Safely Managing Acute Osteoarthritis in the Emergency Department

An Evidence-Based Review

Scott E. Young, DO, CAQSM; Jason D. Bothwell, MD; Ryan M. Walsh, MD

Disclosures

J Emerg Med. 2016;51(6):648-657. 

In This Article

Abstract and Introduction

Abstract

Background: Joint pain caused by acute osteoarthritis (OA) is a common finding in the emergency department. Patients with OA often have debilitating pain that limits their function and ability to complete their activities of daily living. In addition, OA has been associated with a high percentage of arthritis-related hospital admissions and an increased risk of all-cause mortality. Safely managing OA symptoms in these patients can present many challenges to the emergency provider.

Objectives: We review the risks and benefits of available treatment options for acute OA-related pain in the emergency department. In addition, evidence-based recommendations will be made for safely managing pain and disability associated with OA in patients with comorbidities, including cardiovascular disease, renal insufficiency, and risk factors for gastrointestinal bleeding.

Discussion: Commonly used treatments for OA include acetaminophen, oral nonsteroidal anti-inflammatory drugs, and opioids, each with varying degrees of efficacy and risk depending on the patient's underlying comorbidities. Effective alternative therapies, such as topical preparations, intra-articular corticosteroid injections, bracing, and rehabilitation are likely underused in this setting.

Conclusions: Emergency providers should be aware of the risks and benefits of all treatment options available for acute OA pain, including oral medications, topical preparations, corticosteroid injections, bracing, and physical therapy.

Introduction

Osteoarthritis (OA) is a common problem, the incidence of which is increasing every day.[1] By 2030, as much as 25% of the adult population is expected to have self-reported or physician-diagnosed arthritis.[2] The prevalence of OA in the ambulatory care setting is approximately 3500 per 100,000 visits, where patients present most commonly with pain related to their knee, hip, and shoulder OA.[3] The primary objective of the emergency provider is to rule out critical diagnoses, such as septic arthritis, fractures, and dislocations. Once this has been accomplished, however, there is still much to be done! Quality of life for this population can be dismal because of their pain.[4,5] Beyond that, OA of the knee and hip joints in an ambulating population can predispose them to falls, potentially leading to intracranial hemorrhage, fractures, and other emergency conditions.[6–8] How is pain and disability best managed in patients presenting with an acute exacerbation of their OA from the perspective of the emergency clinician?

This article will provide evidence-based recommendations to help relieve pain and suffering, minimize disability, and prevent future injury in patients presenting to the emergency department (ED) with an acute exacerbation of OA.

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