Aug 172017

BJH SCN Seeks Pathway to Better Care for Obese Patients with Osteoarthritis

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Ania Kania-Richmond

Alberta’s first workshop on how to improve care for osteoarthritis sufferers who have the added burden of being obese revealed that patients and their care providers need new evidence-informed guidance.

“What we heard over the course of two days is that we need to shift patient perception of the role of surgery, adapt OA treatment strategies to reflect the unique needs of obese patients, and develop provincial-level treatment guidance for surgeons,” Dr. Ania Kania-Richmond, Assistant Scientific Director, Bone and Joint Health Strategic Clinical Network (BJH SCN), said.

This advice came from orthopaedic and bariatric surgeons, family doctors, dieticians, occupational therapists, physiotherapists, researchers and, importantly, patients themselves who attended the June 13-14 workshop organized by Dr. Kania-Richmond and Dr. David Hart, the BJH SCN’s Scientific Director. The attendance reflected the rapidly growing rate of obesity and OA in the population and the dearth of evidence-informed knowledge about treating patients who have both conditions.

“There is little knowledge about how the two conditions interact,” Dr. Kania-Richmond said. “Our strategy was to bring together people who have knowledge of OA and people who have knowledge of obesity and get them to interface.”

The workshop was especially relevant to Alberta Bone and Joint Health Institute (ABJHI), which has for several years been measuring outcomes of obese Albertans with OA who have had hip or knee replacement. Last year, ABJHI established a Music in Motion postdoctoral fellowship to study the effects of obesity on hip and knee OA and on the outcomes of patients who have these joints replaced. Postdoctoral fellow Behnam Sharif presented some of his research at the workshop.

“One of the main issues that emerged was patient perception of surgery as the only viable option for someone with OA and obesity,” Dr. Hart said. “We need to help patients understand and appreciate the non-surgical strategies available to alleviate joint pain and stiffness and help them lose weight. And we need to communicate when surgery is appropriate and what it can realistically do.

“Surgeons are saying they need evidence-based guidance for treating obese patients who have OA,” he added. “We have a framework for OA care in Alberta. But we haven’t yet adapted this framework for obesity.”

Dr. Kania-Richmond said the workshop was a starting point for a pathway forward. “We started to frame this out as a responsibility shared by patients and their families, the health care system, government and researchers. We all have a vested interest and a role. The next step toward that pathway is to identify action teams that can tackle the issues that emerged in the workshop.”

Seven research projects were presented at the BJH SCN’s workshop by graduate students interested in the link between OA and obesity and improving care for people who have the two conditions. The following were selected as prize-winning poster presentations:

  • First prize of $300 to Nicole Thompson, Christopher Hewison and Kirsten Barton. They proposed devising a screening tool clinicians can use to increase their patients’ willingness to make lifestyle changes that will reduce their risk of complications.
  • Second prize of $200 to Kristine Godziuk. She proposed two studies. The first would test methods of assessing knee replacement patients for sarcopenic obesity, a condition of low muscle mass and high fat mass, which can increase surgical risk and slow recovery. The second study would compare post-surgery outcomes of patients with sarcopenic obesity with patients who do not have the condition.
  • Two proposals tied for third prize of $100 each. Kelsey Collins’ research project found whole-body inflammation in rats with diet-induced obesity may play a role in shoulder and knee joint damage. Jaqueline Lourdes Rios’ research suggested exercise and fibre supplementation together can delay or may even prevent OA in the knees of obese rats.
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