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Regular reviews/monitoring for OA?

Megrose489Megrose489 Posts: 734
edited 5. Oct 2015, 18:16 in Living with Arthritis archive
I was prompted by another post to read through the NICE guidelines for OA and was interested to see that the advice is that patients should be regularly seen for a review of their OA to monitor it and to discuss the effectiveness of treatment. It also said that if a patient has OA in more than one joint, they should be seen annually.

Whilst I have an annual general MOT, as I'm over 60, I have never had a regular review for OA and I have it in many joints. The MOT is purely with the nurse who checks blood pressure and takes bloods to check kidney and liver function and cholesterol level. OA has never been mentioned. Do others have regular reviews/monitoring for OA?

Meg

Comments

  • ITLSusanITLSusan Posts: 74
    edited 30. Nov -1, 00:00
    Nothing for me.

    Diagnosed in 2006 - GP arranged the xray, told me the results, asked me if I wanted pain relief and when I said no she said "Come back when you need surgery".

    To be honest I don't have a problem with this. I know what's available on the NHS and none of it was appropriate to me.
  • stickywicketstickywicket Posts: 25,993 ✭✭✭
    edited 30. Nov -1, 00:00
    I've just had my annual RA review - the second in 50 odd years of RA. Apparently it's a new reqirement and both GP and I agreed a complete waste of both our times. I see my rheumatologist regularly, have my bloods conscientiously, make an appointment whenever they ask me to. Maybe some people would welcome this but not me.
    “There is always a well-known solution to every human problem - neat, plausible, and wrong.” H.L. Mencken
  • GraceBGraceB Posts: 1,598
    edited 30. Nov -1, 00:00
    I'm 11+ years into my OA journey and have never had a yearly review with my GP. In fact, all my GP does - and this depends who I can actually get to see on the day I have an issue - is usually to tell me to take more of my meds or refers me to an orthopaedic consultant.

    GP's probably aren't the best people to do this in my view as this needs to be done by an orthopaedic specialist.

    I won't hold my breath waiting to be called into my surgery for this.

    GraceB
    Turn a negative into a positive!
  • ITLSusanITLSusan Posts: 74
    edited 30. Nov -1, 00:00
    My guess is that this is about concern for the people struggling on unnecessarily with pain that could be treated or symptoms that could be helped.

    Some people will go to their doctor if they have a problem but many will just suffer in silence.

    Also, research is constantly uncovering new information. Understanding of OA has changed significantly in the 9 years since I was diagnosed. Mmany people rely totally on what their doc has told them. If someone is diagnosed and never has need to go back to the doc they might be clinging to beliefs that are 10, 20 or more years out of date.

    Maybe more recent research could give people new ways to help themselves? It wasn't long ago that OA was considered 'wear and tear' now the know it's 'wear and REPAIR' that little change in understanding can make a big difference to what a person can do to help themselves. It wasn't long ago that it was thought activity would make worn joints worse - I've even had a physiotherapist tell me that in 2012! So annual reviews are a good way to make sure patient knowledge is up to date.
  • dreamdaisydreamdaisy Posts: 31,567 ✭✭✭
    edited 30. Nov -1, 00:00
    My PsA was regularly reviewed but I think that is due to the nature of the medications involved which are strong beasts. Now I'm lucky if it's once a year but as I know what's what and when to get in touch I am not unduly concerned by that.

    OA is one that is left up to GPs, maybe orthopaedics and the patient themselves. As with the PsA , I know what's what and when to get in touch if things change. I know you've been having a rough time lately, Megrose, how are things going now? DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • Megrose489Megrose489 Posts: 734
    edited 30. Nov -1, 00:00
    Thank you everybody for your replies.

    ITLSusan - It actually says on the NICE guidelines that one of the purposes of a regular review is to make sure the patient is up to date with information about their condition and I agree with you that this is a good thing.

    I'm pretty clued up about OA and fibromyalgia, but, as the OA slowly spreads into different joints and I struggle sometimes with the fibromyalgia, I would appreciate a regular review which looks at the disease as a whole. I know I would find it useful to discuss the stage I am at with the OA, when surgery would be useful, how it is affecting my life and a review of pain medication. At the moment, I see my GP occasionally about specific joints when they become very painful and I need a steroid injection, but there is no overall review. I suppose, really, I'm talking about the value of a holistic approach.

    I'm OK, DD, thank you for asking. I'm due to see the consultant about my foot OA in three weeks, so I'll know a little more then about whether it's time for surgery or not. Still waiting for my next eye appointment - maybe this month? - and, again, I'll know more then about the necessity for an op. I hope that things are good with you.

    Meg
  • ITLSusanITLSusan Posts: 74
    edited 30. Nov -1, 00:00
    Meg - print out the guidelines, take it with you to the doc and say "this - I'd find it useful. Can I have it please!".

    I bet most doctors do want to help patients more. It's just that they know from bitter experience that most of the time the best they can do is hand out drugs. I bet they'd be overjoyed to have a proactive patient that knows what help they want from the doc. Especially a patient looking to take a holistic approach. Go for it! It would also be really interesting to hear how things go.

