Professor David Hunter,
rheumatology clinician-researcher regarded as world authority in osteoarthritis.
During a recent tour to four cities in New Zealand, Professor David Hunter proposed smarter ways for the New Zealand health system and its professionals to manage osteoarthritis.
GPs consider osteoarthritis a very challenging condition to treat. Two in three people with osteoarthritis say that the last time they were pain-free was over a year ago. About half of them are of working age leading to premature retirement.
The first step to better treatment is to stop using terminology like “wear and tear” and “bone on bone”. Words like these lead people to believe that the joint is vulnerable.
Osteoarthritis pain is mechanical; in other words, it hurts when you move the joint. People tend to limit exercise and movement to prevent pain and degradation of the joint when they believe the joint is vulnerable, and osteoarthritis is only caused by “wear and tear”. People then think there is nothing they can do to make it better, it will only get worse, and surgery is the only thing that can fix it.
“This thinking is wrong. Most people educated in effective self-management of their hip or knee osteoarthritis never need a joint replacement.”
Prof. Hunter said that most people don’t get appropriate care before they see a surgeon.
How should we manage osteoarthritis?
People should focus on weight loss, exercise and physical activity, mood and sleep management, topical medications and heat/cold, walking aids and assistive devices, as well as have a regular review of medications.
Judicious use of analgesia and joint replacement surgery should be considered for severe disease when all conservative options have failed.
“Things that have no place in the management of osteoarthritis are reactive care, glucosamine and chondroitin supplements, opioids, viscosupplementation, repeat injections of glucocorticoids, and arthroscopy.”
Some examples of care are muscle strengthening for muscle weakness and assistive devices (like bracing) for joint overuse or injury. Modification of duties at work, diet and exercise to manage weight, physical activity to combat sedentariness, and exercise and cognitive behavioural therapy can help improve sleep and mood.
The burden of osteoarthritis in New Zealand
Osteoarthritis is extraordinarily prevalent in New Zealand, with over 400,000 people living with the condition, and is a leading cause of disability. Changing demographics like obesity and longer life expectancy are leading to a more significant burden.
Arthritis as a whole cost the New Zealand economy $12,2 billion in 2018, of that hospital inpatient costs amounts to $321 million (public $244 million and private $77 million). Osteoarthritic knee and hip surgeries dominate both public and private inpatient costs.
“There are several ways to address this burden. The public health agenda, providing appropriate non-operative management, and reasonable use of surgery.”
Prof. Hunter visited Christchurch, Wellington, Hamilton and Auckland from 13 to 18 September 2019 and gave two tailored presentations – for health professionals and people with arthritis respectively. Prof. Hunter is a rheumatology clinician-researcher regarded as world authority in osteoarthritis.