Half of opioid prescriptions made today are not aligned with treatment guidelines, say researchers reporting this weekend in Toronto at the Osteoarthritis Research Society International (OARSI) World Congress on Osteoarthritis. In this slideshow, we highlight this and other presentations made at the meeting on Friday.
Half of opioid prescriptions made today are not aligned with treatment guidelines, say researchers reporting this weekend in Toronto at the Osteoarthritis Research Society International (OARSI) World Congress on Osteoarthritis. In this slideshow, we highlight this and other presentations made at the meeting on Friday.Â Â Â
Most Opioid Prescriptions not Aligned with Treatment Guidelines: Jonas Bloch Thorlund of the University of Southern Denmark reported that “half of opioids dispensed to patients with a new knee or hip osteoarthritis diagnosis are inappropriate according to current treatment guidelines.” In a review of a healthcare registry database, Dr. Thorlund and colleagues found that 50 percent of opioids prescribed in the first year of a knee or hip osteoarthritis diagnosis was “inappropriate” based on recommended treatment guidelines. The study included 399,670 knee osteoarthritis patients and 414,216 hip osteoarthritis patients. Kneed osteoarthritis patients were prescribed codeine (42.5 percent), oxycodone (23.9 percent), tramadol (20.6 percent) or morphine (9.7 percent). Hip osteoarthritis patients were prescribed codeine (39.5 percent), oxycodone (25.4 percent), tramadol (20.9 percent) and morphine (11.5 percent). (©LumineImages, AdobeStock)
A Maternal Link to Osteoarthritis: Men and women with a mother or sibling who have osteoarthritis, have an increased risk of osteoarthritis in the hips, knees and hands. The risk is higher in cases in which the mother or sibling has had osteoarthritis of the knee or hip so severe, that it required surgery. “Our findings suggest a stronger role of genetic inheritance from the mother than the father in OA disease etiology, which has not been previously observed in OA research,” wrote researchers who were led by Eirik Weldingh, M.D., University of Oslo. Specifically, clinical and surgical hip osteoarthritis occurred in 16 and 10 percent of patients, respectively, and in 18 and 8 percent, respectively, of the knee. The increased relative risk of surgical hip and knee osteoarthritis was 1.58-1.92. Having a father with osteoarthritis did not increase the risk of osteoarthritis. (©Philip Steury, AdobeStock)
Cane Use Doesn’t Foster the Growth of Bone Marrow Lesions: Australian researchers reporting at the Osteoarthritis Research Society International (OARSI) World Congress on Osteoarthritis held this weekend in Toronto, say that the use of cane by osteoarthritis patients does not worsen or improve medial tibiofemoral bone marrow lesions (BML) in knee osteoarthritis. “We found no evidence of an effect of cane use for approximately 2-3 hours per day over 3 months on medial tibiofemoral BML volume changes, compared to not using any gait aids,” A. Van Ginckel, et al. wrote in the April issue of the journal Osteoarthritis and Cartilage. The findings were presented at OARSI on Friday. Patients with knee osteoarthritis are believed to be at high risk for developing bone marrow lesions, cartilage loss and structural deterioration due to joint loading. But in this study of 78 patients, no such evidence was found. (©Tevalux11, AdobeStock)
Osteoarthritis Pain Relief with Injectable: Flexion Therapeutics, Inc., presented the results of a phase IIIb trial for the extended release injectable, triamcinolone acetonide (Zilretta, Flexion). The study found that 60 percent of osteoarthritis patients demonstrated an analgesic response after two injections with a more than 50 percent improvement in pain, stiffness and function. In a safety study of triamcinolone acetonide for hip osteoarthritis, no new safety concerns were found. The treatment “resulted in lower peak plasma levels and reduced systemic exposure relative to triamcinolone acetonide crystalline suspension, a pattern similarly observed in knee OA.” (©Kikkerdirk, AdobeStock)
Osteoarthritis Persists Despite Visual Evidence: Osteoarthritis of the hands may be more widespread than previously thought, a study presented at OARSI on Friday shows. This was a case control study of 479 patients with interphalangeal osteoarthritis (with a KL score of two in two or more joints), and 479 healthy controls. Researchers found that healthy joints in patients with hand osteoarthritis showed a “significantly narrower JSW (4-10% less)” compared to joints of patients in the control group who did not have osteoarthritis. “We showed that unaffected finger joints in adults with hand OA had significantly narrower joint space on radiographs than joints of healthy controls. This implies a systemic nature of hand OA, in which the patient may have a predisposition for general cartilage loss or thinner cartilage,” researchers stated. The research was presented by I. Onuoha, R. Lu, A. Mathiessen, et al. of Brigham and Women's Hospital in Boston. (©Africa Studio,Shutterstock.com)
30-Day Readmission Rates for Joint Surgery Dips, ED visits Rise: Readmission rates for joint surgery patients are down in Ontario where post-surgery in hospital stays have been shortened, researchers from the Krembil Research Institute in Toronto reported at OARSI on Friday. “However, this decline appears to have been partially offset by the greater number of comorbidities among patients over time and an increase in visits to the ED,” they reported. This was a population-based study based on data collected between 2004 with 22,700 orthopedic surgery cases and 2016 with 41,900 surgeries on record.
Thirty-day hospital readmissions declined from 3.7 percent in 2004 to 2.9 percent in 2016. But, ED visits increased from 11.1 percent in 2004 to 15.5 percent in 2016.
In 2004, 33.1 percent of patients stayed in hospital for two days post-surgery; compared to 58.2 percent in 2016. Men living in rural areas, of older age and who had more comorbidities were significantly more likely to visit the ED post-surgery and be readmitted within 30-days of discharge. Higher income, shorter hospital stays and being discharged home were less likely to visit the ED or be readmitted with complications. (©SuphatthraChina,Shutterstock.com)
The Patient’s Voice in Clinical Practice Informs Policy: Deborah Marshall, Ph.D., of the University of Univ. of Calgary, reported on Friday at OARSI that today in the era of “shared decision making” and “patient-centered care,” patient preferences should be incorporated into clinical practice. She suggested incorporating a survey-based approach. She tested the discrete choice experiment (DCE) which is typically used in healthy policy analyses. The results of such surveys could be used in clinical practice, but also in informing clinical practice guidelines and the regulatory approval process. “Incorporating patients' preferences into treatment recommendations is the next step in guideline development and has been identified as the standard for developing treatment recommendations,” she wrote in the conference abstract. (©AdobeStock_Chinnapong)