    Good luck with it.
  • stickywicketstickywicket Posts: 25,993 ✭✭✭
    edited 30. Nov -1, 00:00
    Sorry, megrose. I kind of hijacked your thread into a more general one of all arthritis. I do prefer to keep away from medics as much as my various conditions allow but I think a good GP would find it very reasonable if you just made an appointment to discuss your OA as a whole. Why not go for it? And ask if you could do so on a regular basis?
    “There is always a well-known solution to every human problem - neat, plausible, and wrong.” H.L. Mencken
  • Megrose489Megrose489 Posts: 734
    edited 30. Nov -1, 00:00
    You didn't hijack the thread at all, Sticky. I do have an appointment with the Nurse Practitioner this afternoon re my blood pressure, so I'm going to take the opportunity to mention it to her then. I've known her for a long time and she's very easy to talk to. I've printed off the NICE information as you suggested, ITLSusan.

    Meg
  • theresaktheresak Posts: 1,998
    edited 30. Nov -1, 00:00
    We have a nurse at our practice whose remit is chronic illness patients, so she normally does an annual review, which takes place on or near the patient`s birthday, the theory being it will help us to remember a review is due, though we do get contacted anyway. The GP does the annual meds review.

    Last time we collected my prescription meds from the pharmacy the pharmacist suggested a review with her, as I `seemed to have a lot of medication.`I declined, and told her if my doctors think I need the meds, then I obviously need the meds.
  • OliverTOliverT Posts: 26
    edited 30. Nov -1, 00:00
    theresak wrote:
    the pharmacist suggested a review with her, as I `seemed to have a lot of medication.`I declined, and told her if my doctors think I need the meds, then I obviously need the meds.

    I knew a theatre nurse who was of the same mindset. The trouble is that when someone is taking many different medications they can interact in odd ways - especially when taken for a loooong time. This theatre nurse believed everything her doctors gave her was doing her good, and they did all do her some good, but the combination she was on was also doing her harm overall, only she didn't get anything reviewed much to her detriment and also that of her daughter and grandson.

    Pharmacists are not idiots - they are trained in drugs and their interactions to a far higher degree than your average GP will be - so if one recommended a review, maybe they have good reason for doing so.

    What harm can having a review do?
  • theresaktheresak Posts: 1,998
    edited 30. Nov -1, 00:00
    I guess I'm lucky that my GP is diligent enough to check for any contra-indications before prescribing anything, while our local pharmacist has given an incorrect dosage on two occasions in the past, entailing another trip to sort it out.
  • OliverTOliverT Posts: 26
    edited 30. Nov -1, 00:00
    Ah - if you know your doc is on the ball then fair play to you and them!

    :)
  • Megrose489Megrose489 Posts: 734
    edited 30. Nov -1, 00:00
    Well, I spoke to the Nurse Practitioner this afternoon and it seems that our practice doesn't have reviews for patients with OA, only those with RA. I did show her the print-out of the NICE guidelines, but she didn't even look at it. To be honest, I think they're just too busy or can't afford to do it, which is a real shame.

    Still, I haven't given up and I may well mention it the next time I see the GP.

    Meg
  • stickywicketstickywicket Posts: 25,993 ✭✭✭
    edited 30. Nov -1, 00:00
    I think all surgeries are very, very busy.

    Could you ask for your next appointment to be a 'double'. That would give you time to talk about this and also ask if you could do a similar thing annually. In my experience docs actually like patients to take responsibility for their own illnesses / diseases provided they don't assume that 6 minutes googling is the equivalent of 6 years medical training :roll:
    “There is always a well-known solution to every human problem - neat, plausible, and wrong.” H.L. Mencken
  • daffy2daffy2 Posts: 1,713
    edited 30. Nov -1, 00:00
    So annual reviews are a good way to make sure patient knowledge is up to date.
    Trouble is the patient knowledge may well be up to date and the GP's not!(for all sorts of reasons - I'm not criticising GPs here)
    I have just been reading the NICE guidelines and noticed this. As it happens my, not very frequent, appointments with my GP tend to be reviews of the situation anyway, since the OA has progressed so rapidly to so many joints in less than 3 years and is in addition to 50 years worth of scoliosis, and the OP diagnosis 3 years ago. The difficulty comes with trying to implement action as a result of such a review, since the NHS sees me as 3 separate conditions, 2 of which the GP is supposed to manage and the 3rd 'does not warrant a consultant's attention'. This is as frustrating to my GP as it is to me, and we continue to try and find a way forward, so I can sympathise Meg with your wish for a more holistic approach to your conditions. It seems obvious to us at the sharp end doesn't it?
  • emmaadamsemmaadams Posts: 140
    edited 30. Nov -1, 00:00
    i have never had a review regarding pain meds and ive been taking them for several years, i was originaly on cocodamol 30/500 mg for just over 4 years and i have been on paracetamol/Dihydracodine 20/500 mg since December last year and i have not once been given any type of review i am now alos on 1800mg of gabapentin as well as sertreline ... mg GP did check with the pharmacist before he prescribed the sertreline that it would be ok to take along with my other meds.... as far as a OA review ive never had one but i do see a orthopaedic specialist .. and physiotherapist every 2 weeks..


    i do feel us with OA just get left to our own devices , i have seen several GPs ove the past 5 yrs and there is only 1 that actually listened to me and got me the help and treatment i need i always ask to see him when i make appointments
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