Abigail Gilbert, MD, on Knee OA Management and Functional Performance Measures

In this podcast, Abigail Gilbert, MD, discusses pharmacologic and behavioral interventions for the management of knee osteoarthritis, as well as findings from her recent study on gait speed among adults with knee osteoarthritis. 

Additional Resources:

• Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2020;72(2):149-162. doi:10.1002/acr.24131
• Gilbert AL, Song J, Cella D, Chang RW, Dunlop DD. What is an important difference in gait speed in adults with knee osteoarthritis? Arthritis Care Res. Published online January 31, 2020. doi:10.1002/acr.24159

Abigail Gilbert, MD, is an assistant professor in the UNC School of Medicine, and a rheumatologist and faculty member in the UNC Thurston Arthritis Research Center in Chapel Hill, North Carolina.

TRANSCRIPT:

Christina Vogt: Hello everyone, and welcome back to another podcast! I’m Christina Vogt, associate editor for the Consultant360 Specialty Network. I’m joined by Dr Abigail Gilbert, who is an assistant professor in the UNC School of Medicine, and a rheumatologist and faculty member in the UNC Thurston Arthritis Research Center. Thank you for joining me today, Dr Gilbert. Today, we’ll be discussing the management of knee osteoarthritis, as well as findings from her recent study, “What is an important difference in gait speed in adults with knee osteoarthritis?” So, Dr Gilbert, could you discuss the overall management of knee osteoarthritis? Dr. Abigail Gilbert: The American College of Rheumatology just released new guidelines this February for management of hip, knee, and hand osteoarthritis to guide clinicians in choosing from available treatments. Management for an individual with the osteoarthritis can include a combination of educational, behavioral, psychosocial, and physical Interventions. We know that exercise, weight loss, and self-management programs have been shown to be helpful for individuals with knee osteoarthritis. Some pharmacologic therapies can be helpful, including topical, oral, or intra-articular medications. Topical NSAIDs are a good first choice for individuals with knee OA, as there's minimal systemic absorption-limiting side effects. Oral NSAIDs are frequently used when comorbidities do not prevent their use. You can also try Tylenol and Cymbalta, though there is less evidence for their benefit. Steroid injections are the next step when oral and topical medications are not sufficient. We also know there are a lot of medicines that don't work–for example, methotrexate, TNF inhibitors, and bisphosphonates. Hyaluronic acid injections don't seem to help that much and are generally not recommended, though frequently used. Patients with knee OA have high rates of medical comorbidities as well, including obesity, hypertension, diabetes, and cardiovascular disease. Additionally, mood disorders including depression, anxiety, and impaired sleep are very common. It's important for a patient to be seen by a primary care provider, who can focus on all his or her medical problems that contribute to worse health outcomes, and to improve quality of life. Often the behavioral recommendations for osteoarthritis–for example, physical activity and weight loss–benefit comorbidities as well. We know the best interventions for OA are really focused on physical activity, physical therapy, and exercises and weight loss. There's a lot of benefit to even small amounts of physical activity to help individuals have improved outcomes and feel better. Christina Vogt: What is a functional performance measure, and why are they important in people with osteoarthritis? Dr Gilbert: Individuals with knee OA are high risk for developing reduced physical function and disability, jeopardizing an individual’s ability to continue to live independently. A functional performance measure is a standardized evaluation of physical function–for example, how fast someone can walk, or how long it takes to stand up from a chair. These standardized measures are frequently evaluated in clinical and epidemiologic studies. Christina Vogt: Could you briefly discuss findings from your study on gait speed in osteoarthritis? Dr Gilbert: The study provides estimates of the important differences in gait speed among adults with knee osteoarthritis for the 20-meter walk and for the 400-meter walk. Prior studies have investigated important differences of functional performance measures such as gait speed among older adults in the general population. This is the first article to look at important differences in gait speed among individuals with rheumatic disease, who may have pain and stiffness that interferes with function. We used data from the Osteoarthritis Initiative (OAI), a multicenter prospective natural history study that investigated the development and progression of knee osteoarthritis. The OAI almost 5000 men and women between the ages of 45 and 79 years of age, all of whom had or were at high risk of developing symptomatic radiographic knee OA. We use different statistical approaches to estimate meaningful differences in functional performance among people with radiographic knee OA, using the 20-meter and the 400-meter walk tests. The important difference in gait speed was somewhere between 3 and 7 meters per minute. Christina Vogt: What key takeaways do you hope to leave with rheumatologists on this topic? Dr Gilbert: The findings from this study provides benchmarks for assessing and understanding functional performance outcomes, not just gait speed, among individuals with knee OA. These important differences can be used as references to design future studies to assess function in individuals with arthritis. This allows us to better understand the significance of results in future studies. We're still working to find the best ways to help individuals with knee OA have better function and less disability. Knowing how to measure differences will help us understand which populations are at higher risk for disability, so we can target them with interventions, and understanding if results of an intervention or meaningful, which will allow us to refine our interventions. Christina Vogt: Thanks again for joining me today, Dr Gilbert. For more podcasts like this, visit Consultant360.com.