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osteoarthritis

 
Medical Encyclopedia: Osteoarthritis
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Definition

Osteoarthritis (OA), which is also known as osteoarthrosis or degenerative joint disease (DJD), is a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The name osteoarthritis comes from three Greek words meaning bone, joint, and inflammation.

Description

OA is one of the most common causes of disability due to limitations of joint movement, particularly in people over 50. It is estimated that 2% of the United States population under the age of 45 suffers from osteoarthritis; this figure rises to 30% of persons between 45 and 64, and 63–85% in those over 65. About 90% of the American population will have some features of OA in their weight-bearing joints by age 40. Men tend to develop OA at earlier ages than women.

OA occurs most commonly after 40 years of age and typically develops gradually over a period of years. Patients with OA may have joint pain on only one side of the body and it primarily affects the knees, hands, hips, feet, and spine.

— Liz Meszaros


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Dictionary: os·te·o·ar·thri·tis   (ŏs'tē-ō-är-thrī'tĭs) pronunciation
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n.
A form of arthritis, occurring mainly in older persons, that is characterized by chronic degeneration of the cartilage of the joints. Also called degenerative joint disease.

osteoarthritic os'te·o·ar·thrit'ic (-thrĭt'ĭk) adj.

Britannica Concise Encyclopedia: osteoarthritis
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Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. Cartilage softens and wears away, and bone grows in its place, distorting the joint's surface and causing pain, stiffness, and limited movement, usually in weight-bearing joints (vertebrae, knees, hips). Treatment may include analgesics, rest, weight loss, corticosteroids, and/or physical medicine and rehabilitation or an exercise program. Hip or knee replacement or surgical removal of unhealthy tissue may be needed.

For more information on osteoarthritis, visit Britannica.com.

Food and Fitness: osteoarthritis
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Osteoarthritis is a degenerative disease of the cartilage overlying bone within a joint. It may progress into the bone itself, causing pain and stiffness. Although osteoarthritis affects some children, it is more common in the elderly. It results in more than 50 000 hip and knee replacements each year in the UK. Its development is associated with obesity, low bone density, abnormalities in the structure of the joint, and repeated mechanical stress. However, a comparison of the incidence of osteoarthritis in pairs of identical twins and non-identical twins, indicates that between 39-65 per cent of the disease is genetically determined.

The relationship between exercise and osteoarthritis is complex. In some cases, the wear and tear incurred during exercise may accelerate degeneration. This is particularly likely if people are genetically predisposed to osteoarthritis, or are already suffering from a joint defect and take part in activities, such as running, which impose high impact forces on the joints. However, there is no scientific evidence that people who are not genetically predisposed to the disease and who have normal joints are at risk of osteoarthritis because they exercise. On the contrary, many experts claim that exercise provides some protection against the development of osteoarthritis by helping to reduce body weight, improve muscle tone and strength, and increase flexibility. In addition, exercise stimulates the secretion of synovial fluid which lubricates and nourishes the joints. Non-weight-bearing exercise, especially swimming, is often promoted as treatment for mild forms of osteoarthritis. However, those suffering from joint disorders should avoid exercise which puts great stress on the joints.

Osteoarthritis can be kept under control for many years by proper treatment which usually includes the use of analgesics.

Dental Dictionary: osteoarthritis
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(ostē ō ärthrī′tis)
n

Chronic degeneration and destruction of the articular cartilage leading to bony spurs, pain, stiffness, limitation of motion, and change in the size of joints. Considered to result from chronic traumatic injury and wear and tear. Heberden’s nodes occur in a special form of the disease. Symptoms may be associated with hormonal, vascular, and/or nutritional disorders. The structural changes of advanced osteoarthritis may involve erosion of the articular cartilages or the subchondral bone. Osteoarthritis rarely affects the temporomandibular joint beyond the “creaking” state.

Alternative Medicine Encyclopedia: Osteoarthritis
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Definition

Osteoarthritis (OA), which is also known as osteoarthrosis or degenerative joint disease (DJD), is a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The name osteoarthritis comes from three Greek words meaning bone, joint, and inflammation.

Description

OA is one of the most common causes of disability due to limitations of joint movement, particularly in people over 50. It is estimated that 2% of the United States population under the age of 45 suffers from osteoarthritis; this figure rises to 30% of persons between 45 and 64, and 63–85% in those over 65. About 90% of the American population will have some features of OA in their weight-bearing joints by age 40. Men tend to develop OA at earlier ages than women.

OA typically develops gradually over a period of years. Patients with OA may have joint pain on only one side of the body. It primarily affects the knees, hands, hips, feet, and spine.

Causes & Symptoms

Osteoarthritis results from deterioration or loss of the cartilage that acts as a protective cushion between bones, particularly in weight-bearing joints such as the knees and hips. As the cartilage is worn away, the bone rubbing against bone forms spurs, areas of abnormal hardening, and fluid-filled pockets in the marrow known as subchondral cysts. As the disorder progresses, pain results from deformation of the bones and fluid accumulation in the joints. The pain is relieved by rest and made worse by moving the joint or placing weight on it. In early OA, the pain is minor and may take the form of mild stiffness in the morning. In the later stages of OA, chronic inflammation develops. The patient may experience pain even when the joint is not being used; and he or she may suffer permanent loss of the normal range of motion in that joint.

Until the late 1980s, OA was regarded as an inevitable part of aging, caused by simple "wear and tear" on the joints. This view has been replaced by recent research into cartilage formation. OA is now considered to be the end result of several different factors contributing to cartilage damage, and is classified as either primary or secondary.

Primary Osteoarthritis

Primary OA results from abnormal stresses on weight-bearing joints or normal stresses operating on weakened joints. Primary OA most frequently affects the finger joints, the hips and knees, the cervical and lumbar spine, and the big toe. The enlargements of the finger joints that occur in OA are referred to as Heberden's and Bouchard's nodes. Some gene mutations appear to be associated with OA. Obesity also increases the pressure on the weight-bearing joints of the body. Finally, as the body ages, there is a reduction in the ability of cartilage to repair itself. In addition to these factors, some researchers have theorized that primary OA may be triggered by enzyme disturbances, bone disease, or liver dysfunction.

Secondary Osteoarthritis

Secondary OA results from chronic or sudden injury to a joint. It can occur in any joint. Secondary OA is associated with the following factors:

  • trauma, including sports injuries
  • repetitive stress injuries associated with certain occupations (like the performing arts, construction or assembly line work, computer keyboard operation, etc.)

Diagnosis

History and Physical Examination

The two most important diagnostic clues in the patient's history are the pattern of joint involvement and the presence or absence of fever, rash, or other symptoms outside the joints. As part of the physical examination, the doctor will touch and move the patient's joint to evaluate swelling, limitations on the range of motion, pain on movement, and crepitus (a cracking or grinding sound heard during joint movement).

