Osteoarthritis: Practical Nondrug Steps to Successful Therapy
The diagnosis of osteoarthritis (OA) is primarily clinical. Key historical clues to idiopathic OA include patient age greater than 45 years, joint pain that increases with activity and is relieved with rest, morning stiffness of 30 minutes duration or less, and involvement of one or more of the following: hips, knees, cervical or lumbar spine, basilar thumb joints, interphalangeal joints of the hands, midfoot joints, and first metatarsophalangeal joints.
For a disorder so common that it may deservedly be considered part of the human condition, osteoarthritis (OA) can be surprisingly complex and controversial. The array of therapeutic options-including educational, physical, pharmacologic, and surgical interventions-is vast.
To reflexively prescribe NSAIDs as the sole therapeutic approach to OA results in missed opportunities to improve patients' quality of life-and risks potentially significant adverse drug effects. Here, we focus on effective nondrug approaches. In the second part of our article (beginning on page 88), we discuss drug therapy and surgery.
OVERVIEW
OA affects more than 20 million Americans. The prevalence of radiographic OA is even higher; many patients who have typical radiographic findings are asymptomatic. For example, almost all persons aged 65 to 74 years have radiographic OA of the hands; one third of those aged 63 to 93 years have findings indicative of OA on knee radiographs.1
Most OA is idiopathic. Idiopathic, or primary, OA can be linked to:
Advancing age.
Obesity.
Occupational overloading of joints.
Familial type II collagen gene polymorphisms.2
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