For some individuals with knee osteoarthritis (OA), their
rheumatologist or family doctor may recommend a knee replacement if other forms
of treatment have not improved the joint’s ability to function or failed to
prevent further joint damage. A knee replacement is a surgical procedure in
which parts of the joint are replaced with artificial material to restore
function and ultimately reduce pain. In some cases, where both knees are
severely affected, patients might consider getting both knees replaced during
the same surgery, a procedure known as a bilateral knee replacement.
A recent story published in MedPage Today, and featured in RheumNow, explored the mixed evidence and experience related to bilateral knee replacement.
The primary advantage to getting a combined surgery is that there
is only one hospital stay and one recovery/rehabilitation period for both
knees. This means less time off work, in pain and needing supportive care. In
addition, the combined procedure often costs less for the patient and the
provider than having them done at different times. In 2016, the Canadian
Institute for Health Information (CIHI) found that the overall cost of the
simultaneous procedure was $20,800 compared to $23,700 for two separate
procedures. In Canada, knee replacement surgery, hospital stay and post-surgery
care (such as physiotherapy) are covered by provincial healthcare plans. Due to
the nature of the healthcare system in the United States, the reduced cost of
surgery can make a significant difference for patients.
Over the last decade, patient-centred care (PCC) has become a focus within rheumatology and in the broader healthcare community. Patient-centred care puts patients and their families at the forefront of the care that they receive. According to the British Columbia Patient-Centred Care Framework, patient-centred care incorporates the following key components:
Shared and informed decision-making;
An enhanced experience of health care;
Improved information and understand; and,
The advancement of prevention and health promotion activities.
This approach emphasizes patient-voice, information sharing and shared decision making – ensuring there is a collaboration between the patient, their family, and their health care provider(s). There should be a balance between the health professional’s knowledge and the patient’s personal knowledge, experiences and preferences. PCC is based around team work rather than a potentially unbalanced healthcare provider-patient relationship. PCC has been shown to increase patient satisfaction, improve self-management, and ultimately lead to better health outcomes. Health authorities, patient advocate groups, and researchers throughout Canada are working to make patient centred care a priority.
There are several challenges to delivering PCC on a systemic level. It requires a significant shift to the way in which the healthcare system operates, and perhaps more importantly, a significant shift in the culture of health care. An effective way of transitioning to PCC is to ensure that the next generation of health professionals have sufficient training in the area. An effective way to achieve this is to have students learn directly from patient advocates and patient educators. In October, the Pharmacy School at the University of British Columbia (UBC) led by example by doing exactly that.
Ask for your rheumatologist’s referral to make an appointment at the clinic!
The recently opened Surrey Inflammatory Arthritis (IA) Clinic is located at the Surrey Memorial Hospital and provides services for people living with inflammatory arthritis. The clinic has therapists (occupational therapy and physical therapy) who are specifically trained to help you manage and treat the physical and mental impacts of rheumatoid arthritis.
Sarah Bryant, an occupational therapist at the Surrey IA Clinic, explains her work relationship with the clinic’s physical therapist: “We work in a transdisciplinary model, which means that we both train each other in the basics of our profession in rheumatology and that if you have something really specific to the discipline, you can see either one of us, as needed.” This transdisciplinary approach eliminates the stress associated with multiple visits to the clinic.
The services provided at the clinic are publicly funded and available for people living with inflammatory arthritis who are:
18 years of age or older
diagnosed with rheumatoid arthritis within the last two years
living in the Fraser Health region
have a rheumatologist’s referral to the Surrey IA Clinic
This video provides general information about what you should expect when you visit an occupational or physical therapist at the Surrey IA Clinic. For more information about the clinic or to schedule an appointment, please call 604-585-5666 (extension 778778).
To subscribers who live outside of British Columbia:
ACE is sharing the latest research news from this year’s European League Against Arthritis’ (EULAR) Annual European Congress of Rheumatology in Amsterdam, Netherlands.
ACE is attending this year’s annual meeting of the European League Against Arthritis (EULAR) in Amsterdam, which will be host to 14,000 participants from more than 120 countries in Europe and around the world. This year, EULAR received more than 5,050 research abstracts – the most ever. The meeting will feature over 175 sessions and 45 themed poster tours with more than 560 speakers showcasing work from 2,256 poster displays. ACE is here to learn the most current information on the impact, burden and cost of arthritis for patients and society, and the improved ability to diagnose and treat different types of arthritis early.
Many of these advances are the product of collaboration between healthcare providers and patients and patient organizations like ACE. We will be reporting over the next few days on how this collaboration is advancing models of care and development of advanced therapies.
ACE is also leading a meeting with members of the Global RA Network who are attending EULAR. At the meeting, ACE will facilitate discussion on the development of tools for Global RA Network members to use in their countries to raise awareness and advocate for improved models of care. Based on the 2017 Global RA survey findings, ACE is proposing to develop tools that will improve RA patients’ understanding about the kind and quality of care they should be receiving in their country to improve their disease and overall health.