Diagnostic Imaging

There is no laboratory test that is specific for osteoarthritis. Treatment is usually based on the results of diagnostic imaging. In patients with OA, x rays may indicate narrowed joint spaces, abnormal density of the bone, and the presence of subchondral cysts or bone spurs. The patient's symptoms, however, do not always correlate with x-ray findings. Magnetic resonance imaging (MRI) and computed tomography scans (CTscans) can be used to determine more precisely the location and extent of cartilage damage.

Treatment

Diet

Food intolerance can be a contributing factor in OA, although this is more significant in rheumatoid arthritis. Dietary suggestions that may be helpful for people with OA include emphasizing high-fiber, complex-carbohydrate foods, while minimizing fats. Plants in the Solanaceae family, such as tomatoes, peppers, eggplant, and potatoes, should be avoided, as should refined and processed foods. Citrus fruits should also be avoided, as they may promote swelling. Foods that are high in bioflavonoids (berries as well as red, orange, and purple fruits and vegetables) should be eaten often. Black cherry juice (2 glasses twice per day) has been found to be particularly effective for partial pain relief.

Nutritional Supplements

In the past several years, a combination of glucosamine and chondroitin sulfate has been proposed as a dietary supplement that helps the body maintain and repair cartilage. Studies conducted in Europe have shown the effectiveness of this treatment but effects may not be evident until a month after initiating this treatment. These substances are nontoxic and do not require prescriptions. Other supplements that may be helpful in the treatment of OA include the antioxidant vitamins and minerals (vitamins A, C, E, selenium, and zinc) and the B vitamins, especially vitamins B6 and B5.

Naturopathy

Naturopathic treatment for OA includes hydrotherapy, diathermy (deep-heat therapy), nutritional supplements, and botanical preparations, including yucca, devil's claw (Harpagophytum procumbens), and hawthorn (Crataegus laevigata) berries.

Electromagnetic field therapy is believed to increase blood flow and oxygen exchange to enhance the body's natural healing processes. This treatment is not suggested for use over an open wound or in combination with transdermal drug delivery patches, or by those who are pregnant or have insulin pumps or pacemakers. Magnets may be worn within a shoe insole, anklet, bracelet, or back support.

Traditional Chinese Medicine

Practitioners of Traditional Chinese medicine treat arthritis with suction cups, massage, moxibustion (warming an area of skin by burning a herbal wick a slight distance above the skin), the application of herbal poultices, and internal doses of Chinese herbal formulas.

Daily acupressure can also provide relief for stiff, achy joints. Massage of the achy joints with a blend of aromatic oils, especially rosemary and chamomile is beneficial. Periods of imagery are another suggested treatment—for 10-20 minutes twice daily—where the joint pain is pictured as transformed into a liquid that trickles from the body into the nearest body of water and eventually into the ocean waves.

Physical Therapy

Patients with OA are encouraged to exercise as a way of keeping joint cartilage lubricated. Exercises that increase balance, flexibility, and range of motion are recommended for OA patients. These may include walking, swimming and other water exercises, yoga and other stretching exercises, or isometric exercises. Physical therapy may also include massage, moist hot packs, or soaking in a hot tub.

Allopathic Treatment

Treatment of OA patients is tailored to the needs of each individual. Patients vary widely in the location of the joints involved, the rate of progression, the severity of symptoms, the degree of disability, and responses to specific forms of treatment. Most treatment programs include several forms of therapy.

Patient Education and Psychotherapy

Patient education is an important part of OA treatment because of the highly individual nature of the disorder and its potential impacts on the patient's life. Patients who are depressed because of changes in employment or recreation usually benefit from counseling. The patient's family should be involved in discussions of coping, household reorganization, and other aspects of the patient's disease and treatment regimen.

Medications

Patients with mild OA may be treated only with pain relievers such as acetaminophen (Tylenol) or propoxyphene (Darvon). Most patients with OA, however, are given nonsteroidal anti-inflammatory drugs, or NSAIDs. These include compounds such as ibuprofen (Motrin, Advil), ketoprofen (Orudis), and flurbiprofen (Ansaid). The NSAIDs have the advantage of relieving inflammation as well as pain. They also have potentially dangerous side effects, including stomach ulcers, sensitivity to sun exposure, kidney disturbances, and nervousness or depression.

Some OA patients are treated with corticosteroids injected directly into the joints to reduce inflammation and slow the development of Heberden's nodes. Injections should not be regarded as a first-choice treatment and should be given only two or three times a year. A series of hyaluronic acid injections into the affected joint may help to lubricate and protect cartilage.

Surgery

Surgical treatment of osteoarthritis may include the replacement of a damaged joint with an artificial part or appliance; surgical fusion of spinal bones; scraping or removal of damaged bone from the joint; or the removal of a piece of bone in order to realign the bone.

Protective Measures

Depending on the location of the affected joint, patients with OA may be advised to use neck braces or collars, crutches, canes, hip braces, knee supports, bed boards, or elevated chair and toilet seats. They are also advised to avoid unnecessary knee bending, stair climbing, or lifting of heavy objects.

New Treatments

Since 1997, several new methods of treatment for OA have been investigated. Although they are still being developed and tested, they appear to hold promise. They include:

  • Disease-modifying drugs. These compounds may be useful in assisting the body to form new cartilage or improve its repair of existing cartilage.
  • Gene therapy.
  • Cartilage transplantation. This technique is presently used in Sweden.

Resources

Books

"Bone, Joint, and Rheumatic Disorders: Osteoarthritis." In The Merck Manual of Geriatrics, edited by William B. Abrams, et al. Rahway, NJ: Merck Research Laboratories, 1995.

Hellman, David B. "Arthritis & Musculoskeletal Disorders." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney, Jr., et al. Stamford, CT: Appleton & Lange, 1998.

"Musculoskeletal and Connective Tissue Disorders: Osteoarthritis (OA)." In The Merck Manual of Diagnosis and Therapy, edited by Robert Berkow, et al. Rahway, NJ: Merck Research Laboratories, 1992.

Neustadt, David H. "Osteoarthritis." In Conn's Current Therapy, edited by Robert E. Rakel. Philadelphia: W. B. Saunders Company, 1998.

"Osteoarthritis." In Professional Guide to Diseases, edited by Stanley Loeb, et al. Springhouse, PA: Springhouse Corporation, 1991.

Theodosakis, Jason, et al. The Arthritis Cure. New York: St. Martin's, 1997.

[Article by: Kathleen D. Wright]

Encyclopedia of Public Health: Osteoarthritis
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Osteoarthritis, which is also called degenerative arthritis or degenerative joint disease, is primarily a disease that results from the breakdown and loss of cartilage in joints (e.g., knees, hips, wrists). Cartilage, a connective tissue that covers the surfaces of articular joints, is essential for proper joint function because it allows the ends of bones to slide over one another smoothly. Osteoarthritis results from both mechanical (e.g., trauma to joints) and biological (metabolic) events that interfere with the maintenance of healthy cartilage. Eventually, cartilage may be lost, causing the bones in the joint to rub together, and bony spurs may form.

Signs, Symptoms, and Diagnosis

Osteoarthritis is characterized by joint pain, tenderness, swelling, and limitation in joint movement. The joints most often affected are the joints of the fingers, the base of the thumb, the hips, the knees, the neck (cervical spine), and the lower back (lumbar spine). Unlike some types of arthritis that affect multiple organ systems, any inflammation associated with osteoarthritis is limited to the joints. Pain after joint use that subsides with resting the joint is a classical sign of osteoarthritis. As osteoarthritis worsens, pain may occur at rest or at night. Health care providers diagnose osteoarthritis based on a history of joint symptoms, physical examination, and radiographic (X-ray) changes. X-ray changes may include joint-space narrowing, changes in the bones, and the presence of bony spurs.

In addition to the physical symptoms, osteoarthritis also impacts psychological, social, and economic well-being. Psychological effects include stress, depression, anger, feelings of helplessness, and anxiety. The social impacts may include decreased community involvement and lack of understanding by family, friends, and coworkers. The economic status of people with arthritis and their families is also affected. The financial burden of health care and days lost from work may seriously impact the financial well-being of persons with arthritis and their families.

Age is a major demographic risk factor for the development of osteoarthritis. Although aging does not cause osteoarthritis, the prevalence of osteoarthritis increases with age. Almost half of people over the age of sixty-five have arthritis—mostly osteoarthritis. Osteoarthritis is also more common among women than among men. In addition to age, risk factors for osteoarthritis include joint injury and being overweight (especially for knee and hip osteoarthritis). Reduction of weight has been shown to reduce the risk of symptomatic osteoarthritis in overweight people.

The Burden of Osteoarthritis

Osteoarthritis is the most common form of the more than one hundred conditions that are considered arthritis and other rheumatic conditions. In 1998, these conditions affected 43 million Americans, and they are among the most common chronic diseases. Arthritis is also a leading cause of disability—it limits activities for 7 million Americans. The costs of arthritis are enormous. In 1992, the costs of medical treatment and lost wages were estimated at $65 billion. The cost of osteoarthritis alone may currently exceed $15.5 billion.

Osteoarthritis affects as many people as all of the other types of arthritis combined. Almost 22 million Americans have osteoarthritis—almost one of every twelve people in the United States. Prevalence estimates of osteoarthritis will differ by how the data are collected or how the diagnosis is made. For example, people who have pain due to osteoarthritis may not show X-ray changes, and those with X-ray changes consistent with osteoarthritis may not have symptoms. The prevalence of osteoarthritis is high and will get even higher as the number of older Americans increases. In 2020, an estimated 60 million Americans will have arthritis—osteoarthritis alone is likely to affect over 30 million people. Osteoarthritis is a major cause of disability. Sixty to 80 percent of people with osteoarthritis are limited in their activities because of the disease.

Osteoarthritis Treatment and Control

There is no known cure for osteoarthritis, yet there are effective treatment and control strategies. Management of osteoarthritis is directed toward reducing pain, minimizing or preventing disability, and improving quality of life. Achieving these goals not only requires good clinical care, but also depends on the active involvement of the person with osteoarthritis in self-management strategies and proactive efforts by the public health system.

Clinical Care. The American College of Rheumatology (ACR) has published guidelines on the medical management of osteoarthritis of the hip and knee that outline the key components of appropriate management. The guidelines list therapeutic strategies, including medications, rehabilitation therapies, and surgery. Medical management of osteoarthritis primarily focuses on prescribing appropriate medications and recommending self-management strategies or making referrals to rehabilitation, self-management, or surgical services.

Medication recommendations for osteoarthritis are evolving. Nonsteroidal anti-inflammatory drugs (NSAID) were, until recently, the primary medication treatment for osteoarthritis. However, due to concerns about the gastrointestinal toxicity of NSAIDs, the 1995 ACR medical-management guidelines concluded that the first-line medication for symptomatic osteoarthritis should be acetaminophen. NSAIDs were recommended for those individuals who do not get sufficient pain relief from acetaminophen. In 1998, a new form of NSAID, called COX-2 Inhibitors, was released. COX-2 medications are similar to other NSAIDs in their effect on pain and joint inflammation, but they have significantly fewer gastrointestinal side effects. Physicians now vary in whether they initiate treatment for osteoarthritis with acetaminophen, another NSAID, or a COX-2 medication.

Other treatments are also used. For example, symptomatic knee osteoarthritis may benefit from an injection of cortisone into the joint. The role of other treatments, such as glucosamine, chondroitin, and injections of hyaluronan are under investigation.

Rehabilitation services, such as physical and occupational therapy, are also important in the management of osteoarthritis. Therapists may prescribe therapeutic exercise to increase joint range of motion, muscle strength, and aerobic conditioning; they make teach strategies to reduce fatigue and stress on joints; and they may recommend environmental or task modification and assistive devices to make it easier to perform daily activities. Rehabilitation services may also be used after joint surgery.

Persons with severe symptomatic osteoarthritis, marked by pain and declining function, may benefit from total joint replacement. Both total hip and knee replacement have substantially reduced pain and improved function in the vast majority of individuals who have received them.

Self-Management Strategies. The ACR guidelines for medical management of osteoarthritis recommend specific self-management strategies as well as clinical interventions. The guidelines specify self-management education, exercise and aerobic conditioning, and weight control as integral to optimal health outcomes in osteoarthritis.

Because of its demonstrated efficacy and cost-effectiveness, the premiere self-management education intervention for osteoarthritis is the Arthritis Self-Help Course (ASHC). ASHC, developed in the early 1980s by Kate Lorig and colleagues, was adopted in the United States by the Arthritis Foundation and has been disseminated nationwide. A 20 percent reduction in pain and a 43 percent reduction in physician visits was demonstrated in four-year follow-up studies of ASHC. Early research demonstrated that each individual's belief that there was "something they could do," which Lorig labeled "self-efficacy," was more strongly correlated with positive health outcomes from ASHC than were specific health behaviors. Cost-effectiveness calculations indicated an annual savings of $189 per osteoarthritis participant due to the decreased need for physician visits.

Physical activity and weight control are important self-management strategies in osteoarthritis. Physical Activity and Health: A Report of the Surgeon General (1996) specifically addressed osteoarthritis and stated that regular moderate exercise programs, either aerobic or resistance training, relieve symptoms and improve physical function and psychosocial status among people with osteoarthritis. Low-impact forms of exercise, such as walking, swimming, and stationary or on-the-road bicycling, are recommended to minimize the stress on affected joints. The Arthritis Foundation disseminates structured physical activity programs. Preliminary studies have shown positive health outcomes among participants in these programs. Obesity is a well-documented risk factor for the development of symptomatic osteoarthritis. A randomized controlled study showed that the amount of weight lost was strongly correlated with improvements in signs and symptoms of knee osteoarthritis.

Some persons with osteoarthritis choose to manage their condition by using various forms of complementary and alternative medicine (CAM) modalities, either along with, or in place of, medically prescribed therapies. Symptoms associated with chronic musculoskeletal conditions, including osteoarthritis, are among the most common reasons for using CAM. More information is needed, however, about the safety and efficacy of CAM modalities.

The Role of Public Health in Arthritis Treatment and Control

Because of its large and increasing prevalence, and the large personal and societal costs, arthritis is recognized as a significant public health problem. In addition, effective management strategies are available yet underused. The National Arthritis Action Plan: A Public Health Strategy (NAAP) was developed under the leadership of the Centers for Disease Control and Prevention, the Arthritis Foundation, and the Association of State and Territorial Health Officials, and with the combined efforts of over ninety organizations. NAAP, released in 1999, outlines a comprehensive, systematic public health approach to decreasing the burden of arthritis for all Americans and improving the quality of life of those affected by arthritis. NAAP focuses on a population-based approach that can complement traditional medical care. Public health agencies and their partners play a role in promoting the importance of early diagnosis and appropriate management of osteoarthritis; and in assuring that persons with osteoarthritis are aware of the importance of, and have access to, effective self-management programs. Policy and system changes are needed to heighten awareness and improve access. Public health professionals are also responsible for monitoring the burden of osteoarthritis and identifying factors that influence the development or progression of osteoarthritis or disability from osteoarthritis.

(SEE ALSO: Chronic Illness; Noncommunicable Disease Control; Predisposing Factors; Rheumatoid Arthritis; Self-Care Behavior; Self-Help Groups)

Bibliography

Arthritis Foundation (1997). Arthritis 101. Atlanta, GA: Arthritis Foundation.

Arthritis Foundation, Association of State and Territorial Health Officials, Centers for Disease Control and Prevention (1999). National Arthritis Action Plan: A Public Health Strategy. Atlanta, GA: Arthritis Foundation.

Felson, D. T., and Zhang, Y. (1988). "An Update on the Epidemiology of Knee and Hip Osteoarthritis with a View to Prevention." Arthritis and Rheumatism 41:1343–1355.

Hochberg, M. C.; Altman, R. D.; Brandt, K. D., et al. (1995). "Guidelines for Medical Management of Osteoarthritis." Arthritis and Rheumatism 38:1535–1546.

Hochberg, M. C. (1997). "Osteoarthritis—Clinical Features and Treatment." In Primer on the Rheumatic Diseases, 11th edition, ed. J. H. Klippel. Atlanta, GA: Arthritis Foundation.

Lawrence, R. C.; Helmick, C. G.; and Arnett, F. C. (1998). "Estimates of the Prevalence of Arthritis and Selected Musculoskeletal Disorders in the United States." Arthritis and Rheumatism 41:778–799.

Lorig, K., and Holman, H. (1993). "Arthritis Self-Management Studies: A Twelve-Year Review." Health Education Quarterly 20(1):17–28.

Minor, M. A. (1996). "Arthritis and Exercise: 'The Times They Are A-Changin.'" Arthritis Care and Research 9:9–81.

Stein, C. M.; Griffin, M. R.; and Brandt, K. D. (1996). "Osteoarthritis." In Clinical Care in the Rheumatic Diseases, eds. S. T. Wegener, B. L. Belza, and E. P. Gall. Atlanta, GA: American College of Rheumatology.

U.S. Department of Health and Human Services (1996). Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention.

—— (1999). Handout on Health: Osteoarthritis. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Yelin, E., and Callahan L. F. (1995). "The Economic Cost and Social and Psychological Impact of Musculoskeletal Conditions." Arthritis and Rheumatism 38(10):1351–1362.

— JOSEPH E. SNIEZEK; TERESA J. BRADY; JAMES S. M<

Sports Science and Medicine: osteoarthritis
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Degeneration of articular cartilage, which may also affect the underlying bone of a joint, causing pain and stiffness. Osteoarthritis may result from trauma, incorrect loading of a joint, ligament injuries, or recurrent dislocations. It is often associated with obesity, low bone density, repeated mechanical stress, and structural abnormalities of the joint. Although it may affect any joint, it most commonly affects the hips, knees, and thumbs. The relationship between osteoarthritis and exercise is complex: in some cases it may exacerbate the condition, in others it may delay its progress. Athletes with osteoarthritis of the hips or knees are often advised not to participate in activities, such as running, which impose high impact forces on the joints. However, there is no scientific evidence that running causes arthritis in athletes whose joints were normal before they started running. Non-weight bearing activities, especially swimming, are recommended for those with mild forms of arthritis. Although children can have osteoarthrits, it tends to be an age-related disease, but it is not an inevitable consequence of ageing. Once it has started to develop, osteoarthritis can usually be kept under control for many years by using anti-inflammatories and analgesics.

Veterinary Dictionary: osteoarthritis
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A noninflammatory degenerative joint disease marked by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane; called also degenerative joint disease.
There is chronic lameness, bulls are reluctant to serve, the gait is stiff, the animals are reluctant to rise and have difficulty doing so. The affected limb shows atrophy, the joint is painful on passive movement and may show crepitus. In pigs epiphysiolysis may occur. See also osteochondrosis, leg weakness of pigs.

  • chronic progressive o. — result of repeated injury to joint surfaces, ligaments and cartilages of serving bulls.
  • inherited o. — in cattle the coxofemoral joint is most affected in Herefords, the stifle in Holstein–Friesian and Angus. In horses the coxofemoral joint is affected.
Wikipedia: Osteoarthritis
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 This article is in need of attention from an expert on the subject. WikiProject Medicine or the Medicine Portal may be able to help recruit one. (May 2009)
Osteoarthritis
Classification and external resources
ICD-10 M15.-M19., M47.
ICD-9 715
OMIM 165720
DiseasesDB 9313
MedlinePlus 000423
eMedicine med/1682 orthoped/427 pmr/93 radio/492
MeSH D010003

Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a group of diseases and mechanical abnormalities involving degradation of joints,[1] including articular cartilage and the subchondral bone next to it. Clinical manifestations of OA may include joint pain, tenderness, stiffness, creaking, locking of joints, and sometimes local inflammation. In OA, a variety of potential forces—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage -- a strong protein matrix that lubricates and cushions the joints. As the body struggles to contain ongoing damage, immune and regrowth processes can accelerate damage.[2] When bone surfaces become less well protected by cartilage, subchondral bone may be exposed and damaged, with regrowth leading to a proliferation of ivory-like, dense, reactive bone in central areas of cartilage loss, a process called eburnation.[3] The patient increasingly experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax.[4] OA is the most common form of arthritis,[4] and the leading cause of chronic disability in the United States.[5]

"Osteoarthritis" is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although the "itis" of osteo arthritis is somewhat of a misnomer -- inflammation is not a conspicuous feature of the disease. Osteoarthritis is not to be confused with rheumatoid arthritis, an autoimmune disease with joint inflammation as a main feature. A common misconception is that OA is due solely to wear and tear, since OA typically is not present in younger people. However, while age is correlated with OA incidence, this correlation may illustrate that OA is a process that takes time to develop -- or that repair and regeneration that may keep pace with damage in the joints of younger people do slow with age. There is usually an underlying cause for OA, in which case it is described as secondary OA. If no underlying cause can be identified it is described as primary OA. "Degenerative arthritis" is often used as a synonym for OA, but the latter involves both degenerative and regenerative changes.

OA affects about 8 million people in the United Kingdom and nearly 27 million people in the United States, where it accounts for 25% of visits to primary care physicians and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the US population will have radiographic evidence of OA by age 65, although only 60% of those will show symptoms.[6] In the United States, hospitalizations for osteoarthritis soared from about 322,000 in 1993 to 735,000 in 2006.[7]

Contents

Classification

OA affects about eight million people in the United Kingdom, and about 27 million people in the United States, where it accounts for 25% of visits to primary care physicians and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the US population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic.[6] Some investigators believe that mechanical stress on joints underlies all osteoarthritis, with many and varied sources of mechanical stress, including misalignments of bones due to congenital or pathogenic causes; mechanical injury; being overweight; loss of strength in muscles supporting joints; and impairment of peripheral nerves, leading to sudden or uncoordinated movements that overstress joints.[8]

Primary

Primary OA in the left knee of an elderly female.

This type of OA is a chronic degenerative disorder related to but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease. As a person ages, the water content of the cartilage decreases[9] due to a reduced proteoglycan content, thus causing the cartilage to be less resilient. Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to that which occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the inflammation, can be both painful and debilitating.

Secondary

This type of OA is caused by other factors but the resulting pathology is the same as for primary OA:

Signs and symptoms

Heberden's nodes may form in osteoarthritis

The main symptom is acute pain, causing loss of ability and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associate muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid and cold weather increases the pain in many patients.[11][12]

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.[13]

OA is the most common cause of joint effusion, sometimes called water on the knee in lay terms, an accumulation of excess fluid in or around the knee joint. [14]

Causes

Although it commonly arises from trauma, osteoarthritis often affects multiple members of the same family, suggesting that there is hereditary susceptibility to this condition. A number of studies have shown that there is a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis [15]. Up to 60% of OA cases are thought to result from genetic factors. Researchers are also investigating the possibility of allergies, infections, or fungi as a cause.

Diagnosis

There is no laboratory or pathological definition of osteoarthritis, and therefore no accepted laboratory tests to diagnose it.[13] Diagnosis can often be made with reasonable certainty by clinical examination[16][17]. Confirmation can be done through x-rays. This is possible because loss of cartilage, subchondral ("below cartilage") sclerosis, subchondral cysts from synovial fluid entering small microfractures under pressure, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes) - from increased bone turnover in this condition, show up clearly on x-rays. Plain films, however, often do not correlate well with the findings of physical examination of the affected joints. Usually other imaging techniques are not necessary to clinically diagnose osteoarthritis.

In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissue enlargement and swelling of certain joints. These criteria were found to be 92% sensitive and 98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis and spondyloarthropities [18].

Related pathologies whose names may be confused with osteoarthritis include pseudo-arthrosis. This is derived from the Greek words pseudo, meaning "false", and arthrosis, meaning "joint." Radiographic diagnosis results in diagnosis of a fracture within a joint, which is not to be confused with osteoarthritis which is a degenerative pathology affecting a high incidence of distal phalangeal joints of female patients.

Treatment

Treatment of OA consists of exercise, manual therapy, lifestyle modification, medication and other interventions to alleviate pain.

Lifestyle modification

No matter the severity or location of OA, conservative measures such as weight control, appropriate rest, exercise, and the use of mechanical support devices can be beneficial. In OA of the knees, knee braces can be helpful. A cane, or a walker can reduce pressure on involved leg joints which can be helpful for walking and support. Regular exercise such as walking or swimming, or other low impact activities are encouraged. Applying local heat before, and/or cold packs after exercise, can help relieve pain, as can relaxation techniques. Weight loss can relieve joint stress and may delay progression although research supporting this is equivocal.

Physical measures

Proper advice and guidance by health care providers such as chiropractors, physical therapists, occupational therapists, and medical doctors is important in OA management, enabling people with this condition to improve their quality of life.

Functional, gait, and balance training has been recommended to address impairments of proprioception, balance, and strength in individuals with lower extremity arthritis. These deficits can contribute to higher fall risk in older individuals.[19]

Patient education

Patient education has been shown to be helpful in the self-management of patients with arthritis in decreasing pain, improving function, reducing stiffness and fatigue, and reducing medical usage.[20] A meta-analysis has shown patient education can provide on average 20% more pain relief when compared to NSAIDs alone in patients with hip OA or rheumatoid arthritis.[21]

Exercise

Moderate exercise leads to improved functioning and decreased pain in people with osteoarthritis of the knee.[22]

Adequate joint motion and elasticity of periarticular tissues are necessary for cartilage nutrition and health, protection of joint structures from damaging impact loads, function, and comfort in daily activities. Exercise to regain or maintain motion and flexibility by low-intensity, controlled movements that do not cause increased pain. Muscle weakness around an osteoarthritic joint is a common finding. Progressive resistive/strengthening exercises load muscles in a graduated manner to allow for strengthening while limiting tissue injury.[23]

Splinting of the thumb for OA of the base of the thumb leads to improvements after one year.[24]

In 2002, a randomized, blinded assessor trial was published showing a positive effect on hand function with patients who practiced home joint protection exercises (JPE). Grip strength, the primary outcome parameter, increased by 25% in the exercise group versus no improvement in the control group. Global hand function improved by 65% for those undertaking JPE. [25]

Medication

Paracetamol

Paracetamol (Tylenol/acetaminophen), is commonly used to treat the pain from OA, and was recommended in 16 of 16 guidelines evaluated in a 2007 review of existing guidelines.[26] A randomized controlled trial comparing paracetamol with ibuprofen in x-ray-proven mild to moderate osteoarthritis of the hip or knee found equal benefit.[27] However, paracetamol at a dose of 4 grams per day can increase liver function tests.[28] In 2006, however, a Cochrane review[29] found a small benefit (effect size of 0.13) from paracetamol, suggesting questionable clinical significance.[30] There is equivocal evidence for gastrointestinal bleeding or renal (kidney) damage with long-term use of 4 g/day.[30] NSAIDs appear to be more potent, but pose greater risk of side-effects.[29]

Non-steroidal anti-inflammatory drugs

In more severe cases, non-steroidal anti-inflammatory drugs (NSAID) may reduce both the pain and inflammation; they all act by inhibiting the formation of prostaglandins, which play a central role in inflammation and pain. However, it should be noted that this class of drugs is not without risk for adverse events including increased gastrointestinal bleeding.[31] Most prominent drugs in the class include diclofenac, ibuprofen, naproxen and ketoprofen. High oral drug doses are often required. However, diclofenac has been found to cause damage to the articular cartilage. Even more importantly all systemic NSAIDs are rather taxing on the gastrointestinal tract, and may cause stomach upset, cramping, diarrhea, and peptic ulcer. Such systemic adverse side effects are normally not observed when using NSAIDs topically, that is, on the skin around the target area. The typically weak and/or short-lived therapeutic effect of such topical treatments may be improved by using the drug in more modern formulations, including or ketoprofen associated with the Transfersome carriers or diclofenac in DMSO solution.

Another type of NSAID, COX-2 selective inhibitors (such as celecoxib, and the withdrawn rofecoxib and valdecoxib) are often used but are no more effective than the other NSAIDs. These latter NSAIDs carry an elevated risk for cardiovascular disease, and some have now been withdrawn from the market.

Corticosteroids

Oral steroids are not recommended in the treatment of OA due to their modest benefit and high rate of adverse effects. However intra - articular corticosteroid temporarily improve symptoms as discussed below.

Narcotics

For moderate to severe pain a narcotic such as morphine may be necessary.

Topical

There are several NSAIDs available for topical use (e.g. diclofenac, ibuprofen, and ketoprofen) with little, if any, systemic side-effects and at least some therapeutic effect. The more modern NSAID formulations for direct use, containing the drugs in an organic solution or the Transfersome carrier based gel, reportedly, are as effective as oral NSAIDs.

Creams and lotions, containing capsaicin, are effective in treating pain associated with OA if they are applied with sufficient frequency.

Injectable

A 2005 review of injections of hyaluronic acid, known as vicosupplementation, did not find that it led to clinical improvement in OA.[32] A subsequent 2009 study found similar results.[33] Injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months.[34]

Surgery

If the above management is ineffective, joint replacement surgery may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones, or fusing bone to increase stability and reduce pain. Arthroscopic surgical intervention for osteoarthritis of the knee has been found to be no better than placebo at relieving symptoms.[35]

Alternative treatments

The majority of patients with arthritis have tried alternative treatments for their pain. Various studies have reported some benefit for many of these approaches, including acupuncture and some herbal supplements. However, the response rates tend to be low and there is concern about bias in many studies.[13]

Acupuncture

Though findings are tentative and preliminary, there is evidence that acupuncture can be useful in the symptomatic treatment of osteoarthritis. All studies suggested that the results were equivocal and more high-quality evidence was needed.

  • A 2007 review suggested that acupuncture is superior to sham treatment for both pain and function in the short- and long-term treatment of chronic knee pain, of which osteoarthritis was one element.[36]
  • A 2007 review suggested acupuncture was an effective treatment for the pain and dysfunction associated with osteoarthritis of the knee[37]
  • A 2007 review suggested acupuncture was useful for older patients with osteoarthritis of the knee and superior to waiting list or usual care groups but results were not clinically relevant for sham and actual acupuncture and were ascribed to a placebo effect.[38]
  • A 2007 review found that electroacupuncture was associated with short-term relief of osteoarthritic knee pain better than placebo, but manual acupuncture was not, and the quality of the articles reviewed with small sample sizes may undermine the validity of conclusions.[39]
  • A 2008 review suggested there was moderate quality evidence that acupuncture reduces pain for patients with osteoarthritis of the knee; the evidence for exercise and weight reduction was higher, and also improved physical function and self-reported disability respectively[40]
  • A 2008 set of consensus recommendations produced by the Osteoarthritis Research Society International concluded that acupuncture may offer symptomatic benefits for osteoarthritis of the knee or hip[41]
  • A 2008 review suggested that acupuncture provides short-term management of osteoarthritis-related knee pain. However, short-term treatment with acupuncture did not have long-term benefits.[42]

Glucosamine/Chondroitin

There is controversy about glucosamine's effectiveness for OA of the knee.[43] A 2005 review concluded that glucosamine may improve symptoms of OA and delay its progression.[44] However, a subsequent large study suggests that glucosamine is not effective in treating OA of the knee[45], and a 2007 meta-analysis that included this trial states that glucosamine hydrochloride is not effective.[46]. In addition, in vitro analysis of glucosamine has revealed that glucosamine inhibits cartilage cell characteristics [47]. There is a "striking" difference between the results reported from trials involving glucosamine sulfate as compared to glucosamine hydrochloride, with glucosamine sulfate reporting an effect size of 0.44 compared to a 0.06 effect size from glucosamine hydrochloride; Osteoarthritis Research Society International recommends discontinuing glucosamine if no effect is observed after six months.[30] There is concern that industry bias has affected the earlier trials, although a 2008 OARSI consensus review stated that this was "unsubstantiated". No adverse effects have been observed. The European League Against Rheumatism practice guidelines recommend glucosamine.[48]

Chondroitin sulfate has also become a widely used dietary supplement for treatment of osteoarthritis, both in combination with glucosamine and by itself. A meta-analysis of randomized controlled trials found no benefit from chondroitin,[49] although this meta-analysis included only 3 trials, one which had "an exceptionally high placebo response" and one which was published as only an abstract.[30]

Other supplements

  • S-Adenosyl methionine (SAMe) has been tested; a review of 10 studies found that it has an effect on pain relief similar to nonsteroidal anti-inflammatory drugs.[50] A 2004 trial comparing SAMe and celecoxib found that during the first month the SAMe group reported more pain, but thereafter there was no significant difference between SAMe and celecoxib on reducing pain. The SAMe group reported somewhat fewer side-effects, consistent with a prior review.[51]
  • Selenium deficiency has been correlated with a higher risk and severity of OA.[56]
  • Vitamin B9 (folate) and B12 (cobalamin) taken in large doses has been thought to reduce OA hand pain in one very small, non-quantitative study of 25 people, the results of which are extremely vague at best.[57]

Epidemiology

Disability-adjusted life year for osteoarthritis per 100,000 inhabitants in 2004.[59]
     no data      less than 200      200-220      220-240      240-260      260-280      280-300      300-320      320-340      340-360      360-380      380-400      more than 400

OA affects nearly 27 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will show symptoms.[6] In the United States, hospitalizations for osteoarthritis soared from about 322,000 in 1993 to 735,000 in 2006.[7]

Gallery

Damaged cartilage in gross pathological specimen from sows. (a) cartilage erosion (b)cartilage ulceration (c)cartilage repair (d)osteophyte (bone spur) formation.

Histopathology of osteoarthrosis of a knee joint in an elderly female patient.
Primary osteoarthrosis (3) at knee joint.jpg
Primary osteoarthrosis (4) at knee joint.jpg
Primary osteoarthrosis (5) at knee joint.jpg

