Arthritis

Arthritis poses significant challenges in post-acute and long-term care (PALTC) settings, given its prevalence among older adults. In addition to causing pain and physical limitations, arthritis can also considerably disrupt one’s overall quality of life.

Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common subtypes clinicians encounter in PALTC. OA, a degenerative joint disease, results primarily from wear and tear of the cartilage and often affects weight-bearing joints such as the knees, hips, and lower back. RA, an autoimmune disorder, leads to inflammation of the synovial membrane and can affect multiple joints.

Management of arthritis in PALTC environments requires an integrative approach. For OA, the first line of intervention hinges on non-pharmacological strategies such as weight reduction, physical therapy focusing on joint mobility and muscle strengthening, and occupational therapy to teach joint protection techniques. Pharmacologically, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays, though caution is exercised in older adults given the gastrointestinal, renal, and cardiac side effects of NSAIDs. Intra-articular corticosteroid or hyaluronic acid injections can provide relief for specific joints.

RA management is more intensive. Disease-modifying antirheumatic drugs (DMARDs) like methotrexate are foundational. More recently, biological DMARDs targeting specific immune mediators, such as TNF-α inhibitors, have revolutionized RA treatment, though their use in older adults requires a risk-benefit assessment, especially considering infection risks. Glucocorticoids, while effective, are used judiciously given their adverse effect profile.

It is paramount to assess and manage arthritis pain effectively, leveraging both pharmacological and non-pharmacological strategies, and ensuring a multidimensional approach that covers physical, psychological, and social aspects.