Osteoarthritis: an alert study on the lack of progress in patient care

in collaboration with

Dr Laurent Grange (Rheumatologist)

In 2013, the French association for the fight against rheumatism (AFLAR) and the Arthrosis Foundation carried out the survey Stop-Arthrosis, to assess the impact of osteoarthritis on the quality of life of patients and their needs and expectations in terms of care. Six years later, they did it again with Stop-Arthrosis II, the results of which were published on January 11, 2022. This study was conducted with 3,400 French and Belgian patients.

And the conclusion is clear: the 2019-2021 study “gives a photograph almost identical to that of 2013, can we read in the summary. There is little or no improvement on all the items. In addition to pain, which concerns almost 9 out of 10 patients, fatigue is a concern for 1 in 2 osteoarthritis patients. Osteoarthritis also interferes with sleep in 68% of patients. The impact on social life remains very significant: leisure (78%), family life (62%), professional life (44%), couple life (25%) with consequences for sexual life for 32% of respondents. And we should not underestimate the poor self-image that affects 64% of osteoarthritis patients.” A finding “hopeless” according to Doctor Laurent Grange, rheumatologist and president of AFLAR, who tells us more about the reasons for this “immobility” in the management of osteoarthritis patients.

Doctissimo: What are the main takeaways from this new study?

Dr Laurent Grange, rheumatologist and president of AFLAR: When we compare it to the first study we did in 2013 (the same questionnaire was asked), we observe thatthere is no significant improvement in the management of osteoarthritis in France, which is a bit hopeless since in other pathologies, there have been quite a few improvements at this level. Obviously, in osteoarthritis, we find almost figure for figure the same results, the same expectations, the same needs, particularly in terms of pain management: 90% of patients say they are poorly managed in terms of pain.

Osteoarthritis is very common: it affects 17% of the French population, or 10 million French people, with 6 to 7 million symptomatic people. It is therefore not considered a real disease, but rather like the wrinkles of the joints: we say to ourselves that it is due to aging and that there is nothing to be done. But in reality, osteoarthritis does not only affect the elderly: it also affects active people who work. More than 40% of respondents in 2021 say that the disease has an impact on their professional activity, for example.

Why is there no improvement in the management of this disease?

First, since it is not considered a real disease, there is probably a problem of initial and secondary training on the management of osteoarthritis in France. You should know that there were no official pharmacological recommendations from learned societies until two years ago, and the non-pharmacological recommendations only came out last December. Then, when we look at the budgetary volume allocated to research for osteoarthritis, it is very low compared to other pathologies. This does not mean that we must stop research on other pathologies, but in my opinion we must focus on osteoarthritis so that we can find molecules that can stop its development. At the moment, we don’t have any. So all of that means it’s not getting any better.

Today, what is the management of osteoarthritis?

The management of osteoarthritis is first non-pharmacological. The first treatment is physical activity and muscle building. It’s a bit crude to say that, but it’s the reality. The muscles will protect the joints, especially at the level of the knee: for example, if we strengthen the quadriceps (the muscle above the knee), we will significantly improve our quality of life. Walking 6,000 steps a day is enough to improve patients. It is simply necessary that the physical activity is adapted: according to the type of osteoarthritis, the stage of the osteoarthritis… We also know that being overweight is a major provider of osteoarthritis, both by the mechanical stresses exerted on the joints, but also by the production of substances in the blood that will promote osteoarthritis (adipokines). Lose 5-10% of your weight can improve their quality of life by 25%. The Spa treatment also has an interest: lots of studies show that in the year following a spa treatment, there is a decrease in the use of analgesics and anti-inflammatories because the patients are better. Then there are all the technical aids : knee pads, rest orthoses, functional orthoses, which will help the resumption of physical activity, which will relieve the joints. There are also canes, which suffer from prejudices, but which help well to walk. And then there are all the heating devices, which have an analgesic effect.

And what about pharmacological management?

First there are the painkillers and the nonsteroidal anti-inflammatory drugs (NSAIDs), which relieve inflammation. Then there are the slow-acting symptomatic anti-osteoarthritis drugs (AASAL), which were delisted a few years ago but which are maintained in the recommendations for the management of osteoarthritis because there are studies that show a certain effectiveness of these drugs. There are also the local topicals : anti-inflammatory dressings, ointments, in particular based on capsaicin, a pepper extract which has an analgesic effect. If you are still in pain, you can take weak opioids, such as tramadol. The strong opioids are only reserved for osteoarthritis that has a contraindication to surgery. And finally there are the local treatments, such as cortisone injections when there are inflammatory flare-ups in the joints and viscosupplementation of hyaluronic acid, which will improve patients over time. Patients also use a lot of food supplements based on turmeric, harpagophytum, etc., to relieve them.

Is this support effective?

The received idea that circulates frequently, especially among general practitioners, is that in osteoarthritis, there is nothing to do. It’s true that we don’t have a lot ofevidence-based medicine (evidence-based medicine, Editor’s note) to say that these different methods work. But for some patients, it works, and it is by combining several methods that we will significantly improve their quality of life. The message to convey is thattalk to your doctor or pharmacist, because even plants can be toxic and can interact with treatments. And therapeutic education, information are important : patients, if they know their disease and its treatments better, are better taken care of. All the studies show that it works very well.

What are the areas for improvement in the management of osteoarthritis?

For me and for AFLAR, we must first promote and improve the training of health professionals : general practitioners, physiotherapists, occupational therapists, etc. There is a major issue because general practitioners manage the majority of osteoarthritis patients (70 to 80%). Then you have to improve patient information, because if we provide them with the information, they will be able to find solutions. Finally, it is necessary promote research. We need to have new molecules available. And other solutions seem interesting in the future, such as stem cell transplants, modulation of the intestinal microbiota…

What is the message to convey today according to you?

The main message is that osteoarthritis is not a fatality. There are things to do. Find out. Contact your doctor, or even consult a rheumatologist via your general practitioner, respecting the patient journey, but you should not stay in your corner suffering.