Improving long-term management of osteoarthritis: Strategies for primary care physicians

Release date: February 1, 2009
Expiration date: February 1, 2010

This activity was submitted by The Primary Care Education Consortium and supported by an educational grant from Endo Pharmaceuticals, Inc. It was edited and peer reviewed by The Journal of Family Practice.

Learning Objectives
• Identify evidence-based guidelines for diagnosis, treatment, and long-term management of patients with osteoarthritis (OA)
• Evaluate the benefits and challenges of lifestyle modifications and nonpharmacologic medical interventions to reduce the pain and disability associated with OA and to prevent or delay progression of OA
• Evaluate the advantages and disadvantages of various pharmacologic options for the treatment of OA and determine the most appropriate agents based on individualized patient assessment of disease severity, lifestyle factors, and coexisting diseases
• Develop an individualized treatment plan for patients with OA, including plans for initial treatment and routine follow-up to assess effectiveness and safety, and to identify patients who require modification to their treatment plan in response to changes in their OA or overall health status
• Identify potential barriers to achieving optimal long-term outcomes for patients with OA

Sponsor Disclosure Statement
The content collaborators at the Primary Care Education Consortium report that there are no existing financial relationships to disclose.

Accreditation Statement
This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the Primary Care Education Consortium.

The Primary Care Education Consortium designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity has been reviewed and is acceptable for up to 2 Prescribed credits by the American Academy of Family Physicians. It conforms to the AAFP criteria for evidence-based CME clinical content. CME credit has been increased to reflect 2-for-1 credit for only the EB CME portion. AAFP accreditation begins 2/1/09. The term of approval is for 1 year from this date, with an option for yearly renewal. When reporting AAFP credit, report total Prescribed and Elective credit earned for this activity. It is not necessary for members to label credit as evidence-based CME for reporting purposes.

The EB CME credit awarded for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

Statement of Support
This program is sponsored by the Primary Care Education Consortium and is supported by an educational grant from Endo Pharmaceuticals, Inc.

Medium: CME print publication

Editorial Support
Editorial support for the development of this supplement was provided by Health Matters, Inc., and Primary Care Education Consortium.

Method of Physician Participation
After reading the supplement in its entirety, go to: www.pceconsortium.org/feb-CCP-OA and complete the online evaluation and post-test. Upon completing the evaluation and passing the post-test, you will be prompted to print your certificate of completion.

Clinical Practice Recommendations for AAFP EB CME Designation
Practice Recommendation: Optimal management of osteoarthritis requires combination treatment with non-pharmacologic and pharmacologic interventions.

Evidence-Based Source: Zhang W, Moskowitz RW, Nuki MB, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137-162.

Volume/Issue/Page Number of Article of Supporting Evidence: Osteoarthritis Cartilage. 2008;16(2):139.

Strength of Evidence: Level 3. Based on expert opinion and results from randomized controlled trials of lower quality and meta-analyses.

Practice Recommendation: Patients with hip and knee osteoarthritis should be encouraged to undertake regular aerobic exercise, muscle strengthening, and range of motion exercises.

Evidence-Based Source: Zhang W, Moskowitz RW, Nuki MB, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137-162.

Volume/Issue/Page Number of Article of Supporting Evidence: Osteoarthritis Cartilage. 2008;16(2):143.

Strength of Evidence: Level 1. Systematic review and meta-analysis of thirteen randomized controlled trials.

Practice Recommendation: Oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who fail to respond to acetaminophen; in patients with increased GI risk, NSAIDs should be administered with a gastroprotective agent or a selective COX-2 inhibitor should be used; in patients with increased cardiovascular risk, COX-2 inhibitors should be used with caution.

Evidence-Based Source: Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISUT). Ann Rheum Dis. 2007;66(3):383.

Volume/Issue/Page Number of Article of Supporting Evidence: Ann Rheum Dis. 2007;66(3):383.

Strength of Evidence: Level 1. Three randomized controlled trials for NSAIDs; systematic review of 112 randomized controlled trials for NSAIDs combined with GI protective medications and COX-2 inhibitors.