcohol use)

  • Symptom information: type and location of pain; duration; effect of motion and rest; range of motion and limitations on activities; instability

  • Current and past medications, including nonprescription agents and dietary supplements, and medications' relief of symptoms

  • Objective data (see Box 90-1)

    • Physical examination; appearance of joints

    • Radiologic evaluation—changes in joints; subchondral bone sclerosis; effusions (see Box 90-3)

    • Body mass index (presence of overweight or obesity)

    • Presence of renal or hepatic disease

Assess

  • Distribution and severity of joint involvement

  • Impact of symptoms on patients' daily activities, interference with occupational functioning, health-related quality of life

  • Effects of pre-existing renal or hepatic disease on choice of medication selection and dose

Plan*

  • Patient education about disease, prognosis, treatment options, application and use of topical products

  • Nonpharmacologic therapy (see Table 90-1)—weight loss (if overweight or obese), exercise, surgery (for severe pain or functional disability)

  • Drug therapy regimen including specific analgesics, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Figures 90-4 and 90-5 and Tables 90-2 and 90-3)

  • Monitoring parameters including efficacy (e.g., symptom relief), safety (medication-specific adverse effects) (see Table 90-3)

  • Self-monitoring of symptoms, exercise, and weight—where and how to record results

  • Referrals to other providers when appropriate (e.g., physician, orthopedic surgeon, physical therapist)

  • Consider joint replacement if patient has severe pain or significant functional impairment, or drug therapy is ineffective or poorly tolerated.

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence. This is particularly important for nonpharmacologic interventions.

  • Schedule follow-up monthly until symptoms controlled to assess efficacy of drug therapy regimen and assess adherence to nonpharmacologic interventions.

Follow-up: Monitor and Evaluate

  • Assess symptom relief, effectiveness of weight loss and exercise programs

  • Presence of adverse effects (see Table 90-3), including cardiovascular and renal effects of NSAIDs, hepatic effects of acetaminophen and glycemic effects of intraarticular corticosteroids.

  • Closely monitor proper use of opioids in all patients, including dependence, addiction, tolerance, hyperalgesia, and diversion (see text).

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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For the chapter in the Wells Handbook, please go to Chapter 2. Osteoarthritis.

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KEY CONCEPTS

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KEY CONCEPTS

  • Image not available. Millions of Americans have osteoarthritis (OA). OA prevalence increases with age and number of other chronic conditions, with women more commonly affected than men.

  • Image not available. Contributors to OA are systemic (age, genetics, hormonal status, obesity, occupational, or recreational activity) and/or local (injury, overloading of joints, muscle weakness, or joint deformity).

  • Image not available. OA is primarily a disease of cartilage that reflects a failure of the chondrocyte to maintain proper balance between cartilage formation and destruction. This leads ...

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