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Patient Journey: Osteoarthritis (OA)

Use this Patient Journey to learn about the various steps in the osteoarthritis (OA) patient experience. Not all steps will apply to everyone, but this can help you learn more about what you might expect and how to effectively manage your OA.

Pre-Diagnosis

If you are not sure about your risk of OA, try out our risk assessment.

Symptoms

You may experience the following signs and symptoms in one or more affected joints: occasional and intermittent pain, aching, morning stiffness lasting less than 30 minutes, reduced range of movement, creaking (crepitus) in your joints and/or swelling. Osteoarthritis can occur in any movable joint, but most commonly affects knees, hips, big toes, hands, neck, shoulder, ankle and spine. Contributing factors can include excess weight, a previous joint injury, and/or heavy physical activity from sports or work that puts more stress on weight-bearing joints. You may have difficulty walking, gripping or climbing stairs, for example, or may avoid physical and recreational activities because of unpredictable moments of joint pain.

Healthcare Provider

Visit your healthcare provider (doctor, nurse practitioner, physiotherapist, occupational therapist) to talk about your symptoms. In some cases, a chiropractor might also be helpful. Tell your healthcare provider about how pain impacts your quality of life. They will assess your symptoms to determine how these affect your energy, mood, sleep, work, hobbies, family and social life. They will also review your history and perform a physical exam. If diagnosed with OA, your healthcare provider will work with you to develop a care plan. Follow up with your healthcare provider as you continue through your patient journey.

There is no single laboratory test or diagnostic image for OA. The most accurate way to diagnose the condition is through a clinical assessment that is based on your symptoms and physical examination findings. If you are over 40 and have symptoms typical of OA, additional testing (such as x-ray, MRI, or blood work) is not needed for diagnosis but may be required to establish the severity of your OA and how to best manage it. Sometimes symptoms of OA don’t always match the results of x-rays. If you’ve had a recent joint injury or have additional signs and symptoms that aren’t typical of OA, such as joint locking, prolonged joint stiffness in the morning, rapid onset of symptoms, a hot, swollen joint, or feeling generally unwell, then additional investigation may be needed.

How to talk to your doctor about joint pain

 

“Visit your healthcare to talk about your symptoms. Tell your healthcare provider about how pain impacts your quality of life.”

Diagnosis

You are diagnosed with osteoarthritis (OA).

Developing Care Plan

Your healthcare provider will complete a comprehensive assessment with you to determine how osteoarthritis affects your overall health and lifestyle and establish a care plan to address identified needs. A care plan also identifies how you and your treatment team will work together to improve your symptoms and help you manage daily activities. This plan should involve education about osteoarthritis, lifestyle changes such as increasing physical activity, eating healthier, weight-loss, as well as doing therapeutic exercises. If these initial interventions are tried and not effective, the use of medications may need to be considered. Your care plan also serves to inform your self-management plan, including what day-to-day actions you can do to help improve your symptoms. The next steps you choose in your OA patient journey will shape the key elements of your care plan.

Learn more about OA

Take the time to learn about OA and how you can manage it.  Your healthcare provider should speak with you about the importance of staying active, doing therapeutic exercise, and maintaining a healthy weight.  They should also tell you about how to protect your joints and prevent injury while you are active.  You can learn more from:

  • The Arthritis Society’s website (arthritis.ca), Support & Education pages (arthritis.ca/support-education) and YouTube channel; AREP (Ontario only)
  • The Arthritis Society’s Information line (toll-free) at 1-800-321-1433
  • Credible information sources, including those created by healthcare professionals and non-commercial organizations, such as rheuminfo.com and rheumatology.org
  • Your care team: family doctor, physiotherapist, occupational therapist, nurse practitioner, dietitian, social worker, orthopedic specialist, pharmacist

Self-Management Plan

Managing your osteoarthritis requires an approach that works best for you. Your self-management plan should be individualized and goal-oriented, created in collaboration with members of your care team. This approach will help you identify priorities and goals, establish an action plan, solve problems, and monitor your progress. The core aspect of this plan is ongoing symptom management, using strategies such as exercise, physical activity and weight management to protect your joints and improve your health outcomes. Your plan might include accessing local or online exercise and weight-management resources, looking after other health conditions, or using assistive devices to help in the completion of your daily tasks.

Part of your self-management plan will likely involve pain control, which is a primary symptom of OA. Pain can come from inflammation, joint damage, or increased sensitivity to stimuli that is normally not painful. Pain is perceived and processed by your brain, and the intensity of pain will vary from person to person. This means pain treatments that work for one person may not work for another or may work differently. Pain management may include mindfulness meditation, cognitive behavioural therapy, therapeutic exercise, physiotherapy, medication (if needed) and complementary therapies offered by regulated health professionals.

 

“Your care plan should involve education about osteoarthritis, lifestyle changes such as increasing physical activity, eating healthier, weight-loss, and doing therapeutic exercises.”

Ongoing Treatment, Management & Education

Everyone’s care plan and self-management plan will be unique, so as you continue through the journey, choose the treatment path(s) that make sense for you and your needs.

Self-Management

Start your treatment with therapeutic exercise, including progressive neuromuscular training, as well as exercises for muscle strength, flexibility, and cardiovascular fitness. Neuromuscular training will increase coordination to help your joints remain stable during physical activity. This treatment will help you improve your ability to function and will not cause any additional joint damage. Be sure to consult with a healthcare professional before starting any new exercise routine. Studies have indicated that exercise and physical activity can help people with osteoarthritis reduce pain and disability, while also improving function, sleep and mood.

From here, you might want to explore other treatment options, or continue monitoring and revising your care plan.

 

“Studies have indicated that exercise and physical activity can help people with osteoarthritis reduce pain and disability, while also improving function, sleep and mood.”

Medication (Pharmacological Symptom Management)

Use of medication will vary based on your symptoms and the affected joint(s) and is individualized to your needs. Regular monitoring is required for all medications so that  side effects can be identified and managed. Common medications include:

  • Topical treatments: creams or rubs that include non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin (a chili pepper extract, recommended for hands).  
  • Pain medication:
    • Acetaminophen is a pain medication sometimes used for osteoarthritis and is available over the counter. You should not exceed the recommended dose.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation and are available over the counter (i.e. ibuprofen and naproxen) or in a stronger form through a prescription. Make sure you have your doctor’s approval before using NSAIDs if you have other health conditions, are frail, or are over the age of 65.
    • Duloxetine can be used to treat chronic pain conditions and may be used if you do not respond to or cannot tolerate acetaminophen or NSAIDs, as it addresses the impact of pain from pain sensitization
    • Opioid medications have strong addictive properties and are not recommended for the management of pain associated with OA
  • Injections: corticosteroid injections may relieve symptoms in lower extremity joints for several weeks or months and are tolerated by many people without side effects. Hyaluronan injections (viscosupplementation) may also provide temporary relief of symptoms related to osteoarthritis in the knee in some patients.
  • Medical cannabis: Although there is currently a lack of evidence on the efficacy of medical cannabis for arthritis, some people report relief of symptoms such as chronic pain, inflammation, anxiety and sleep problems through its use.  Medical cannabis can be taken as CBD oil, capsules, topical creams, or edibles. It is also available in dried plant form, though smoking or vaping cannabis can pose serious health hazards and are therefore not advised.

Health Care Professionals with Additional Skills in OA Management

Health care providers offer primary and specialty care for people with arthritis. Specialty care can include services from a rheumatologist, sports medicine clinician, orthopedic surgeon, physiotherapist or occupational therapist. Some people also find relief from the signs and symptoms of OA using other management approaches , including:

  • Therapeutic modalities, such as hot and cold treatment
  • Complementary therapies to support overall wellness, such as massage or acupuncture
  • Psychosocial support (including cognitive behavioural therapy) provided by a social worker or mental health counselor

Your care plan may include referrals to health care professionals with additional skills in managing the signs and symptoms of osteoarthritis, including pain, poor sleep quality, anxiety and weight management. These professionals could include a rheumatologist, advanced practice therapist, chiropractor, dietitian, pharmacist or psychologist.

Referral for Consideration of Joint Surgery

If your osteoarthritis becomes severe and other non-surgical treatments are no longer working, surgery may be considered. The most common surgical procedures for osteoarthritis include hip and knee replacements (arthroplasty).

The decision to undergo surgery depends on the amount of pain your arthritis is causing, the degree to which your quality of life is negatively impacted, as well as the risks and benefits of surgery. This should be discussed further with your doctor and care team. Not everyone will be an appropriate candidate for surgery.

Surgery is not a final step in the patient journey – in fact, many people with osteoarthritis may never require surgery. If you undergo surgery for your osteoarthritis, you must continue your self-management plan to maintain your joint health.

Monitoring

Continue your self-management plan and maintain follow-up appointments with your healthcare provider(s). Your care plan will be revised based on your response to treatment, which may change the path(s) you take on your patient journey. In consultation with your care team, you may also need to revise your self-management plan to address changes in weight management, exercise and daily living.

 

 

Recognition

This information was last updated in April 2020 with expert advice from:

Dr. Julia M.K. Alleyne MD CCFP(SEM)
Primary Care Sport Medicine Physician, Cleveland Clinic Canada
Associate Professor, University of Toronto

Jocelyne Murdoch OT Reg.(Ont.)
Occupational Therapist,
Arthritis Rehabilitation and Education Program,
Arthritis Society
Advanced Clinician Practitioner in Arthritis Care

Gail Paterson, BSc P.T.
Physiotherapist, Arthritis Rehabilitation and Education Program, Arthritis Society

Dr. Sarah Ward, MD, FRCSC
Orthopaedic Surgeon, St. Michael’s Hospital
Assistant Professor, Department of Surgery, University of Toronto

This resource was made possible through unrestricted educational grants from:
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