The Management of Osteoarthritis: An Overview and Call to Appropriate Conservative Treatment

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This article presents a general outline for the management of the patient with osteoarthritis in the form of a narrative review considering diagnosis, investigation, and treatment. It is not a comprehensive discussion (subsequent articles on imaging, weight management, exercise, braces and orthotics, pharmacologic intervention, and surgery provide more detail); rather, it provides the clinician with an overview of what is available. Inevitably, there is much the interested clinician can do rather than practice nihilistic waiting. The authors encourage active clinician involvement and instilling self-management strategies in patients to further promote effective long-term treatment of this pervasive disease.

Section snippets

Diagnosis of osteoarthritis

In clinical practice, the diagnosis of OA should be made on the basis of history and physical examination. The role of radiography is to confirm this clinical suspicion and rule out other conditions.12 The cardinal features that suggest a diagnosis of OA include pain, stiffness, reduced movement, swelling, and crepitus in typically involved joints (eg, hand distal interphalangeals and proximal interphalangeals, hips, knees, and metatarsophalangeals) in individuals who are older (eg, the

Investigation of osteoarthritis

Imaging can assist in making a diagnosis, predominantly by assessing the constellation of presenting clinical features. When disease is advanced, it is visible on plain radiographs, which show narrowing of joint space (in most joints due to loss of hyaline articular cartilage and, in the knee, also due to damage to the meniscus,21 osteophytes, and sometimes changes in the subchondral bone). In light of the lack of therapy that can modify the disease course and measurement imprecision, there is

Potential differential diagnoses

Other forms of arthritis may present with hand, knee, or hip pain, including rheumatoid arthritis, psoriatic arthritis, other seronegative spondyloarthropathies (ankylosing spondylitis, arthritis associated with inflammatory bowel disease (IBD), reactive arthritis), and sarcoidosis. Several other diseases may also predispose to the development of OA and should be treated, including metabolic diseases (hemachromatosis, Wilson's disease, ochronosis), endocrine disease (acromegaly,

Treatment

The aims of management of OA are (1) patient education about the disease and its management, (2) pain control, (3) improved function and decreased disability, and (4) altering the disease process and its consequences.

The management of OA should be individualized and will likely consist of a combination of treatment options. Unfortunately, the overwhelming preponderance of treatments tested and used for OA are currently drugs or surgery. In a recent meta-analysis of trials in OA, 60% assessed

Summary

Despite the increasing prevalence of OA, many uncertainties exist pertaining to its management. Many putative risk factors are characterized by excessive loading of vulnerable joint structures. Clinical examination should include an assessment of joint function and the influence of modifiable risks such as malalignment, muscle strength, and obesity. Braces, footwear, exercises, and dieting are prescribed for the purpose of improving the distribution of loads on the joints and reducing the

References (58)

  • R.C. Lawrence et al.

    Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

    Arthritis Rheum

    (1998)
  • E. Badley et al.

    Arthritis in Canada: an ongoing challenge

    (2003)
  • A.A. Guccione et al.

    The effects of specific medical conditions on the functional limitations of elders in the Framingham study

    Am J Public Health

    (1994)
  • R.H. Glazier et al.

    Management of common musculoskeletal problems: a survey of Ontario primary care physicians

    CMAJ

    (1998)
  • K.M. Jordan et al.

    EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis. Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT)

    Ann Rheum Dis

    (2003)
  • W. Zhang et al.

    EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

    Ann Rheum Dis

    (2005)
  • Anonymous

    Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines

    Arthritis Rheum

    (2000)
  • D. Hunter

    In the clinic: osteoarthritis

    Ann Intern Med

    (2007)
  • D. Hunter et al.

    Osteoarthritis

    BMJ

    (2006)
  • R. Altman et al.

    Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association

    Arthritis Rheum

    (1986)
  • G. Peat et al.

    Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care

    Ann Rheum Dis

    (2001)
  • C.L. Hill et al.

    Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis

    J Rheumatol

    (2001)
  • D. Witonski et al.

    Distribution of substance P nerve fibers in osteoarthritis knee joint

    Pol J Pathol

    (2005)
  • M.A. Freeman et al.

    The innervation of the knee joint: an anatomical and histological study in the cat

    J Anat

    (1967)
  • K.W. Marshall et al.

    Distribution of substance P and calcitonin gene related peptide immunoreactivity in the normal feline knee

    J Rheumatol

    (1994)
  • D.J. Hunter et al.

    Change in joint space width: hyaline articular cartilage loss or alteration in meniscus?

    Arthritis Rheum

    (2006)
  • M.T. Hannan et al.

    Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee

    J Rheumatol

    (2000)
  • T. Bhattacharyya et al.

    The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee

    J Bone Joint Surg Am

    (2003)
  • M. Englund et al.

    Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy

    Arthritis Rheum

    (2004)
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    A version of this article originally appeared in the 34:3 issue of the Rheumatic Disease Clinics of North America.

    The corresponding author (DJH) had full access to all of the data in this study and had final responsibility for the decision to submit for publication. Dr. Hunter receives research or institutional support from AstraZeneca, DonJoy, Lilly, Merck, NIH, Pfizer, Stryker, and Wyeth.

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