From the Guidelines
For a 67-year-old patient with asthma and a BMI of 27 recently diagnosed with osteoarthritis in the right hip, the initial treatments that should be discussed include application of heat and/or cold to the hip joint, benefit of weight loss, and initiating oral nonsteroidal anti-inflammatory drug (NSAID) therapy with caution due to asthma. The patient's healthcare provider should consider the following options:
- Application of heat and/or cold to the hip joint to help manage pain and stiffness, as recommended by various guidelines 1.
- Benefit of weight loss, as even modest weight loss can reduce joint stress and improve symptoms, with studies showing that weight loss of 5-10% can lead to significant improvements in osteoarthritis symptoms 1.
- Initiating oral nonsteroidal anti-inflammatory drug (NSAID) therapy, but with caution due to the patient's asthma, as NSAIDs can exacerbate asthma in some individuals 1. Other options that may be considered include:
- Enrollment in a Tai Chi class, which has been shown to be beneficial for patients with knee and/or hip osteoarthritis, improving strength, balance, and fall prevention, as well as reducing depression and improving self-efficacy 1.
- Reevaluation of asthma medication currently prescribed, to ensure that the patient's asthma is well-controlled and to minimize potential interactions with osteoarthritis treatments 1. It is essential to prioritize the patient's safety and well-being, considering their existing conditions and potential interactions between treatments, as recommended by the 2020 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip & Knee Osteoarthritis 1.
From the Research
Initial Treatments for Osteoarthritis
The healthcare provider may discuss the following initial treatments with the patient:
- Application of heat and/or cold to the hip joint: According to 2, heat and cold therapy modalities can be used to facilitate pain reduction and promotion of healing in musculoskeletal injury, including osteoarthritis.
- Benefit of weight loss: Although there is no direct evidence in the provided studies, weight loss is often recommended for patients with osteoarthritis, especially those with a high body mass index (BMI) like the patient in question (BMI of 27).
- Enrollment in a Tai Chi class: Studies such as 3, 4, 5, and 6 suggest that Tai Chi can be beneficial for patients with osteoarthritis, improving symptoms such as pain, physical function, and stiffness.
- Initiating oral nonsteroidal anti-inflammatory drug (NSAID) therapy: While not directly mentioned in the provided studies, NSAIDs are commonly used to manage pain and inflammation in osteoarthritis.
- Reevaluation of asthma medication currently prescribed: Although not directly related to osteoarthritis treatment, the patient's asthma medication may need to be reevaluated in consideration of potential interactions with other medications or treatments for osteoarthritis, as mentioned in the patient's history.