See also

References

  1. ^ osteoarthritis at Dorland's Medical Dictionary
  2. ^ Brandt, Kenneth D.; Dieppe, Paul; Radin, Eric (2008). "Etiopathogenesis of Osteoarthritis". Med Clin N Am 93 (1): 1–24. doi:10.1016/j.mcna.2008.08.009. PMID 19059018. 
  3. ^ Siddiqui, Furqan (2008-09-12). "Osteoarthritis". Emedicine. http://emedicine.medscape.com/article/1270114-overview. Retrieved 2009-01-27. 
  4. ^ a b Conaghan, Phillip. "Osteoarthritis - National clinical guideline for care and management in adults" (PDF). http://www.nice.org.uk/nicemedia/pdf/CG059FullGuideline.pdf. Retrieved 2008-04-29. 
  5. ^ Centers for Disease Control and Prevention (CDC) (February 2001). "Prevalence of disabilities and associated health conditions among adults—United States, 1999". MMWR Morb Mortal Wkly Rep. 50 (7): 120–5. PMID 11393491. 
  6. ^ a b c Green GA (2001). "Understanding NSAIDs: from aspirin to COX-2". Clin Cornerstone 3 (5): 50–60. doi:10.1016/S1098-3597(01)90069-9. PMID 11464731. 
  7. ^ a b Hospitalizations for Osteoarthritis Rising Sharply Newswise, Retrieved on September 4, 2008.
  8. ^ Brandt, K.D.; Dieppe, P.; Radin, E. (2009). "Etiopathogenesis of osteoarthritis". Med Clin North Am. 93 (1): 1–24. doi:10.1016/j.mcna.2008.08.009. PMID 19059018. 
  9. ^ Simon, H; Zieve D (2005-05-08). "Osteoarthritis". University of Maryland Medical Center. http://www.umm.edu/patiented/articles/what_osteoarthritis_000035_1.htm. Retrieved 2009-04-25. 
  10. ^ "Childhood abuse may be linked to osteoarthritis". Toronto: Prokerala News. 03 November 2009. http://www.prokerala.com/news/articles/a90291.html. 
  11. ^ McAlindon, T., Formica, M., Schmid, C.H., & Fletcher, J. (2007). Changes in barometric pressure and ambient temperature influence osteoarthritis pain. The American Journal of Medicine, 120(5), 429-434.
  12. ^ MedlinePlus Encyclopedia Osteoarthritis
  13. ^ a b c Kokebie R and Block JA (June 28, 2008). "Managing osteoarthritis: Current and future directions". Journal of Musculoskeletal Medicine. http://jmm.consultantlive.com/display/article/1145622/1404662. 
  14. ^ Water on the knee, MayoClinic.com
  15. ^ Valdes AM, Spector TD (August 2008). "The contribution of genes to osteoarthritis". Rheum Dis Clin North Am. 34 (3): 581–603. doi:10.1016/j.rdc.2008.04.008. PMID 18687274. 
  16. ^ Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505-514.
  17. ^ Bierma-Zeinstra SM, Oster JD, Bernsen RM, Verhaar JA, Ginai AZ, Bohnen AM. Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care. J Rheumatol. 2002;29:1713-1718
  18. ^ Altman R, Alarcón G, Appelrouth D, et al. (1990). "The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand". Arthritis Rheum. 33 (11): 1601–10. doi:10.1002/art.1780331101. PMID 2242058. 
  19. ^ Sturnieks DL, Tiedemann A, Chapman K, Munro B, Murray SM, Lord SR. Physiological risk factors for falls in older people with lower limb arthritis. J Rheumatol. 2004;31:2272-2279
  20. ^ Hip Pain and Mobility Deficits – Hip Osteoarthritis: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther 2009;39(4):A1-A25. doi:10.2519/jospt.2009.0301
  21. ^ Hip Pain and Mobility Deficits – Hip Osteoarthritis: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther 2009;39(4):A1-A25. doi:10.2519/jospt.2009.0301
  22. ^ http://www.cfp.ca/cgi/content/abstract/55/9/871?etoc
  23. ^ Hip Pain and Mobility Deficits – Hip Osteoarthritis: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther 2009;39(4):A1-A25. doi:10.2519/jospt.2009.0301
  24. ^ "Splint for Base-of-Thumb Osteoarthritis: A Randomized Trial -- Rannou et al. 150 (10): 661 -- Annals of Internal Medicine". http://www.annals.org/cgi/content/abstract/150/10/661. e
  25. ^ Stamm TA, Machold KP, Smolen JS, et al. (2002). "Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial". Arthritis Rheum. 47 (1): 44–9. doi:10.1002/art1.10246. PMID 11932877. 
  26. ^ Zhang W, Moskowitz RW, Nuki G, et al. (September 2007). "OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence". Osteoarthr. Cartil. 15 (9): 981–1000. doi:10.1016/j.joca.2007.06.014. PMID 17719803. 
  27. ^ Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI (1991). "Comparison of an antinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and paracetamol in the treatment of patients with osteoarthritis of the knee". N. Engl. J. Med. 325 (2): 87–91. PMID 2052056. 
  28. ^ Watkins PB, Kaplowitz N, Slattery JT, et al. (2006). "Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial". JAMA 296 (1): 87–93. doi:10.1001/jama.296.1.87. PMID 16820551. 
  29. ^ a b Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G (2006). "Acetaminophen for osteoarthritis". Cochrane Database Syst Rev (1): CD004257. doi:10.1002/14651858.CD004257.pub2. PMID 16437479. 
  30. ^ a b c d Zhang W, Moskowitz RW, Nuki G, et al. (February 2008). "OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines". Osteoarthr. Cartil. 16 (2): 137–62. doi:10.1016/j.joca.2007.12.013. PMID 18279766. 
  31. ^ Goldkind L, Simon LS. Patients, their doctors, nonsteroidal anti-inflammatory drugs and the perception of risk. Arthritis Res Ther. 2006;8:105
  32. ^ Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M (April 2005). "Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis". CMAJ 172 (8): 1039–43. doi:10.1503/cmaj.1041203. PMID 15824412. 
  33. ^ Richette P, Ravaud P, Conrozier T, et al. (March 2009). "Effect of hyaluronic acid in symptomatic hip osteoarthritis: a multicenter, randomized, placebo-controlled trial". Arthritis Rheum. 60 (3): 824–30. doi:10.1002/art.24301. PMID 19248105. 
  34. ^ Arroll B, Goodyear-Smith F (April 2004). "Corticosteroid injections for osteoarthritis of the knee: meta-analysis". BMJ 328 (7444): 869. doi:10.1136/bmj.38039.573970.7C. PMID 15039276. 
  35. ^ Moseley JB, O'Malley K, Petersen NJ, et al.. A controlled trial of arthroscopic surgery for osteoarthritis of the knee is proven to bring an improvement lasting for about two years. doi:10.1056/NEJMoa013259. PMID 12110735. http://content.nejm.org/cgi/content/full/347/2/81. 
  36. ^ White A, Foster NE, Cummings M, Barlas P (2007). "Acupuncture treatment for chronic knee pain: a systematic review". Rheumatology (Oxford) 46 (3): 384–90. doi:10.1093/rheumatology/kel413. PMID 17215263. http://rheumatology.oxfordjournals.org/cgi/content/full/46/3/384. 
  37. ^ Selfe TK, Taylor AG (2008 Jul-Sep). "Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials.". Fam Community Health 31 (3): 247–54. doi:10.1097/01.FCH.0000324482.78577.0f (inactive 2009-11-06). PMID 18552606. 
  38. ^ Manheimer E, Linde K, Lao L, Bouter LM, Berman BM (2007). "Meta-analysis: acupuncture for osteoarthritis of the knee". Ann. Intern. Med. 146 (12): 868–77. doi:10.1001/archinte.146.5.868. PMID 17577006. 
  39. ^ Bjordal, JM; et al. (2007). "Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials". BMC Musculoskeletal Disorders 8: 51. doi:10.1186/1471-2474-8-51. PMID 17587446. PMC 1931596. http://www.biomedcentral.com/1471-2474/8/51. 
  40. ^ Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I et al. (2008). "Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews." (pdf). Phys Ther 88 (1): 123–36. doi:10.2522/ptj.20070043. PMID 17986496. http://www.ptjournal.org/cgi/reprint/88/1/123. 
  41. ^ Zhang, W; et al. (2008). "OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines" (pdf). Osteoarthritis and Cartilage 16 (2): 137–162. doi:10.1016/j.joca.2007.12.013. PMID 18279766. http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf. 
  42. ^ Wang, S; Kain ZN; White PF (2008). "Acupuncture Analgesia: II. Clinical Considerations" (pdf). Anesth Analg 106 (2): 611–21. doi:10.1213/ane.0b013e318160644d. PMID 18227323. http://www.anesthesia-analgesia.org/cgi/reprint/106/2/611. 
  43. ^ "The effects of Glucosamine Sulphate on OA of the knee joint". http://www.bestbets.org/bets/bet.php?id=979. 
  44. ^ Poolsup N, Suthisisang C, Channark P, Kittikulsuth W (2005). "Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials". The Annals of pharmacotherapy 39 (6): 1080–7. doi:10.1345/aph.1E576. PMID 15855241. 
  45. ^ McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K (November 2004). "Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial". Am J Med 117 (9): 643–9. doi:10.1016/j.amjmed.2004.06.023. PMID 15501201. 
  46. ^ Vlad SC, Lavalley MP, McAlindon TE, Felson DT (2007). "Glucosamine for pain in osteoarthritis: Why do trial results differ?". Arthritis & Rheumatism 56 (7): 2267–77. doi:10.1002/art.22728. PMID 17599746. 
  47. ^ Terry DE, Rees-Milton K, Smith P, Carran J, Pezeshki P, Woods C, Greer P, Anastassiades TP. (2005). "N-acylation of glucosamine modulates chondrocyte growth, proteoglycan synthesis, and gene expression". J. Rheumatol. 32 (9): 1775–86. PMID 16142878. 
  48. ^ Reginster J.Y. The efficacy of glucosamine sulfate in osteoarthritis: financial and nonfinancial conflict of interest. Arthritis & Rheumatism, 2007; 56 (7): 2105-2110. Free full text.
  49. ^ Reichenbach S, Sterchi R, Scherer M, et al. (2007). "Meta-analysis: chondroitin for osteoarthritis of the knee or hip". Ann. Intern. Med. 146 (8): 580–90. PMID 17438317. 
  50. ^ Hardy et al. (2002). S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease. AHRQ, U.S. Department of Health and Human Services.
  51. ^ Najm WI, Reinsch S, Hoehler F, Tobis JS, Harvey PW (February 2004). "S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. [ISRCTN36233495]". BMC Musculoskelet Disord 5: 6. doi:10.1186/1471-2474-5-6. PMID 15102339. 
  52. ^ "JOINT RELIEF". www.herbcompanion.com. http://www.herbcompanion.com/health/JOINT-RELIEF.aspx?page=2. Retrieved 2009-01-12. 
  53. ^ Brien S, Lewith G, Walker A (2004). "Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies". Evidence-based complementary and alternative medicine: eCAM. 1 (3): 251–257. doi:10.1093/ecam/neh035. PMID 15841258. 
  54. ^ McAlindon TE, Jacques P, Zhang Y, et al. (1996). "Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis?". Arthritis Rheum. 39 (4): 648–56. doi:10.1002/art.1780390417. PMID 8630116. 
  55. ^ Altman RD, Marcussen KC (2001). "Effects of a ginger extract on knee pain in patients with osteoarthritis". Arthritis Rheum. 44 (11): 2531–8. doi:10.1002/1529-0131(200111)44:11<2531::AID-ART433>3.0.CO;2-J. PMID 11710709. 
  56. ^ "UNC News release -- Study links low selenium levels with higher risk of osteoarthritis". http://www.unc.edu/news/archives/nov05/jordan111005.htm. Retrieved 2007-06-22. 
  57. ^ Flynn MA, Irvin W, Krause G (1994). "The effect of folate and cobalamin on osteoarthritic hands". J Am Coll Nutr 13 (4): 351–6. PMID 7963140. 
  58. ^ Arabelovic S, McAlindon TE (2005). "Considerations in the treatment of early osteoarthritis". Curr Rheumatol Rep 7 (1): 29–35. doi:10.1007/s11926-005-0006-y. PMID 15760578. 
  59. ^ "WHO Disease and injury country estimates". World Health Organization. 2009. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html. Retrieved Nov. 11, 2009. 

