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Osteoarthritis Treatments: Are Medications Needed for Better Quality of Life?

August 19, 2021
Nonpharmaceutical and alternative treatment modalities are underused but may offer patients with OA just as much support.

A PPM Brief with Padma Gulur, MD, Kevin Byram, MD, and Philip Conaghan, PhD

The incidence of osteoarthritis has increased worldwide by more than 30% during the most recent decade examined (2007-2017)  as part of the Global Burden of Disease Study.1 An estimated 300 million people suffer from this painful and disabling condition.1 Current treatment guidelines for osteoarthritis recommend both pharmacological and nonpharmacological approaches, with surgery as a last resort, but pharmaceutical outcomes are not always great and getting patients to pursue nonpharmaceutical options can be difficult.

To make the best use of available treatment options, clinicians can explore how various treatment modalities influence the quality of life (QoL) in those living with osteoarthritis (OA) (Image: iStock).


Osteoarthritis Treatments and Quality of Life: Medication May Not Matter

To make the best use of available treatment options, clinicians need to understand how various treatment modalities influence the quality of life (QoL) in those living with osteoarthritis (OA). An international group of researchers looked into the relationship between pain severity, prescription treatments, and QoL.

Published in the Clinical and Experimental Rheumatology, the study used data from the 2016/2017 European National Health and Wellness Survey (NHWS), a cross-sectional survey that compiles a database of patient-reported health conditions for almost 2 million adults from Europe, the US, Russia, China, Japan, and Brazil. In this study, the researchers examined data from five European nations: UK, Germany, France, Spain, and Italy. 

Individuals with physician-diagnosed OA who had experienced pain in the past 12 months were included in the review. Those who reported neuropathic pain or phantom limb pain were excluded. Respondents completed a separate arthritis module with specifics about their OA pain, such as joint site.

The final sample included 1,151 respondents from the UK; 503 from France; 342 from Germany; 292 from Spain; and 129 from Italy, for a total of 2,417 respondents. The researchers gathered data on age, sex, marital status, height, weight, BMI, employment status, smoking status, alcohol use, and comorbidities, as well as self-reported physician diagnoses of anxiety, depression, and sleep disturbances. All subjects were over 18 years old.

The team analyzed outcomes including QoL, health utility, health status, work productivity, activity impairment, and health resources utilization and divided the respondents into four categories:

  1. mild pain untreated with prescription medications
  2. mild pain treated with prescription medications
  3. moderate/severe pain untreated with prescription medications
  4. moderate/severe pain treated with prescription medications.

After adjusting for covariates, the researchers found that those whose OA was treated with prescription medications reported substantially lower QoL than those not receiving medications, no matter the severity of their OA pain. Specifically, individuals being treated for their OA symptoms reported reduced health status, lower health-related QoL, impaired work productivity, impaired daily activities, and increased use of health-care resources.

“These data suggest that irrespective of treatment history, there is a need for more effective prescription medications,” wrote the study authors, “which could be used in conjunction with appropriate non-pharmacologic modalities, to support a comprehensive approach to OA management.2

Alternative Treatments for Osteoarthritis Underused

However, the team also pointed out that nonpharmacologic modalities (eg, physical therapy, and OTC curcumin or glucosamine) are typically underused. This is likely the case in the United States as well, says Padma Gulur, MD, professor of anesthesiology and population health at the Duke University School of Medicine.

Cost is a factor, since nonpharmaceutical therapies are often not covered by insurance, she adds. It can also be difficult to get patient buy-in for these kinds of treatments. Even after giving patients self-care approaches to do, such as exercises, the use of hot and cold packs, and other therapies, Dr. Gulur says, in her experience, “patients respond with ‘So you’re telling me there’s nothing you can do?’ When in fact, it’s quite the opposite; there’s a lot you can do.”

The medical community does not always support alternative methods, either. “In The American College of Rheumatology guidelines for treating OA, some of the non-pharmacologic approaches are sometimes rated down a little bit,” notes Kevin Byram, MD, assistant professor of medicine in the Division of Rheumatology and Immunology at Vanderbilt University Medical Center. “That’s because of lack of evidence that they are effective. But I think the risk is pretty low, so why not try it out?”

Osteoarthritis Pain Can Spread to Other Areas

To make the best use of various treatment modalities for osteoarthritis, there is a need to better understand the nature of this kind of pain, Philip Conaghan, PhD, professor of musculoskeletal medicine at the University of Leeds in the UK,  director of the Leeds Institute of Rheumatic and Musculoskeletal Medicine, and first author of the study, told PPM.

“Multisite joint pain usually represents a combination of back pain, osteoarthritis (in knees and feet), and tendon inflammation (hands and shoulders),” says Dr. Conaghan.

“How you use your body can lead to other pains. For example, people with a single painful knee will quickly lose quadriceps muscle strength and use that leg as a stilt, causing them to get pain in the outer thigh, aggravating their back pain and often causing ligament pain around the ankle. We need to have a clear understanding of the biomechanical ‘spread’ of pain and how important, for example, strengthening leg muscles might be for reducing pains in other joints.”

At-Home Stretches for Osteoarthritis Pain

Because current pharmaceutical treatments have limited value, Dr. Conaghan advises clinicians to “Learn one grip strength exercise and one quadriceps strengthening exercise that you can teach your patients. Muscle strengthening is highly effective for reducing joint pain and has no side effects. One or both of those two exercises will be relevant for the vast majority of people who you see with joint pain.”

As the study found, stressing the elimination of pain might not be the best way to help patients achieve their aims. Dr. Byram says he frames therapy around three main goals — and a pain level of zero is not number one. First is to increase function. “That’s more important than decreasing pain,” he notes. Decreasing pain is the second goal. And third is  to minimize treatment-related toxicity.



Last updated on: August 24, 2021
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