Osteoarthritis: diagnosis and management – physical, emotional and employment consequences need assessment

Agreement: 
I Agree
Body: 

Dear Editor

I welcome the review of osteoarthritis (OA) [1] – a common and sometimes disabling condition. I entirely endorse the importance of exercise in the management of OA, but ensuring compliance over months and years may be problematic. I have had this conversation many times:-

Did you see a physiotherapist after I saw you previously – Yes
Did they recommend some exercises for you – Yes
Were the exercises helpful – Yes
Are you still doing your exercises – No!

Whilst the reasons for non-compliance may be complex, developing a close rapport with an individual with OA (IWOA) consulting you is likely to be beneficial, as well as discussing the importance and likely outcome of any exercise programme. Understanding that exercise is likely to improve function but will not necessarily abolish pain is important.

It is also important to fully understand the effects that the IWOA is experiencing, both physically and emotionally [2]. What the IWOA is worried about may be totally different from the concerns (or lack of them) of the clinician [3] and may need to be explored to minimise distress.

Furthermore, the degree of disability needs to be explored, preferably with questions that can be repeated at follow-up to define the extent of any improvement or deterioration e.g. how far can you walk before the arthritis makes you want to stop walking? [2].

For those of working age [4], details of how the arthritis may be impacting on their ability to work needs exploring. The two aspects relate to [5]:-

• Is the nature of the employment influencing the degree of symptoms?
• Are the symptoms interfering with the ability to work?

Contacting the employer through the Fit Note or other means can facilitate job modifications which may be helpful and reduce the need for analgesics taken during the working day. The assistance of any occupational health provision can be really useful. Supporting the working IWOA may prevent early and unnecessary work loss with the economic consequences felt by the IWOA, their family, the employer and the state [6].

1. Wood G et al., Osteoarthritis in people over 16: diagnosis and management-updated summary of NICE guidance. BMJ (Clinical research ed.) 2023; 380: p. 24.
2. Frank A. How to improve discussions about osteoarthritis in primary care. Quick questions can indicate both physical and emotional consequences of the arthritis. BMJ 2022; 379(17 November ) – rapid response
3. Grogan E, Frank A and Keat A. Patients in rheumatology clinics need reassurance. BMJ 2000; 321(29 July): p. 300-300.
4. Allen KD, Thoma LM and Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis and cartilage 2022; 30(2): 184-195.
5. Frank A and Maddison P. Work and the musculoskeletal conditions: a conference report. Clin Med JRCPL, 2004; 4(4): 362-365.
6. Torjesen I. NHS in England will have one strategy for all major conditions, including cancer. BMJ (Clinical research ed.) 2023; 380: 194.

No competing Interests: 
Yes
The following competing Interests: 
Electronic Publication Date: 
Thursday, February 9, 2023 – 09:47
Workflow State: 
Released
Full Title: 

Osteoarthritis: diagnosis and management – physical, emotional and employment consequences need assessment

Check this box if you would like your letter to appear anonymously:: 
Last Name: 
Frank
First name and middle initial: 
Andrew O.
Address: 
Harrow HA1 3UJ
Occupation: 
Retired consultant in rehabilitation medicine and rheumatology
Affiliation: 
Northwick Park Hospital
BMJ: Additional Article Info: 
Rapid response

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