Project Osteoarthritis: Recovering Quality of Life Through Education

INTRODUCTION

Osteoarthritis (OA) has a major impact on mobility, disability and loss of productivity of patients. Patients can become disabled early in life by OA.(1,2,3) Osteoarthritis is primarily a genetic disease but can be triggered by trauma, intra-articular fractures, axis deviations and joint overloading, including overweight / obesity.

Perhaps the most common type of disease is hand OA, as debilitating to the patient as the changes generated by rheumatoid arthritis. On the other hand, among the most debilitating, is knee OA, that greatly diminish the quality of life of the affected patients. (4) At the Knee Surgery Group of Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP) - Orthopedics and Trauma Institute of University of São Paulo's General Hospital - there is a large number of young adult patients who were economically active, until the advent of a joint trauma, which led to early OA. There is also a large number of people seeking our group for a Total Knee Arthroplasty (TKA) without been offered all non-surgical alternatives of treatment. As there are also patients who underwent surgical treatment but suffer from consequences of OA and clinical treatment is their current need. These patients do not receive an appropriate OA clinical care.

Those patients should be reabsorbed by the basic health network. But the patient is returned by the social services at IOT-HCFMUSP, because there is no such reference in the Unified Health System The OARSI is concerned to publish guidelines with the respective levels of evidence on the various forms of treatment of osteoarthritis of the knee and hip. Those guidelines show the importance of education, phone calls, non-drug methods such as physical therapy, exercise, acupuncture, mind and body therapies, the use of insoles and orthotics, canes, crutches and knee pads, and finally the drugs for pain and to slow the progression of the disease. (5,6) It is believed that an education program has a positive impact on quality of life of patients with OA. In England, the simple delivery of educational material showed no different from a course associated with the delivery of educational material. But in countries like Sweden, primary care is concerned to give courses on OA. In France, teaching about the pathology associated with medical consultation was superior to simple medical consultation to improve patients' symptoms and treatment adherence. (6) No paper on only telephone follow-up was performed, but the addition of patient care by phone, always shows better results than a single intervention. (6) The Osteometabolic Diseases Group of IOT-HCFMUSP, initially focused on the care of osteoporosis and other diseases of bone metabolism such as thalassemia and osteogenesis imperfecta. More recently took over the care and research in the treatment of OA, starting with the knee OA, since it's among the most prevalent and debilitating types of OA.(3)

Obesity and knee OA are the most frequent comorbidities in the elderly in the United States (U.S.). Although not presenting the same level of obesity of U.S. patients, our patients with OA also are overweight, and often have diabetes and hypertension. Changing the habits of those patients is imperative for clinical improvement. Those patients should incorporate healthier eating habits as well as daily physical activity. But to change behavior, it is necessary: