1. A New Vision for Chronic Osteoarthritis Management A Call to Action from the Chronic Osteoarthritis Management Initiative (COAMI) Prepared by the United States Bone and Joint Initiative, NFP

2. What is COAMI?  A Work Group representing:  Health care professionals who treat patients with osteoarthritis (OA)  orthopaedic nurses and surgeons  specialists in rheumatology, rehabilitation and sports medicine  osteopathic physicians  physical therapists  athletic trainers  Providers who may not specialize in OA, but see patients at risk  Pediatricians and pediatric nurses, family physicians, nurse practitioners, physician assistants  Epidemiologists and researchers studying OA

3. The Burden of OA  OA is prevalent  Most common type of arthritis, affecting 27 million Americans (and 10% of adults)  OA is disabling  Significant cause of disability and pain  Interferes with work and activity levels  Undermines physical activity levels recommended for weight loss and controlling other chronic diseases  OA is co-occurring  Over half (52 percent) of patients with diagnosed diabetes also have OA  OA is costly  $42.3 billion spent on 905,000 knee and hip replacements in 2009 alone

4. Missed Opportunities to Approach OA as a Chronic Disease

5. A Vision for the Future Not every case of OA can be prevented, but a significant degree of the pain and disability caused by OA can and should be prevented or ameliorated. Improved Technology to Identify Patients Better Predictors of Who Is at Risk Screening for High-risk Phenotypes Targeted Interventions to Avoid or Delay Joint Damage and/or Death

6.  Treat OA as a chronic disease  Adopt best practices of other successful chronic disease models  Ask patients about joint pain, injury, mobility, and function  Reinforce and support weight management, physical activity, and pain management A Unique Role for Health Care Professionals

7. What Will It Take? COAMI Recommendations 1.Develop an OA Call to Action, specifically geared to health care professionals 2.Convene an OA Management Conference  Identify areas of agreement and gaps  Review models of care  Develop a research agenda and priorities 3.Reach out to other partners to include them in future COAMI work

8. What Will It Take? COAMI Recommendations (Continued) 4.Explore standardizing screening tools and indicators of OA, to make early diagnosis more consistent and likely  E.g., Fracture Risk Assessment Tool (FRAX) model 5.Develop tools and prompts that promote patient engagement in learning about and managing OA (and pre-OA)  E.g., Exercise is Medicine™

9. What Will It Take? COAMI Recommendations (Continued) 6.Lend COAMI’s support to existing advocacy and awareness efforts and seek specific opportunities to reinforce key messages:  OA should be managed as a chronic disease  “Pre-OA” (like pre-diabetes) could be identified and addressed more systematically  Health care providers should support and motivate patients to become more physically active and maintain a healthy weight

10. What Will It Take? COAMI Recommendations (Continued) 7.Develop and support an OA-specific research agenda to fill gaps in evidence and practice  Managing patients with mild to moderate symptoms and limitations  Identifying and tracking OA risk factors (e.g., using Electronic Medical Records)  Educating clinicians about musculoskeletal conditions and OA

11. What’s Our Role?  How can our organization/field/discipline support COAMI’s recommendations?  Which ones are a particularly good fit with our own mission and goals?  What do we bring to the table that’s unique?