PRACTICE GUIDELINES PeeR-ReViewedPractice guidelines for pharmacists: The management of osteoarthritisJason Kielly, BSc(Pharm), PharmD; Erin M. Davis, BSc(Pharm), PharmD; Carlo Marra, PharmD, PhD, ACPR, FCSHPOsTEoARTHRiTis (OA) is THE mosT commoN form of arthritis, affecting more than 1 in 8 Cana- dians.1 With an aging population, the prevalence of OA in Canada is rising. From 2010 to 2031, the prevalence of OA is projected to increase from 13.8% to 18.6%, with the total direct costs projected to increase from $2.9 billion to $7.6 billion, an almost 2.6-fold increase.2 OA has traditionally been thought to be a progressive disease of the synovial joints that is due to daily “wear and tear” from excessive and repetitive force on joint cartilage. While this is partially true, OA is now believed to be a systemic disorder due to an imbalance between joint destruction and repair.3-6 The result is a break- down of cartilage and bone, leading to symptoms of pain, stiffness and functional disability.The joints most commonly affected by OA (in order of prevalence) are the hands, knees, hips and spine. OA is more prevalent with age, affecting nearly half the population older than 70.3 In addition to advancing age, female gen- der is a significant risk factor. Other risk factors include obesity, quadriceps muscle weakness, family history, joint injury and joint overuse or injury (e.g., participation in certain sports).3,7Evidence for pharmacist care in OAPharmacists are frontline, accessible health care professionals who see patients 5 times more fre- quently than family physicians.8 Community pharmacists have proven they can address gaps in OA patient care. Many people with OA are not diagnosed and are not referred for treatment. Pharmacists are ideally placed to screen for OA and make treatment recommendations, as they are often consulted about the choice of over-the- counter (OTC) analgesics to manage OA pain.Research conducted in Canadian pharmacies has shown that pharmacists can effectively screen for OA. Community pharmacists in Edmonton and Vancouver, using a simple screening question- naire (<10 minutes to complete), identified >80% of patients with knee pain who had undiagnosed knee OA.9 Within 6 months of receiving their diagnosis, >90% of participants had visited their family physician to discuss their OA, >50% took either a prescription or nonprescription analge- sic and a significant number (p < 0.001 for all) of patients saw improvements in their pain, function and daily activity scores.10 Canadian pharmacists have also effectively launched multidisciplinary interventions to improve health outcomes for patients with undiagnosed knee OA.11 Patients who reported knee pain at community phar- macies in Vancouver were effectively screened for OA and assigned to either “usual care” (i.e., provided with a pamphlet on knee OA created by the...