We had the privilege of chatting with Social Scientist Dr. Laura Nimmon at the Canadian Rheumatology Association (CRA) Annual Scientific Meeting and Arthritis Health Professions Association (AHPA) last month. Laura is an assistant professor in the Department of Occupational Science and Occupational Therapy, as well as a scientist at the Centre for Health Education Scholarship at the University of British Columbia. Laura shared her time with #CRArthritis and sat down with us to answer some questions we had. As patients, we find her research meaningful, and we think you will too! Below are some highlights of the in person interview.
What is a social scientist and what do they do?
Social science is a broad field but can generally be categorized by the study of human society and social relationships. Social scientists aim to understand how our society works and will often use the information they gather to create or promote change within the society.
As a social scientist, how did you become involved in rheumatology?
I entered into the field of rheumatology by being awarded The Arthritis Society Young Investigator Salary Award, which gave me an opportunity to do research in the area. My focus is on teamwork. I look at how healthcare teams coordinate patient centred care and some of the tensions and social dynamics that exist in these interactions. I am conducting this research alongside an incredible team of colleagues consisting of health professionals and patient partners; it is a wonderful combination of minds with different experiences and backgrounds.
Could you share with us the key messages from your presentation at the conference?
Massage therapy for arthritis is conducted by a licensed massage therapist or physiotherapist. After consulting with your specialist, you can do self-massages at home. In a research study, Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, found that regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand grip strength and overall functions of the joints.
In another study, Field and her team found that massage also benefits people with painful hand or wrist arthritis. There were twenty-two adults, mostly women, in this study. The women have been diagnosed with either hand or wrist arthritis. Each participant was given four weekly massages from a therapist and taught to do their own massage to alleviate joint pain and soreness at home. Field concluded: “Just a 15-minute, moderate pressure massage per day, led to reduced pain and anxiety, and increased grip strength for the participants as measured on comparative pre- and post-therapy tests.”
Do you have moderate to severe plaque psoriasis or care for someone who does? We need your valuable input.
The Common Drug Review (CDR) is currently welcoming patients and their caregivers to provide input to patient organizations on the manufacturer’s submission for guselkumab for the treatment of moderate to severe plaque psoriasis.
Guselkumab belongs to the biologic response modifier class of inflammatory arthritis medications. It works by blocking the interleukin (IL)-23 molecule, a cytokine that plays a key role in plaque psoriasis.
The CDR is part of the Canadian Agency for Drugs and Technologies in Health (CADTH). The CDR conducts objective, rigorous reviews of the clinical and cost effectiveness of drugs, and provides formulary listing recommendations to the publicly funded drug plans in Canada (except Quebec).
To help them make their recommendations, the CDR accepts input from patient organizations and groups, like Arthritis Consumer Experts (ACE). Because patient input is vitally important to government decision-making about public reimbursement of medications, we would like to gather your views and share them with the CDR.
The College of Family Physicians of Canada (CFPC), the Arthritis Alliance of Canada (AAC), and the Centre for Effective Practice (CEP) have joined forces to develop the Osteoarthritis (OA) Tool to help family physicians and other health care providers understand that osteoarthritis is a common, treatable, chronic illness by providing a tool that helps providers:
Identify, assess, and monitor OA
Equip patients for high quality self-management
Recommend specific non-pharmacologic and pharmacologic therapies
We encourage you to raise your voice to support this important initiative by:
Posting to Twitter using the hashtag #OATool
Promoting this initiative in your professional networks, such as LinkedIn, using the hashtag #OATool
ACE is attending this year’s European League Against Rheumatism (EULAR) annual congress in Madrid. The city is currently experiencing above normal temperatures with highs near 40°C and the rheumatology topics inside the convention centre are equally hot. Our first dispatch from the meeting looks at the launch of the “Don’t Delay, Connect Today” early intervention campaign. At a joint session for patients, clinicians, and health professionals, attendees heard how all three groups can contribute to the early diagnosis and treatment of rheumatic diseases.
Commenting on the campaign, Cheryl Koehn, ACE President said: “This campaign, by our colleagues in the European Union, neatly parallels the work the arthritis community in Canada has undertaken through the models care initiatives of the Arthritis Alliance of Canada where we define early identification of inflammatory arthritis and access to care as a key element.”
The EULAR campaign will encourage patients with typical arthritis symptoms to take action and consult their doctors as soon as possible.
At a presentation on the campaign, John Church, CEO of Arthritis Ireland, explained: “With the development of powerful biologic medications, improvements in care pathways for patients and very effective self-care options, early diagnosis and intervention can lead to significant improvement in lifestyle, physical movements, increased well-being, and work force participation.”
Findings from a recent study published in the European Journal of Pharmacology may explain why Raynaud’s is more common in women of childbearing age. The study examined the relationship between palm blood flow and estrogen in mice. According to researchers, “estrogen may contribute to the development of Raynaud’s phenomenon in women”.
Estrogen is a one of two main sex hormones that women have. It is responsible for female physical features and reproduction. Estrogen creates the changes common in puberty, such as growth of the breasts, hair in the pubic area and under the arms and the beginning of menstruation. The hormone helps control the menstrual cycle, protect bone health and keep cholesterol in control. Below is a helpful infographic Hormone Health Network to help you understand what estrogen is.