How should I approach the management of joint pain in patients with comorbidities such as diabetes or hypertension?

Approach to managing joint pain in patients with comorbidities such as diabetes or hypertension:

• Offer an individualized management plan that considers the severity of joint symptoms, affected joints, physical function, and importantly, the presence of comorbidities like diabetes or hypertension. This plan should include advice on self-care, weight management if overweight, and appropriate footwear to reduce joint stress.
• Encourage therapeutic exercise tailored to the individual, including local muscle strengthening and general aerobic fitness, as regular exercise benefits joint function and pain, even if initial discomfort increases. Consider referral to musculoskeletal first contact practitioners or physiotherapists for support with exercise and pacing activities.
• For symptom relief, suggest topical NSAIDs (e.g., ibuprofen 5% gel) applied up to three times daily if no contraindications exist. If topical NSAIDs are unsuitable or ineffective, consider oral NSAIDs at the lowest effective dose for the shortest duration, carefully weighing risks especially in patients with comorbidities such as hypertension or diabetes, due to potential adverse effects and drug interactions.
• Paracetamol or weak opioids may be considered only if other treatments are contraindicated, not tolerated, or ineffective, and should be used infrequently and short-term. Strong opioids and glucosamine are not recommended.
• Consider referral to specialist services such as pain management, psychology, or musculoskeletal teams if pain is uncontrolled or if there are associated mental health issues like anxiety or depression, which can be more common in multimorbid patients.
• Regularly review and follow up the patient, tailoring the frequency based on clinical need, treatment response, and the complexity added by comorbidities. Share and coordinate the individualized management plan with all involved healthcare professionals to reduce treatment burden and improve quality of life.

This approach aligns with the principles of managing multimorbidity by personalizing care, prioritizing treatments, and coordinating services to optimize outcomes and minimize risks in patients with joint pain and comorbid conditions such as diabetes and hypertension.

References: ¹,²,³,⁴