Clinicians Not Adhering to Arthritis Guidelines

Emphasis should be on weight loss and exercise rather than imaging, pharmacology, and surgery

MONDAY, Jan. 10 (HealthDay News) -- Clinicians are not following evidence-based recommendations for the diagnosis and treatment of osteoarthritis (OA), despite the consistency among the numerous guidelines available, according to a review published in the January issue of Arthritis Care & Research.

David J. Hunter, M.B.B.S., Ph.D., of the University of Sydney in Australia, and colleagues reviewed how standard clinical practice differs from evidence-based recommendations. They also examined the reasons for this divergence, followed by suggestions for improved health care quality in OA.

The researchers found that clinicians often failed to recommend conservative nonpharmacologic management options. Weight management and exercise programs, which are advocated by most OA recommendations, are infrequently implemented in clinical practice. The researchers also suggested that surgery be resisted when symptoms can be managed more conservatively. Earlier studies have shown that up to 30 percent of some surgical procedures are inappropriate, but this has not been reflected in a change in clinical practice. Diagnostic imaging is also overused, given that OA is primarily a clinical diagnosis based on history and physical exam. Earlier research has shown that 20 to 50 percent of high-tech scans (CT, MRI, PET) done annually in the United States were unnecessary. Current evidence suggests that imaging should be used when the diagnosis is unclear because the imaging could rule out other processes.

"Future efforts to guide the management of OA are better directed toward implementing practices known to be effective in a context-dependent manner to optimize health care quality," the authors write.

One author disclosed financial ties with a number of pharmaceutical companies.

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