Empowering Patients With Self-Care Measures for the Management and Prevention of Osteoarthritis

Osteoarthritis (OA), the most common form of arthritis, is a chronic progressive disease that causes joint degeneration, contributing to significant pain and disability. OA causes varying degrees of continual or episodic pain, stiffness, swelling, tenderness, and decreased range of motion. Although OA can affect any joint, the most commonly affected joints include 1 or more of the following: fingers/hands, back, hips, knees, and ankles.^1-3

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The CDC and the Arthritis Foundation indicate that more than 33 million adults in the US have some degree of OA.^1,2 The CDC also notes that OA is an ongoing public health issue, with the incidence rate projected to expand due to the growing aging population and the ongoing obesity epidemic.^1,2 According to a recent publication in the Lancet Rheumatology, researchers project that by 2050, an estimated 1 billion people will have some degree of OA, with knee OA cases anticipated to surge by 74.9%, hand OA by 48.6%, hip OA by 78.6%, and OA in other joints by 95.1%.⁴ These findings accentuate the augmenting incidence of OA and the need to expand awareness about preventive and treatment measures.⁴

In general, the incidence of OA frequently augments with age, especially after age 50 years.³ Examples of established risk factors for OA include having a familial history of arthritis, female sex, age older than 50, being overweight or obese, repetitive or overuse of joint or injury due to occupational duties or participation in sports, and musculoskeletal abnormalities.^1-3

The severity and clinical presentation of OA vary from patient to patient, and various publications have found that symptoms associated with OA can negatively impact health-related quality of life and day-to-day productivity, cause sleep disturbances, and affect work-related and social functioning.^1-3 Recent studies have also demonstrated that high levels of pain, poor levels of function, the number of joints affected, and mobility issues may increase rates of depression, stress, and anxiety.⁵

Self-Treatment and Preventive Measures

Treatment goals for OA are to diminish both pain and functional loss, and comprehensive management involves the incorporation of both nonpharmacologic and pharmacologic therapies.⁶ Pharmacists have a critical role in guiding patients in the proper selection and use of nonprescription products marketed for the treatment and management of OA. Pharmacists can also be instrumental in assessing the appropriateness of self-treatment and screening for possible drug interactions and contraindications. They can also encourage patients to visit their primary care provider for an official diagnosis of OA so the proper patient-centered clinical interventions can be initiated in a timely manner to slow OA progression, provide pain relief, and improve symptoms. Factors to consider when devising a treatment plan include the type and severity of the patient’s symptoms, allergies, medical history, and patient preferences.

Generally, recommended nonpharmacological measures for managing OA may include 1 or more of the following⁷:

• Avoidance of activity that may cause or exacerbate symptoms
• Rest, elevation, ice, and compression
• Weight loss if needed
• Braces and support devices
• Heat therapy, such as a heating pad
• Exercise and physical therapy

Nonprescription pharmacological therapies may include oral and topical analgesic formulations, including extra strength and long-acting formulations, and should be tailored to patient needs. Oral nonprescription analgesics include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin.⁷ Additionally, there are joint supplements that contain glucosamine and chondroitin marketed for joint health.⁷

Nonprescription topical analgesic products are available in gel, spray, ointment, cream, lotion, and patch formulations, which may contain menthol, camphor, capsaicin, trolamine salicylate, lidocaine, diclofenac sodium, and methyl salicylate. Topical analgesic formulations are available as a single entity and combination product and can be categorized as local analgesic, anesthetic, antipruritic, and/or counterirritant effects. The first and only topical OTC NSAID, diclofenac sodium gel 1% (Voltaren;Haleon), is available to temporarily relieve OA pain.⁷

News and Recent Clinical Data

According to recent study results, researchers examined the association between a history of bicycling and symptomatic and structural outcomes of knee OA. The study involved 2607 individuals with OA. Results revealed that patients who routinely used bicycles were 21% less likely to have x-ray evidence and report OA symptoms compared with those who did not have a history of bicycling.⁸

In another study, researchers sought to assess whether resistance exercise interventions impact pain and function differently based on the comparison group and to examine the link between improved lower extremity strength and pain and function in knee and hip OA. The researchers discovered that pain associated with knee OA responds best when exercise is combined with nonexercise interventions, such as dietary changes and psychosocial/behavioral interventions. Additionally, pain correlated with hip OA moderately benefits more from nonexercise interventions than resistance exercises.⁹

Finally, according to findings of a recent study published in Annals of the Rheumatic Diseases, researchers developed an automated machine learning tool using clinical, x-ray, MRI, and biochemical data. Researchers discovered that it could accurately predict the progression of knee OA, especially in younger patients and those in the early stages of OA. Based on their findings, the authors concluded that earlier and more accurate identification of high-risk patients could enable more timely and targeted interventions, particularly among younger individuals and those with early-stage OA.¹⁰

Conclusion

If left undiagnosed and untreated, the symptoms associated with OA can significantly diminish an individual’s mobility, productivity, and health-related quality of life. With the increasing prevalence of OA, enhancing patient education initiatives is vital for early identification and clinical intervention, which can help slow the progression of joint damage. It is critical that during counseling, pharmacists ensure that patients are well informed about the proper use of the selected OTC products, covering key facets, such as dosage, recommended duration of use, potential adverse effects, and when to seek medical care.

Through effective clinical interventions, pharmacists can assist patients in making informed choices regarding the treatment and prevention of OA by properly implementing pharmacological and nonpharmacological measures to improve patient outcomes and health-related quality of life.

REFERENCES

1. Osteoarthritis. CDC. January 26, 2024. Accessed October 31, 2024. https://www.cdc.gov/arthritis/osteoarthritis/index.html

2. Osteoarthritis. Arthritis Foundation. Accessed October 31, 2024. https:// www.arthritis.org/diseases/osteoarthritis

3. Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Updated September 2023. Accessed October 31, 2024. https://www.niams.nih.gov/health-topics/osteoarthritis

4. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522. doi:10.1016/S2665-9913(23)00163-7

5. Wang ST, Ni GX. Depression in osteoarthritis: current understanding. Neuropsychiatr Dis Treat. 2022;18:375-389. doi:10.2147/NDT.S346183

6. Sen R, Hurley JA. Osteoarthritis. In: StatPearls. StatPearls Publishing; 2024. Accessed October 31, 2024. https://www.ncbi.nlm.nih.gov/books/NBK482326/

7. Olenak JL, Pezzino NC. Musculoskeletal injuries and disorders. In:Krinsky DL, Ferreri SP, Hemstreet BA, eds. Handbook of Nonprescription Drugs. American Pharmacists Association; 2020.

8. Lo GH, Richard MJ, Kriska AM, et al. Bicycling over a lifetime is associated with less symptomatic knee osteoarthritis: data from the Osteoarthritis Initiative. Med Sci Sports Exerc. 2024;56(9):1678-1684.doi:10.1249/MSS.0000000000003449

9. Marriott KA, Hall M, Maciukiewicz JM, et al. The control group matters: pain, physical function and strength improvements relative to the comparator intervention in knee and hip osteoarthritis. Semin Arthritis Rheum. 2024;68:152538. doi:10.1016/j.semarthrit.2024.152538

10. Castagno S, Birch M, van der Schaar M, McCaskie A. Predicting rapid progression in knee osteoarthritis: a novel and interpretable automated machine learning approach, with specific focus on young patients and early disease. Ann Rheum Dis. Published online September 4, 2024.doi:10.1136/ard-2024-225872