OVERVIEW<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_2,1_2″ _builder_version=”4.17.4″ _module_preset=”default” custom_margin=”||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n
Key Messages for Clinician Assessment<\/strong><\/p>\n Adults (typically aged 40+) who present with joint pain, swelling or stiffness in hips, knees or lowers backs should be thoroughly examined for a diagnosis of OA.<\/p>\n Imaging and laboratory investigations are not required<\/strong> to assist with clinical OA diagnosis of typical presentation. Findings on imaging may not always match the individual\u2019s symptoms, and do not predict the response to treatment.<\/strong><\/p>\n If required, weight bearing x-rays are the most appropriate imaging for viewing OA degradation.<\/strong><\/p>\n Stay familiar with the criteria for immediate referral to an orthopaedic surgeon<\/strong> as every individual seeks care at a different stage of their journey.<\/p>\n The use of the terms \u2018early\u2019, \u2018moderate\/mild\u2019 or \u2018late\/advanced\u2019 are not recommended<\/strong> to describe clinical presentation of OA because they don\u2019t accurately describe an individual\u2019s lived experience.<\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_text_color=”#000000″ text_font_size=”18px” background_color=”#f2f2f2″ custom_padding=”20px|20px|20px|20px|true|true” border_radii=”on|20px|20px|20px|20px” global_colors_info=”{}”]<\/p>\n View All Resources<\/strong><\/a><\/p>\n View References<\/strong><\/a>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ module_class=”desk” _builder_version=”4.16″ _module_preset=”default” background_color=”rgba(255,255,255,0.86)” background_image=”https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/Pngtree\u2014blue-hexagon-abstract-medical-technology_1298247-e1653654071890.jpg” background_size=”initial” background_position=”top_left” background_blend=”overlay” custom_margin=”||||false|true” custom_padding=”||100px||false|true” global_colors_info=”{}”][et_pb_row column_structure=”1_4,3_4″ _builder_version=”4.18.0″ _module_preset=”d55fc8c6-b5de-4b77-a65b-80d125d2b382″ global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.18.0″ _module_preset=”e067a3d0-44a1-4396-9c39-e633c5db2c25″ background_color=”rgba(255,255,255,0.64)” z_index=”1″ global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]<\/p>\n Introduction<\/a><\/p>\n [\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Screening<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]History<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Physical exam<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Imaging and referrals<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Staging Osteoarthritis<\/a>[\/et_pb_text][\/et_pb_column][et_pb_column type=”3_4″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”||||false|false” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n This standard sets out the components that should be present to make an accurate clinical diagnosis of osteoarthritis (OA). OA is a chronic disease caused by joint changes from a progression of cartilage loss which may result in pain, declining quality of life, loss of function and increasing disability.<\/p>\n Both regulated<\/a> and non-regulated clinicians<\/a> may be involved in the assessment and care of an individual with OA.<\/p>\n Adults (typically aged 40 years and older) who present with joint pain, swelling or stiffness in their hips, knees or lower backs should be assessed thoroughly to determine if they have OA in their knees or hips. 1, 2<\/sup><\/a><\/p>\n 1<\/sup> Arthritis Association of Canada, The College of Family Physicians of Canada, Centre for Effective Practice. Osteoarthritis tool. 2017.<\/p>\n 2<\/sup> The Arthritis Society. Getting a grip on arthritis:\u00a0Best\u00a0practice guidelines. 2017.<\/p>\n<\/div>\n<\/div>\n<\/div>\n These symptoms may affect more than one joint at a time. Prior injuries, existing comorbidities and congenital deformities may be present along with typical OA symptoms.<\/p>\n If the individual does not have hip and\/or knee OA<\/a> or meets criteria for consideration for inflammatory arthritis<\/a> then these standards are not appropriate and other guidelines and tools should be used to inform diagnoses and care.<\/p>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_margin=”20px||||false|false” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text module_id=”screening” _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n If OA is suspected, a diagnosis can be made with a comprehensive biopsychosocial clinical assessment. The Hip & Knee Osteoarthritis Assessment Template<\/a>\u00a0can be used to help guide the assessment and to record the details.<\/p>\n Consider the following screening questions to help rule out other pathologies:<\/span><\/p>\n If inflammatory arthritis or other serious pathologies are identified, then these standards are not the appropriate tool for the individual.<\/p>\n Below is a list of serious pathologies which may require urgent care and\/or a different approach to care planning1<\/sup>1<\/sup> Arthritis Association of Canada, The College of Family Physicians of Canada, Centre for Effective Practice. Osteoarthritis tool. 2017.