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Hip and Knee Osteoarthritis Guideline for Nonsurgical Management
Hello, I'm Norman Swan. Welcome to this programon the new guidelines for the nonsurgical managementof hip and knee osteoarthritis. It's a timely program, as we're broadcastingduring Arthritis Awareness Week. Arthritis, as you know, is a major causeof disability and chronic pain. There's around 100 different formsof arthritis, and osteoarthritis is the most common.
This program is the thirdin a series of four on the musculoskeletal guidelines that have been developedby the Royal Australian College of GPs and approved by the NH and MRC. This program will cover the diagnosisof osteoarthritis and discuss recommendednonpharmacological and pharmacological interventions in a multidisciplinaryprimary healthcare setting.
As always,you'll find a number of resources available on the Rural Health EducationFoundation's website: Let's meet our panel. Geoff McColl is a rheumatologistand professor of Medical Education and Trainingat the University of Melbourne. Welcome, Geoff. Thank you, Norman. Geoff is the current president ofthe Australian Rheumatology Association and was part of the working partydeveloping this guideline.
Rana Hinman is a physiotherapistand senior lecturer in the University of Melbourne Schoolof Health Sciences. Welcome, Rana. Rana has particular expertisein evaluating conservative treatments for osteoarthritis, and was alsoa member of the working party. Michael Yellandis a general practitioner and associate professorof Primary Health Care at Griffith University in Queensland.Welcome, Michael. His teaching and research interestsfocus on evidencebased diagnosis
and the treatmentof musculoskeletal pain. And David Ng, who's a pharmacist and director of the South Australianand Northern Territory Branch of the Pharmaceutical Societyof Australia. Welcome, David. Thank you, Norman. From the home of fish oil. That's correct. We'll talk about fish oil later to see whether or not it'sthe magic panacea for osteoarthritis.
Many myths about osteoarthritis,Geoffreyé There are many myths, Norman. Probably the best place to start is that this is an illness that you acquireas you grow old that you can do nothing about. You're just going to creak your wayto the wall at the bottom of the garden. Absolutely. There's a certain acceptancethat this is the way it will be. NORMAN:Are you telling me it's reversibleé
Biologic Therapy Anti rheumatic drugs dont increase surgical risk
Antirheumatic drugs don't increase surgicalinfection risk Bruce Jancin writing for Skin and AllergyNews reported on a study presented at the national meeting of the American College ofRheumatology. Rheumatoid arthritis patients undergoing surgery who stayed on their antirheumaticmedication didn't have a higher risk of early postoperative infection compared with thosewho temporarily stopped treatment before surgery, according to findings from a large nationalVeterans Affairs study. Until now many rheumatologists and surgeonshave taken a conservative approach, reasoning that the immunosuppressive drugs used in controllinginflammation in rheumatoid arthritis might
also increase the risk of surgical wound infection. A common practice has been to have RA patientsstop their medication a month ahead of elective surgery, or at least two drug halflives beforehand,then start treatment again roughly a month after the operation, or when the wound hashealed. The new Veterans Affairs (VA) study findings suggest this practice may be unnecessary, Zaki Abou Zahr said. Bernard Ng, his senior coinvestigatorin the study, added that temporarily stopping antirheumatic agents before surgery may actuallybe harmful in that it increases the risk of a flare of the RA.
But there is a major weakness regarding theVA study: Participation was restricted to RA patients on only a single conventionaldiseasemodifying antirheumatic drug (DMARD) or biologic agent leading up to surgery. Thisrestriction, imposed to make for a more clearcut analysis, means that the study results can'tbe extrapolated to patients on multidrug therapy. And multidrug therapy is quite common. Comment: Interesting and valuable study.