and

present

Non-pharmacological treatmentsNon-pharmacological treatmentsfor osteoarthritisfor osteoarthritis

Why use non-pharmacologicaltreatments?

The international recommendations for osteoarthritisof the lower limbs and hands stress the importance of individualised care combining non pharmacological measures with medicinal treatments

Utility: Effects on symptoms and function at least equivalent

to those of medicinal treatments No serious side effects Structural effects not demonstrated as yet

2Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.

What exactly are they?

Patient education

Exercises

Technical aids: insoles, crutches, braces, etc.

Dietary advice

Hydrotherapy

Weight loss, for overweight patients with knee osteoarthritis

3Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53. Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.

Weight loss

Most effective non-pharmacological treatment for knee osteoarthritis

Must be at least 5% of initial weight to be fully effective

Improves function and decreases pain.

Also has cardiovascular benefits, which is important given the high incidence of comorbidities in these patients

4

Treatment education (1)

The aim is to boost autonomy and compliance with osteoarthritis recommendations

Improves treatment management

This is not the same as patient informationand should be planned in several stages

Several healthcare professionals are involved

It is a part of the patient's treatment and must be assessed

5 Beauvais C. Éducation thérapeutique en rhumatologie. Rev Prat Med Gen 2012 ;26 :155-60.

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Treatment education (2)

Main treatment and educational goalsfor osteoarthritis*:

compliance with non-pharmacological treatments

management of pain-relief and analgesics

physical exercise and specific home exercises (compliance, regularity)

weight loss if necessary

7Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.

*Osteoarthritis in the legs and fingers

Lifestyle measures*

Weight loss for overweight patients

Avoid standing for long periods, long walks and carrying heavy loads during painful episodes (relative rest) – “pacing of activities”

Recommend strengthening exercises between flares and regular aerobic activity

Use a walking stick on the contralateral side

Suitable footwear, cushioning soles

8 Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.

* Osteoarthritis of the legs

Endurance-building sports* Type: rapid walking (30 minutes 3 times a week),

exercise bike or exercises in water Improve the aerobic capacity of patients and their quality of life

Help maintain cardiorespiratory function

Have an impact on joint range of motion, strengthen muscles, enhance motor function and improve proprioception and balance disorders

Improve sleep restoration, reduce pain, and improve energyand well-being

9 Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53. Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.

* Osteoarthritis of the legs

Knee osteoarthritis: two types of specific exercises

Muscle strengthening Aimed at the stabilising muscles of the knee:

obviously the quadriceps but also the hamstrings Reduce pain and improve function Static exercises or exercises against gravity,

natural resistance or weightsFor example: ask the patient in a sitting positionto hold their leg out straight (static) or to alternatebending and straightening the knee (dynamic)

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Range of motion Exercises designed to fight knee flexion deformity

Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53. Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.

Patello-femoral osteoarthritis: specific exercises

Isometric rehabilitation of the internal portions of the quadriceps (vastus medialis)

Helps prevent the kneecap from rubbingon the trochlear as a result of subluxation

11Sellam J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.

Knee osteoarthritis: prescriptionfor rehabilitation (example)

12 physiotherapy sessions at a rate of 2 sessions a week

Relaxing massages

Fight against knee flexion deformity

Gentle motor reinforcementof the quadriceps and hamstrings,isometric exercises followedby dynamic exercises

Proprioceptive rehabilitation

Stamina building exercises

Exercises for home use

12Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.

Knee osteoarthritis: sole orthoticsor insoles

Advice on shoes: sports shoes, thick, flexible soles Cushioning soles:

recommended, irrespective of the joint compartment affected(internal or external tibio-femoral, patello-femoral)

can help relieve pain and improve walking custom-made by a podiatrist or purchased from the pharmacy

Sole orthotics: with a posterior-external pronator corner to relieve the internal

compartment (internal tibio-femoral knee osteoarthritis) or a posterior-internal supinator wedge (external tibio-femoral knee

osteoarthritis) decrease pain and NSAID consumption

13Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53. Zhang W, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377-88.

Knee osteoarthritis: Knee orthotics

Flexible, non-adhesive orthoses or elastic knee braces with or without a peripatellar device

Can reduce pain, enhance stability and decreasethe risk of falls

Recommended for young subjects, to allow reintroduction of sports and for all other subjects with a view to delaying the need for joint replacement

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Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53. Zhang W, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377-88.

Hip osteoarthritis: specific exercises

Preserve joint range of motion

Strengthen the hip stabiliser muscles

Prevent angular deformity and loss of back-step function

Reduce pain

15Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.

Finger osteoarthritis:

The following are recommended:

Exercises: to protect the joints, improve mobilityand enhance muscle strength

The application of heat (paraffin, heated dressings, etc.), especially before taking exercise

Braces for osteoarthritis of the carpo-metacarpal jointof the thumb

Orthoses for the prevention and correction of angular deformities during lateral extension and flexion

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Zhang W, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377-88.

Sample prescription for thumb osteoarthritis

Osteoarthritis located between the trapezoid boneand the first metacarpal, most often bilateral

Common (8 to 22% of women), affects more women (80%) than men

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Prescription 1 Increase in range of motion, stretching and self-stretching exercises aimed at the space between the thumb and indexStrengthening of the intrinsic and extrinsic muscles of the hand and thumb-index pincerFunctional exercisesAerobic exercisesHome trainingNo ultrasound, no massage

Prescription 2 Resting splint for the thumb-index pincer to be worn at night

Rannou F, La rhizarthrose. Rev Prat 2012, 62:639.