<\/span><\/span>:<\/span><\/p>\n Fever, meningism, history of immunosuppression or IV drug use<\/p>\n x-rays, MRI, CBC<\/p>\n<\/div>\n<\/div>\n Rheumatoid arthritis, polymyalgia rheumatica, giant cell arthritis<\/p>\n Rhuematology consult and blood tests for ESR, CRP, and rheumatological markers<\/p>\n<\/div>\n<\/div>\n Osteoporotic fracture, traumatic fall with risk of fracture<\/p>\n x-rays, CT<\/p>\n<\/div>\n<\/div>\n History of cancer, unexplained weight loss, significant night pain, severe fatigue<\/p>\n x-rays, MRI<\/p>\n<\/div>\n<\/div>\n Presence of psychosocial risk factors means the individual will benefit from reassurance and education to reduce chronicity. Reassess psychosocial risk factors for any individual with unimproved or poorly managed pain, after six weeks of treatment.<\/strong><\/p>\n RISK FACTOR #1:<\/strong> Belief that joint pain is harmful or potentially severely disabling<\/p>\n KEY SCREENING QUESTION:<\/strong> Do you think your pain will improve or become worse?<\/p>\n<\/div>\n<\/div>\n RISK FACTOR #2:<\/strong> KEY SCREENING QUESTION:<\/strong> Do you think you would benefit from activity, movement or exercise?<\/p>\n<\/div>\n<\/div>\n RISK FACTOR #3:<\/strong> KEY SCREENING QUESTION:<\/strong> How are you emotionally coping with your joint pain?<\/p>\n<\/div>\n<\/div>\n RISK FACTOR #4:<\/strong> KEY SCREENING QUESTION:<\/strong> What treatments or activities do you think will help you recover?<\/p>\n<\/div>\n<\/div>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text module_id=”history” _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n Documenting a thorough health history must include:<\/p>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text module_id=”phisical-exam” _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n The physical examination helps to deepen the understanding of the individual\u2019s disease activity and allows for a baseline collection of information to inform treatment planning over time. It is important to explain the process and ask for consent as the clinician moves through each step of the physical examination.<\/p>\n The examination must include recording the height, weight, body mass index (BMI) and blood pressure. Blood pressure is only necessary for medication modification. <\/span><\/p>\n A good examination will include:<\/p>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text module_id=”imaging” _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n Imaging and laboratory investigations are not required<\/u><\/strong> to assist with clinical OA<\/strong> diagnosis<\/strong> of typical presentation.3<\/sup>3<\/sup> Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskeletal Disorders. 2008;9(1):1-11. doi: https:\/\/doi.org\/10.1186\/1471-2474-9-116.<\/span><\/span> If the screening questions<\/a> have indicated further investigation is required or if the diagnosis is uncertain, then the assessing clinician can begin with preliminary imaging<\/a> (x-rays) and proceed to advanced imaging<\/a> only if indicated. Preferred x-rays views can be found here<\/a>.<\/p>\n\n
KEY RESOURCES<\/strong><\/span><\/span><\/h3>\n
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\n<\/span><\/li>\n
\n<\/span><\/li>\n
\n<\/span><\/li>\n<\/ul>\nINTRODUCTION<\/h1>\n
Osteoarthritis of the hip or knee will likely present with at least one of these symptoms:<\/h5>\n
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SCREENING<\/h1>\n
1. Asking Five Screening Questions<\/strong>1<\/sup>
\n1<\/sup> Arthritis Association of Canada, The College of Family Physicians of Canada, Centre for Effective Practice. Osteoarthritis tool. 2017.
\n<\/span>
\n<\/span><\/h5>\nSerious pathologies to screen for:<\/h5>\n
![\"Flow](\"https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/Screening-Questions-4.png\" "\\"Screening")
<\/p>\nInfection<\/h4>\n
Indication<\/h5>\n
Investigations to consider<\/h5>\n
Inflammatory Arthritis<\/h4>\n
Indication<\/h5>\n
Investigations to consider<\/h5>\n
Fracture<\/h4>\n
Indication<\/h5>\n
Investigations to consider<\/h5>\n
Tumour<\/h4>\n
Indication<\/h5>\n
Investigations to consider<\/h5>\n
Psychosocial risk factors which may affect diagnosis and care planning<\/h5>\n
\nFear and avoidance of activity or movement<\/p>\n
\nTendency to low mood and withdrawal from social interaction<\/span><\/p>\n
\nExpectation of passive treatment(s) rather than a belief that active participation will help<\/span><\/p>\nHISTORY<\/h1>\n
2. Documenting a Thorough Health History<\/strong><\/h5>\n
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Consider asking:<\/strong> How many minutes of exercise and\/or physical activity (Standard 5<\/a>) do you do per week?<\/li>\n
Consider asking:<\/strong> \u201cDo you (ever) have difficulties making ends meet?\u201d<\/li>\nPHYSICAL EXAM<\/h1>\n
3. Performing a Physical Exam<\/h5>\n
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IMAGING AND REFERRALS<\/h1>\n
Imaging<\/h3>\n
Clinical diagnosis is sufficient to begin care planning<\/strong> and treatment of OA and clinical presentation, in combination with shared decision-making<\/a>, should guide the ongoing conservative management of OA. Findings on imaging may not always match the individual\u2019s symptoms, and do not predict the response to treatment.<\/p>\n