Regular review: Medical management of osteoarthritis

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 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 …