External links

v • d • e
Musculoskeletal disorders: Arthropathies (M00-M19, 711-719)
Arthritis
(monoarthritis/
polyarthritis)
Noninfectious
Noninflammatory
Osteoarthritis: Heberden's node · Bouchard's nodes
Other
joint navs: anat, non-congenital arthropathies/deformities/dorsopathies/soft tissue arthropathy/congenital, eponymous signs, proc

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Translations: Osteoarthritis
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Home > Library > Literature & Language > Translations

Dansk (Danish)
n. - osteoarthritis

Nederlands (Dutch)
osteoartritis

Français (French)
n. - ostéoarthrite

Deutsch (German)
n. - (Med.) Degenerierung der Gelenkknorpel

Ελληνική (Greek)
n. - (παθολ.) οστεοαρθρίτιδα

Italiano (Italian)
osteoartrite

Português (Portuguese)
n. - osteoartrite (f), inflamação crônica das articulações

Русский (Russian)
остеоартрит

Español (Spanish)
n. - osteoartritis

Svenska (Swedish)
n. - osteoartrit, ledgångsinflammation

中文（简体）(Chinese (Simplified))
骨关节炎

中文（繁體）(Chinese (Traditional))
n. - 骨關節炎

한국어 (Korean)
n. - 관절염

日本語 (Japanese)
n. - 骨関節炎, 骨関節症

العربيه (Arabic)
‏(الاسم) مرض التهاب المفاصل‏

עברית (Hebrew)
n. - ‮דלקת פרקים‬

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Medical Encyclopedia. © 2006 through a partnership of Answers Corporation. All rights reserved.  Read more
Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
Britannica Concise Encyclopedia. Britannica Concise Encyclopedia. © 2006 Encyclopædia Britannica, Inc. All rights reserved.  Read more
Food and Fitness. Food and Fitness: A Dictionary of Diet and Exercise. Copyright © 1997, 2003 by Oxford University Press. All rights reserved.  Read more
Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved.  Read more
Alternative Medicine Encyclopedia. Encyclopedia of Alternative Medicine. Copyright © 2005 by The Gale Group, Inc. All rights reserved.  Read more
Encyclopedia of Public Health. Encyclopedia of Public Health. Copyright © 2002 by The Gale Group, Inc. All rights reserved.  Read more
Sports Science and Medicine. The Oxford Dictionary of Sports Science & Medicine. Copyright © Michael Kent 1998, 2006, 2007. All rights reserved.  Read more
Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Osteoarthritis".  Read more
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