When the cartilage in their knees begins to deteriorate and osteoarthritis sets in, patients have a number of treatment options for this painful but common condition. Doctors can prescribe glucosamine tablets, weight loss plans, or even acupuncture to help lessen the pain.
The challenge is in knowing what will work best for each patient. This question, and the condition of knee osteoarthritis in general, is becoming pressing enough that a federal agency has started conducting continuous reviews of medical literature related to the condition, a process it follows for just two other health issues. The other two are autism and venous thromboembolism, or blood clots.
“A lot of people have osteoarthritis,” said Stephanie Chang, director of the Agency for Healthcare Research and Quality's Evidence-Based Practice Centers (EPC) program, which is overseeing the review. Yet the plethora of treatments for the condition can be confusing and the data might not be readily available.
“There is a lot of new research going on, and new developments,” Chang added.
The EPC published a call Thursday for the public to submit supplemental evidence and data as part of its systematic review of existing literature on treatments for knee osteoarthritis. The compilation is supposed to help inform doctors and clinicians of which treatments work well—or don't—and for which patients. Sex, severity of disease, weight, baseline fitness and comorbidities are just a few of the factors that can influence the effectiveness of a treatment.
By the time they reach the age of 85, nearly half of Americans have likely developed knee osteoarthritis, the Centers for Disease Control and Prevention estimates. But the condition cannot be shrugged off simply as “bad knees” or as an inevitability of aging.
Two-thirds of people with obesity—more than a third of American adults are classified as being obese, according to their body mass index—might develop symptoms of knee osteoarthritis. Trauma and disease can also bring on secondary osteoarthritis. In 2013, osteoarthritis ranked among the five most expensive medical conditions in the U.S. It was also the most costly condition billed to private insurers.
The number of patients with knee osteoarthritis rose the past two decades, and so did the proportion of them who want treatment, said David Jevsevar, an orthopedic surgeon who is chair of the research council for the American Academy of Orthopedic Surgeons. Still, many questions remain about what works for a specific patient.
“We have lots of treatments, but the reality is that what you're really trying to do is match the treatment as best you can with the patient you're dealing with," Jevsevar said. Some patients have osteoarthritis that an X-ray indicates would be excruciating, yet they report minimal pain. For other patients, the opposite holds true, he said.
The continuous systematic review of the literature on treatments of osteoarthritis of the knee— this means that every year and a half, it will be updated—came about as a result of popular demand, according to the AHRQ.
“We picked a review that we'd done previously that was of high interest to many people,” said Chang, adding, “Whether or not there's information out there to answer the question, that's a different question.”
In compiling its update, the EPC scours existing published medical literature using manual and electronic database searches. It also solicits information and scientific studies, published or not, from the public.
Knowing how to tailor treatments to the patient is increasingly applicable given demographic shifts and prevailing health trends. “The aging of the baby boomer population, along with the increased incidence and prevalence of obesity have increased the risk for this condition, all representing an increasing strain on Medicare resources,” AHRQ notes in the background for its systematic review.
As doctors attempt to treat more knee osteoarthritis cases, they will benefit from AHRQ's regular reviews of medical literature, where all the information they're looking for is gathered in one place, Jevsevar said.
“It's hard to get that level of data that's gone through that rigorous of an analysis if you were to do it individually on your own,” he added.