A New Vision for Chronic Osteoarthritis Management

1. A New Vision for Chronic Osteoarthritis Management A Call to Action from the Chronic Osteoarthritis Management Initiative (COAMI) Prepared by the United States Bone and Joint Initiative, NFP

2. What is COAMI? • A Work Group representing: • Health care professionals who treat patients with osteoarthritis (OA) • orthopaedic nurses and surgeons • specialists in rheumatology, rehabilitation and sports medicine • osteopathic physicians • physical therapists • athletic trainers • Providers who may not specialize in OA, but see patients at risk • Pediatricians and pediatric nurses, family physicians, nurse practitioners, physician assistants • Epidemiologists and researchers studying OA

3. The Burden of OA • OA is prevalent • Most common type of arthritis, affecting 27 million Americans (and 10% of adults) • OA is disabling • Significant cause of disability and pain • Interferes with work and activity levels • Undermines physical activity levels recommended for weight loss and controlling other chronic diseases • OA is co-occurring • Over half (52 percent) of patients with diagnosed diabetes also have OA • OA is costly • $42.3 billion spent on 905,000 knee and hip replacements in 2009 alone

4. Missed Opportunities to Approach OA as a Chronic Disease

5. A Vision for the Future Better Predictors of Who Is at Risk Screening for High-risk Phenotypes Targeted Interventions to Avoid or Delay Joint Damage and/or Death Improved Technology to Identify Patients Not every case of OA can be prevented, but a significant degree of the pain and disability caused by OA can and should be prevented or ameliorated.

6. A Unique Role for Health Care Professionals • Treat OA as a chronic disease • Adopt best practices of other successful chronic disease models • Ask patients about joint pain, injury, mobility, and function • Reinforce and support weight management, physical activity, and pain management

7. What Will It Take?COAMI Recommendations • Develop an OA Call to Action, specifically geared to health care professionals • Convene an OA Management Conference • Identify areas of agreement and gaps • Review models of care • Develop a research agenda and priorities • Reach out to other partners to include them in future COAMI work

8. What Will It Take?COAMI Recommendations (Continued) • Explore standardizing screening tools and indicators of OA, to make early diagnosis more consistent and likely • E.g., Fracture Risk Assessment Tool (FRAX) model • Develop tools and prompts that promote patient engagement in learning about and managing OA (and pre-OA) • E.g., Exercise is Medicine™

9. What Will It Take?COAMI Recommendations (Continued) • Lend COAMI’s support to existing advocacy and awareness efforts and seek specific opportunities to reinforce key messages: • OA should be managed as a chronic disease • “Pre-OA” (like pre-diabetes) could be identified and addressed more systematically • Health care providers should support and motivate patients to become more physically active and maintain a healthy weight

10. What Will It Take?COAMI Recommendations (Continued) • Develop and support an OA-specific research agenda to fill gaps in evidence and practice • Managing patients with mild to moderate symptoms and limitations • Identifying and tracking OA risk factors (e.g., using Electronic Medical Records) • Educating clinicians about musculoskeletal conditions and OA

11. What’s Our Role? How can our organization/field/discipline support COAMI’s recommendations? Which ones are a particularly good fit with our own mission and goals? What do we bring to the table that’s unique?