Patient Care

• List the joints most commonly involved in primary osteoarthritis (OA) and compare the joint distribution with that of rheumatoid arthritis (RA)
• List commonly described features of the pain associated with OA
• Review the physical exam changes characteristic of OA and be able to identify these changes on patient examination (1, 2, 3)
• Recognize the classification criteria for OA of the hand, hip, and knee
• Identify the radiographic findings which are characteristic of OA (1, 2, 3)
• Summarize the results of blood and joint fluid analysis typical of OA and contrast with that expected with an inflammatory joint process
• Review and demonstrate appropriate utilization of the pharmacological treatment options (see links: 1, 2) for OA. Recognize oral therapies (acetaminophen, non-steroidal anti-inflammatory agents, and analgesics/narcotics), topical agents, and inter-articular options and include a discussion of the appropriate indications, anticipated benefit, cost, and potential risks associated with each agent
• Locate and employ a patient narcotic use contract
• Review and demonstrate appropriate utilization of non-pharmacological therapies, including patient education, exercise, physical therapy, occupational therapy, and prosthetics
• Identify the indications and options for the surgical interventions commonly employed including joint replacement

• Review the cartilage changes which occur in OA (see images: 1, 2, 3)
• Describe the epidemiology of OA Distinguish localized and generalized OA
• Review the common risk factors for the development of primary OA
• Identify and review conditions and disorders associated with secondary OA [including, but not limited to trauma, avascular necrosis, chondrocalcinosis (see images: 1, 2), hemochromatosis (see images: 1, 2), and acromegaly (see images: 1, 2)], and identify any differences in joint disease distribution which may be characteristic of each condition
• Review inflammatory (erosive) OA and describe its characteristic findings (see images: 1, 2)
• Review diffuse idiopathic skeletal hyperostosis (DISH) as a distinct subset of OA (see images: 1, 2, 3)

• Explain the diagnosis and the anticipated course of the disease in a way that incorporates patients' perspectives.
• Provide reassurance regarding long term outcomes and help establish practical, patient-oriented long-term goals.
• Advise on the choices of therapy and the rationale for each, including the potential risks and benefits.
• Review life style modification which may provide long term benefit.
• Acknowledge and include family and social support as designated by the patient.
• Provide reassurance and adequate time and accessibility to address patient concerns.

• Display integrity and honesty in discussing patient care issues and management
• Ensure patient privacy
• Promote patient autonomy in clinical and therapeutic decisions
• Communicate in a timely fashion regarding study results
• Communicate in a timely fashion with the other members of the patient's health care team including the primary care physician
• Serve as the patient's advocate

Practice-Based Learning

• Utilize web-based resources to supplement and update current knowledge base and to explore patient-specific problems
• Incorporate evaluation and feedback into practice and management
• Utilize errors and complications to improve understanding and future management
• Set learning goals in diagnostic strategies and management of OA

• Identify barriers to accessing optimal medical care for each individual patient and utilize alternative resources when available to overcome these barriers
• Engage and incorporate the input of all medical providers including other physicians, the nursing staff, and physical and occupational therapists as necessary
• Serve as a source of learning and education for other members of the health care team for the patient
• Utilize the existing health care system to support established patient care goals
• Incorporate considerations of cost and risk-to-benefit ratios in clinical evaluations, monitoring and therapeutic decisions for individual patients
• Recognize the impact of both diagnostic and therapeutic interventions on the health care system locally and globally