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Background
Aches and pains are commonly seen in general practice and osteoarthritis may be an underlying cause. Chronic pain can be very distressing for patients and management may be challenging for the general practitioner. Osteoarthritis is a common cause of chronic pain and disability.
Objective
This article looks at an approach to a patient with chronic aches and pains caused by osteoarthritis.
Discussion
Osteoarthritis is diagnosed clinically. Other causes of joint and bone pain such as inflammatory arthritis and malignancy should be excluded by history, examination and investigations. It is important to assess lifestyle factors, comorbid physical and psychological conditions, and social issues such as isolation and financial stress. Engagement by the GP, along with education, can empower the patient to access the right treatments and reduce pain and disability.
* Musculoskeletal 'aches and pains' are common in general practice.1 When they become chronic, these symptoms can be very distressing for the patient, and management challenging for the general practitioner. Making a definitive diagnosis may be difficult, and evidence based treatment is frequently limited by other considerations such as comorbid disease states, the cost of physical therapies, and the usual challenges associated with lifestyle change such as weight loss.
In 2007, Access Economics estimated that 3.85 million Australians suffer from arthritis.2 Prevalence is increasing, partly due to the aging of the population, but also to the increased prevalence of obesity. Arthritis costs $23.9 billion per year2 and patients, carers and families suffer a significant burden of disease.
Mild and/or acute musculoskeletal 'aches and pains' can often be treated adequately with simple over-the-counter analgesia. Chronic and disabling pain associated with osteoarthritis (OA) requires a shift in focus to longer term strategies for control of the disease. This requires assessment and modification of lifestyle issues, and consideration of longer term pharmacological disease modifying agents. To make this shift, patients such as Claudia need education about the disorder and ongoing support in adopting management.
Assessment
Making the diagnosis
According to Murtagh's diagnostic model,3 the 'probability diagnosis' in Claudia's case is OA. She has a number of risk factors for OA, including age and being female, as well as the recent, repetitive, heavy lifting she was required to do as a carer (Table 1). She also demonstrates the...