Medical management of osteoarthritis
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7266.936 (Published 14 October 2000) Cite this as: BMJ 2000;321:936
- 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 …
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