Medical management of osteoarthritis

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Karen Walker-Bone, clinical research fellow,
Kassim Javaid, senior house officer in rheumatology,
Nigel Arden, senior lecturer in rheumatology,
Cyrus Cooper, professor of rheumatology (cc@mrc.soton.ac.uk)

MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD

Correspondence to: C Cooper

Accepted 25 May 2000

Osteoarthritis is a common, chronic, musculoskeletal disorder. Symptomatic osteoarthritis, particularly of the knee and hip, is the most common cause of musculoskeletal disability in elderly people. In the Western world it ranks fourth in health impact among women and eighth among men.1 Given this high prevalence, therapeutic approaches to treatment will have to be shared between primary and secondary care. A range of non-surgical interventions has been proposed as components of such a therapeutic strategy.

Summary points

Osteoarthritis is a major cause of pain and disability in Western populations

The prevalence of osteoarthritis necessitates a “shared care” approach to management between general practitioners and hospital specialists

Several non-surgical interventions to alleviate pain and disability in lower limb osteoarthritis are now available:

Non-pharmacological measures (education, social support, physiotherapy, and occupational therapy)

Pharmacological measures (simple analgesics, non-steroidal anti-inflammatory drugs, COX-2 inhibitors, topical non-steroidal anti-inflammatory drugs, and capsaicin)

Intra-articular therapy: corticosteroids, hyaluronic acid derivatives, and tidal irrigation

These interventions have been evaluated to varying degrees, but they can be incorporated into an algorithm for the management of osteoarthritis

Therapeutic options in osteoarthritis

Non-pharmacological treatment

Education (patient and spouse or family)

Social support (telephone contact)

Physiotherapy (aerobic exercises, muscle strengthening, and patellar strapping)

Occupational therapy (aids and appliances, joint protection)

Weight loss

Acupuncture

Transcutaneous electrical nerve stimulation (TENS)

Pharmacological treatment

Simple analgesia

Non-steroidal anti-inflammatory drugs

COX-2 inhibitors (cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drugs)

Topical (non-steroidal anti-inflammatory drugs, capsaicin)

Chondroprotective agents

Intra-articular treatment

Corticosteroids

Hyaluronans

Tidal irrigation

Methods

Systematic reviews and controlled clinical trials were located through Medline and BIDS 1991-9, searching under the key words: osteoarthritis; guidelines; glucosamine; capsaicin; physiotherapy, occupational therapy, acupuncture, drug therapy, education, intra-articular injection, heat, cold, rehabilitation, epidemiology, therapy. When available, the most recent reviews or meta-analyses are cited; if not available, individual controlled trials were included and methodological shortcomings discussed. We did not perform assessments of quality of individual reviews. Semiquantitative estimates …