Catching knee osteoarthritis early

Pharmacists are about to take on a bigger role in preventive health care by offering early screening for osteoarthritis (OA) of the knee.

“People see their pharmacists about seven times as often as their doctor, showing this is a good place to catch people, educate them about the disease and offer screening.” Dr. John Esdaile, University of British Columbia

The screening program was launched on September 9, 2013 at Shoppers Drug Mart stores across Canada. The program is the result of a partnership between the Arthritis Research Centre of Canada (ARC), Arthritis Consumer Experts (ACE) and Shoppers Drug Mart.

Pharmacists are ideally positioned to help tackle the anticipated increase in osteoarthritis (OA). Pharmacoeconomist Dr. Carlo Marra with the Arthritis Research Centre of Canada explains that pharmacists can identify people with knee OA early on in the disease while it is still mild and treatable.

Arthritis is the most expensive disease in Canada, outpacing heart disease in terms of cost and disability, according to Dr. John Esdaile, professor of medicine at the University of British Columbia (UBC) and a founder of ARC. Some estimates place the costs of arthritis at about $33-billion annually, including health care costs and costs related to lost productivity.

OA of all types affects about 10% to 12% of the population, and about 38,000 knee replacements are performed to treat OA each year in Canada.

“A problem is that OA tends to be diagnosed late, when people go to their doctor after they are already suffering significant pain and disability,” says Dr. Esdaile. At that point, irreversible damage has already occurred in the joints.

But if it is detected early, people have a chance to prevent the problem from getting worse and reduce or prevent future disability. This is where a new screening tool developed by ARC researchers comes in. It will enable pharmacists to screen patients before minor problems evolve into more severe ones.

“People see their pharmacists about seven times as often as their doctor, showing this is a good place to catch people, educate them about the disease and offer screening,” he says.

The screening tool, in the form of a questionnaire, takes only a few minutes to complete, according to Dr. Carlo Marra, professor of pharmacy at UBC and an ARC research scientist.

With the help of funding from the Canadian Institutes of Health Research, the tool was tested in a pilot project in several pharmacies. Patients who tested positive on the screening were then sent to a rheumatologist for a formal medical evaluation. The pharmacists were correct over 93% of the time, showing this is a highly effective tool.

“These were people who had not been previously diagnosed with OA,” says Dr. Marra. Once patients in the study received a diagnosis, their family physician was informed, and they were referred to services such as physiotherapy and exercise programs known to slow or prevent the progression of the disease.

For example, being overweight is an important risk factor for OA. But the pilot studies showed that once people got the diagnosis, “they went and did do exercise and lost weight. This doesn’t happen when you get people who are diagnosed a decade later, likely because they are afraid to exercise because of the pain,” Dr. Esdaile says.

The screening program promises to save the health care system money too. A report released by ARC, ACE and Shoppers Drug Mart suggests expanding the role of pharmacists in care of a variety of chronic diseases, including arthritis, could save the system upwards of $1.4 to $1.9 billion dollars over a three year period.

This would mean pharmacists playing a more active role in developing and managing patient care plans, sharing more information with physicians, and making more decisions regarding drug selection within classes and prescription renewals.

They already do much of this in many areas in Canada, including giving vaccinations – but there is room for more, says Dr. Marra.

Source Canadian Institutes of Health Research Updated October 6, 2013.

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Arthritis Lifestyle Management Guide, Arthritis Research Canada

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