An official health care protocol coordinates all healthcare professionals involved in treating a patient's condition to ensure the best possible care. This document discusses the protocol for treating osteoarthritis patients. It involves general practitioners overseeing care and referring patients to specialists like rheumatologists or orthopedic surgeons as needed. The protocol's goals are to relieve joint stiffness and pain, encourage exercise and weight control, and consider surgery when joints are severely damaged. A multidisciplinary team including physiotherapists and dieticians helps patients manage their osteoarthritis.

1. and
present
Osteoarthritis official healthOsteoarthritis official health
care protocolcare protocol

2. What is an official health care protocol?
 A health care protocol is designed to coordinate all the healthcare
professionals involved in the provision of care for a patient to ensure
that patients receive the best possible treatment for their specific
condition.
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• Avenir de l’Assurance Maladie: les options du Haut Conseil pour l’Avenir de l’Assurance Maladie (HCAAM)
http://www.securite-sociale.fr/IMG/pdf/l_avenir_de_l_assurance_maladie_les_options_du_hcaam.pdf
• Médecine de parcours: un objectif et des enjeux à confirmer. Interview with Denis Piveteau, Chairman of the Haut Conseil pour l’Avenir de l’Assurance
Maladie, Le Concours médical, June 2012 (pages 428-429).
 This type of official protocol is particularly useful for patients with chronic
conditions requiring input from several healthcare professionals:
the patient's GP therefore plays a central, coordinating role.
 Health care protocol efficiency (in other words the best treatment
at the best price) is one of the priority focuses identified by the Haut Conseil
pour l'Avenir de l'Assurance (National Council for the Future
of Healthcare Insurance) and is seen as a means of ensuring the continued
existence of the healthcare system and its founding principles, especially
equality of access to quality care and solidarity between the sick
and the healthy.

3. An example of a condition
that has become chronic
 Type 2 diabetes: the incidence of this disease is rising
rapidly, hand in hand with the number of overweight
and obese patients. However, when properly managed,
many of the complications of type 2 diabetes can
be avoided: myocardial infarction, renal failure, blindness
and amputations, etc.
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Several healthcare professionals with complementary skills
are involved caring for patients with chronic conditions:
this is the patient's health care protocol or pathway.

4. Osteoarthritis is a chronic condition
 As people are living longer and obesity is a growing
problem, the number of patients with osteoarthritis is
continuously rising:
 65% of people aged over 65 have radiological osteoarthritis
 80% of people over the age of 80 have osteoarthritis
 Osteoarthritis has a negative impact on quality of life
and could, in some cases, increase mortality
by augmenting the cardiovascular risk which is at least
partially related to a sedentary lifestyle.
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The management of osteoarthritic patients is more complicated than it
appears. As the population gradually ages and the number of replacement
procedures rises, this disease places a considerable financial burden
on society as a whole.
Société Française de rhumatologie website:
http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.asp

5. The goals of treatment for patients
with osteoarthritis
 Limit joint stiffness.
 Manage pain, while reducing the long-term consumption
of NSAIDs especially.
 Encourage patients to take exercise adapted to their
condition.
 Encourage patients to maintain a healthy bodyweight.
 Have recourse to surgery when necessary.
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Société Française de rhumatologie website:
http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/sommaire-arthrose.asp
ANSM:
http://www.ansm.sante.fr/var/ansm_site/storage/original/application/257d8be960ac8372dbdc513708956d50.pdf
OARSI:
http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf

6. The main healthcare providers involved
The official treatment goals for patients with osteoarthritis clearly list the healthcare professionals
liable to become involved, the first of these being the treating physician, almost always a GP.
Some specialists play an important role in caring for patients with osteoarthritis.
The rheumatologist: for cases that are difficult to manage (refractory pain, extensive joint
damage), the GP may refer the patient to a rheumatologist for needle aspiration followed,
in most cases, by injections of steroids or a hyaluronic acid into the joint space.
An orthopaedic surgeon: when joint replacement or corrective surgery is necessary
(this mainly concerns the hip or knee).
The radiologist: the images obtained are used to diagnose osteoarthritis and assess the extent of
the joint damage.
An endocrinologist to provide support for patients who need to lose weight.
A community pharmacist, who is trained to advise patients who have been officially diagnosed
with a chronic condition.
And various other healthcare professionals, for instance:
A physiotherapist: to teach patients how to move an osteoarthritic joint correctly
and to strengthen the muscles supporting the damaged joint.
A nutritionist or dietician: to help overweight or obese patients.
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7. The GP as coordinator of the health
care protocol
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 All patients must have their own doctor; in most cases this
will be a GP. These doctors know their patients, their
medical history and personal situation (family, social and
working lives) best.
 The GP will refer his/her patients to other healthcare
professionals for treatment (physiotherapist, dietician or
nutritionist, etc.) or a specialist opinion (rheumatologist or
orthopaedic surgeon, etc.)

8. Are tests necessary?
The diagnosis of OA can usually be made on clinical grounds alone.
 The only tests that are essential in patients with osteoarthritis are
those allowing a precise evaluation of the structural condition
of the joints. These are standard x-rays of the joints.
More sophisticated examinations, such as an MRI or CT scan,
are of no use for the diagnosis of osteoarthritis and are not
appropriate.
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 When should these tests be done? Standard x-rays are
essential during the diagnostic work-up and it is rarely
necessary to repeat them unless surgery is being
discussed or rapidly progressing osteoarthritis is
suspected.
Société Française de rhumatologie website:
http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/sommaire-arthrose.asp
 Conversely, no specific blood tests are necessary A CT or MRI scan is rarely
necessary.

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Frontal radiographs of the hips. Right supra-external hip
osteoarthritis (condition); early osteoarthritis on L.

10. Recourse to surgery
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Site de la Société Française de rhumatologie :
http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/sommaire-arthrose.asp
The decision to replace a damaged joint with a prosthetic joint
is no simple matter. It depends on:
The impact of osteoarthritis on the patient's quality of life
Failure to derive sufficient improvement on conservative
management alone
The age of the patient and his or her comorbidities
And indeed, his or her life expectancy
The following are recommended before surgery:
Exercises to "prepare" the muscles, tendons and ligaments
for the roles they will have after the replacement joint
has been inserted; and to reduce joint stiffness to a minimum.
 And, as is the case before any surgical procedure, give up smoking which
reduces the risk of infection and improves the post-operative course.

11. Is hydrotherapy a legitimate part
of the health care protocol for patients
with osteoarthritis?
 A recent study showed that hydrotherapy can
improve the painful symptoms of knee
osteoarthritis .
 Hydrotherapy can be beneficial by giving patients
the chance to recommence appropriate physical
exercise, change their eating habits and lose
some weight within the framework of treatment
education programmes. This is why hydrotherapy
can be useful in the health care protocol
for patients with osteoarthritis.
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