Osteoarthritis

Osteoarthritis is the most common type of arthritis affecting over 250 million people worldwide. This is a disease that more commonly affects older adults; however, there are several risk factors (e.g., obesity, genetics, prior trauma) that accelerate OA. Commonly affected joints are the knees, hips, interphalangeal joints, first CMC joints, and spine. Patients often seek care when they have symptoms associated with OA such as pain, stiffness, and limitations in function. Diagnosis can be made clinically but X-rays can show joint space narrowing, subchondral sclerosis, and osteophyte formation. Treatment recommendations focus on combination of non-pharmacologic and pharmacologic management. Use of joint protection techniques, assistive devices, and thermal modalities may be trialed. For knee and hip OA, non-pharmacologic modalities such as aquatic and/or resistance exercises in addition to weight loss are recommended. Topical therapies including capsaicin and topical nonsteroidal anti-inflammatory drugs (NSAIDs) may be beneficial for hand and knee OA and particularly appropriate for older adults who have contraindications to oral NSAIDs. Pharmacologic modalities for knee and hip OA include acetaminophen, oral and topical NSAIDs, tramadol, intra-articular corticosteroid injections, and duloxetine, and (in certain circumstances) opioids can be considered in patients who are refractory to medical therapy and not ideal surgical candidates. Since this is a chronic condition, a collaborative approach between patient and provider is beneficial in the management of OA.