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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000406409.03697.8a
AJN Reports

Osteoarthritis: Setting Nursing's Agenda

Kennedy, Maureen Shawn MA, RN, editor-in-chief; Jacobson, Joy

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In July, a 'state of the science' symposium made recommendations on nurses' role in prevention and management.

Known as the "wear-and-tear" type of arthritis, osteoarthritis usually afflicts people over the age of 40 and is considered less debilitating than its more inflammatory sibling, rheumatoid arthritis. But those facts contribute to a misconception that many people, including some nurses, have about osteoarthritis: that it's a normal, even inevitable, aspect of aging.

Figure. At the sympo...
Figure. At the sympo...
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In 2010 the Centers for Disease Control and Prevention (CDC) in collaboration with the Arthritis Foundation set forth a "national agenda" for osteoarthritis designed to make improvements in clinical care, policymaking, and research over a three-to-five-year period (access the agenda at Because people are living longer, and obesity rates are on the rise, the CDC said, "bold and innovative action" was urgently needed. But despite the visibility of such efforts, many nurses remain unaware of them.

As attendees of a recent symposium on the "state of the science" on osteoarthritis asked: how bold and innovative can an osteoarthritis action plan be without the involvement of nurses? On July 14 and 15, more than 45 nurses, physical therapists, social workers, physicians, and other clinicians gathered to identify what keeps the 27 million Americans with osteoarthritis from receiving a more multidisciplinary approach to care so that they might live more fully with the disease.

The symposium was a joint project of AJN, the National Association of Orthopaedic Nurses (NAON), and the Hospital for Special Surgery (HSS), a New York City facility dedicated to orthopedics and rheumatology and the host for the meeting. Directing the project are Laura Robbins, senior vice president of education and academic affairs at the HSS and a past chairperson of the Arthritis Foundation; Maureen Shawn Kennedy, AJN's editor-in-chief; and Marjorie G. Kulesa, past president of NAON.

"The idea of prevention and early intervention for osteoarthritis is novel," Robbins said in her opening remarks. The HSS recently hosted a meeting of experts in osteoarthritis research from around the world, she said, including professionals in public health, consumer awareness, patient education, medicine, and pain management. "But nurses were missing," Robbins noted.

The organizers of this collaboration between AJN, the HSS, and NAON set out to achieve the following objectives:

* to describe the state of the science on osteoarthritis, especially as it concerns interventions for preventing immobility and managing symptoms

* to identify gaps in the science and the barriers to early identification and treatment of osteoarthritis

* to reach consensus on the top priorities for nurses—in the clinical arena, as well as in education, research, and policy—in an attempt to better meet the needs of patients with the condition

* to publicize the group's recommendations to nurses and other clinicians, health care leaders, educators, researchers, nursing organizations, policymakers, consumer advocates, and the public

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On the first day of the symposium, Kathy Geller, a middle-aged New Jersey woman who has lived with osteoarthritis for 13 years, gave those gathered a view of the toll the disease has taken on her life. She listed the therapies and attempts at management she has endured: intraarticular steroid injections in both hips, injections of hyaluronic acid in both knees, prescriptions for nonsteroidal antiinflammatory drugs, visits with orthopedists and rheumatologists, braces for her knees and wrists, orthotics, physical therapy and occupational therapy, several surgical procedures, a move from her large family home to a single-floor condominium, and "every imaginable assistive device for the hands" to help with cooking and gardening.

Despite the support these approaches have given her, she described herself as "an orphan in the arthritis world." Biologic drug therapies give measurable reason for hope to people with rheumatoid arthritis, she said, but research hasn't yet found treatments that significantly improve the quality of the lives of people like her, whose osteoarthritis is severe.

"Stroke gets front-page news," Geller said, "but people don't die of osteoarthritis all at once. Your life gets whittled away."

Indeed, Louise Murphy, an epidemiologist at the CDC, told the gathering that osteoarthritis was the reason for 12.3 million outpatient medical visits in 2006–2007 and that the rate of total knee replacements among Medicare beneficiaries rose by 58% from 2000 to 2006. And Murphy reported on the findings of a study she and her colleagues published in the September 15, 2008, issue of Arthritis and Rheumatism: by age 85 a person has a one-in-two chance of developing osteoarthritis of the knee and an obese person has a two-in-three chance.

Osteoarthritis is treated with a therapeutic regimen that involves muscle strengthening, weight control, and pain management, with the goals of preventing disease progression and minimizing pain and disability. The symposium participants seemed to agree that nurses could and should have greater involvement in promoting these and other recommendations the CDC put forth in its national agenda for osteoarthritis.

Those who attended the meeting have been working in the months since to refine the list of barriers to care and recommendations for overcoming them. AJN will publish an executive summary of the meeting in an upcoming issue and will issue a special report in 2012. (Partial funding has been secured through an unrestricted educational grant from Genzyme Corporation, and the planners are seeking additional funding for dissemination.)

In the meantime, Robbins and Kulesa encourage nurses to get more involved in identifying who has osteoarthritis and whether it's at an early or advanced stage. "We need to put a face on this type of arthritis," Robbins told participants.—Maureen Shawn Kennedy, MA, RN, editor-in-chief, and Joy Jacobson

© 2011 Lippincott Williams & Wilkins, Inc.


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