Safely managing acute osteoarthritis in the emergency department

An Evidence-Based Review.

Osteoarthritis (OA) is a common problem, the incidence of which is increasing every day. By 2030, as much as 25% of the adult population is expected to have self-reported or physician-diagnosed arthritis.

Paramedics with patients awaiting triage at Toronto East General Hospital. Peter Power, Toronto Star

The Journal of Emergency Medicine, Medscape January 13, 2017

The prevalence of OA in the ambulatory care setting is approximately 3500 per 100,000 visits, where patients present most commonly with pain related to their knee, hip, and shoulder OA. The primary objective of the emergency provider is to rule out critical diagnoses, such as septic arthritis, fractures, and dislocations. Once this has been accomplished, however, there is still much to be done! Quality of life for this population can be dismal because of their pain.

Beyond that, OA of the knee and hip joints in an ambulating population can predispose them to falls, potentially leading to intracranial hemorrhage, fractures, and other emergency conditions. How is pain and disability best managed in patients presenting with an acute exacerbation of their OA from the perspective of the emergency clinician?

1. Why is this topic important?
Acute osteoarthritis pain is common in patients presenting to the emergency department. Side effects of common methods of managing osteoarthritis pain include an increased risk of cardiovascular complications, gastro-intestinal bleeding, and falls.
2. What does this review attempt to show?
This review evaluates the safety and efficacy of the many treatment options available for managing osteoarthritis-related pain.
3. What are the key findings?
Nonsteroidal anti-inflammatory drugs can be used safely in many patients with gastro-intestinal bleeding and cardiac risk factors, as long as the appropriate medications are selected. Corticosteroid injections are not harmful to the joint and provide significant short-term pain relief. Multiple effective nonstandard options are available to treat patients with osteoarthritis pain, such as topical preparations, bracing, and physical therapy.
4. How is patient care impacted?
Safer management of acute osteoarthritis pain can help to prevent complications and provide better symptom relief.

Safely Managing Acute Osteoarthritis in the Emergency Department: An Evidence-Based Review, Young SE, Bothwell JD, Walsh RM. J Emerg Med. 2016 Dec;51(6):648-657. doi: 10.1016/j.jemermed.2016.05.052. Epub 2016 Jul 29.

Also see
Viscosupplementation: managed care issues for osteoarthritis of the knee, Arnold W, Fullerton DS, Holder S, May CS. J Manag Care Pharm. 2007 May;13(4 Suppl):S3-19; quiz S20-2.

Healthcare Utilization and Costs of Knee or Hip Replacements versus Pain-Relief Injections, Pasquale MK, Louder AM, Cheung RY, Reiners AT, Mardekian J, Sanchez RJ, Goli V. Am Health Drug Benefits. 2015 Oct;8(7):384-94.

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