The Management of Osteoarthritis: An Overview and Call to Appropriate Conservative Treatment
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
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Cited by (0)
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.