Osteoarthritis

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Osteoarthritis

Also known as degenerative joint disease, osteoarthritis is a condition caused by degeneration of articular cartilage and remodeling of subchondral bone. Prevalence increases with age with up to 33% of persons over 63 years of age effected (1). Controversy exists as to whether the radiographic appearance of osteoarthritis alone is sufficient for a diagnosis or if symptomology must accompany radiographic appearance (2). Additionally the term “osteoarthritis” may be a misnomer as inflammation is rarely involved.

(1) Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1987; 30(8):914-918.; (2) Hinton R, Moody RL, Davis AW, Thomas SF. Osteoarthritis: diagnosis and therapeutic considerations. Am Fam Physician 2002; 65(5):841-848.

Clinical Reviews

Osteoarthritis: Prevention

Osteoarthritis (OA) is a condition that can involve any moveable joint in the body and can have profound impact on quality of life. It is commonly associated with the aging process yet early onset and accelerated progression is usually the result of poor lifestyle choices. Prevention strategies can be very effective in reducing the risk of developing early OA or slowing progression when established.

Osteoarthritis: Diagnosis

Diagnosis of osteoarthritis is primarily based on history, examination and radiographic examination. Interestingly no clear consensus has been developed that specifically defines the diagnostic criteria for OA. One question that has yet to be answered is whether radiographic changes without pain or disability are properly diagnosed as OA. The criteria established by the American Board of Rheumatology for diagnosis follows.

Osteoarthritis: Therapy

The osteoarthritic patient presents the physician with a wide variety of treatment options. Interventions ranging from avocado/soybean unsaponifiables to water based-exercise have been investigated with at least limited evidence to support their efficacy. Although none are curative, many appear to be able to reduce pain and disability as well as improve function associated with osteoarthritis (OA).

Medical Subject Heading (MeSH) Information

MeSH Term: Osteoarthritis

Scope Note: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans.

MeSH Synonyms:

Osteoarthritis
Osteoarthritides
Osteoarthrosis
Osteoarthroses
Arthritis, Degenerative
Arthritides, Degenerative
Degenerative Arthritides
Degenerative Arthritis
Osteoarthrosis Deformans

Applicable MeSH Subheadings:

analysis
anatomy and histology
blood
cerebrospinal fluid
chemically induced
classification
complications
congenital
cytology
diagnosis
diet therapy
drug therapy
economics
embryology
enzymology
epidemiology
ethnology
etiology
genetics
history
immunology
metabolism
microbiology
mortality
nursing
organization and administration
parasitology
pathology
physiology
physiopathology
prevention and control
psychology
radiography
radionuclide imaging
radiotherapy
rehabilitation
statistics and numerical data
surgery
therapy
ultrasonography
ultrastructure
urine
veterinary
virology

One-Click Literature Search

Osteoarthritis AND Prevention

Osteoarthritis AND Diagnosis

Osteoarthritis AND Therapy

Informative Links

MayoClinic.com Osteoarthritis Information

Mayo Clinic Health Solutions' award-winning consumer Web site offers health information and self-improvement tools. MayoClinic.com's medical experts and editorial professionals bring you access to the knowledge and experience of Mayo Clinic for all your consumer health information needs, from cancer, diabetes and heart disease to nutrition, exercise and pregnancy.

MedlinePlus: Osteoarthritis

MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

Current Clinical Trials Relating to Osteoarthritis

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

Conjoint Analysis of Treatment Preferences for Osteoarthritis

(Status: Active, not recruiting)

Patient and Provider Interventions for Managing Osteoarthritis in Primary Care

(Status: Active, not recruiting)

Patient and Provider Interventions for Managing Osteoarthritis in Primary Care

(Status: Recruiting)

A Study of the KineSpring System Versus High Tibial Osteotomy Surgery for the Treatment of Medial Compartment Knee Osteoarthritis

(Status: Enrolling by invitation)

Etude 3000 ARTHROSES Symptomatic Knee and Hip Osteoarthritis Prevalence Survey

(Status: Completed)

A Study of the Safety and Efficacy of Hylan G-F 20 (Synvisc) in Patients With Symptomatic Osteoarthritis of the Knee

(Status: Completed)

A Safety and Effectiveness Study of Acetaminophen (4000 mg/Day) and Naproxen (750 mg/Day) in the Treatment of Osteoarthritis of the Hip or Knee

(Status: Completed)

Milnacipran for Chronic Pain in Knee Osteoarthritis

(Status: Recruiting)

An Analysis of Potential Sex Differences in Knee Osteoarthritis

(Status: Enrolling by invitation)

Assessment of Efficacy of Low Intensity Resistance Training in Women at Risk for Symptomatic Knee Osteoarthritis

(Status: Active, not recruiting)

Cupping in Osteoarthritis of the Knee

(Status: Completed)

A Double-Blind, Double Dummy, Randomized Comparison Study Of The Efficacy And Safety Of Valdecoxib 10mg Once Daily And Naproxen 500mg Twice Daily In Treating The Signs And Symptoms Of Osteoarthritis Of The Knee Or Hip In Taiwan

(Status: Completed)

A Dose-ranging Study of the Safety and Effectiveness of JNJ-42160443 as add-on Treatment in Patients With Osteoarthritis-related Pain

(Status: Terminated)

Investigation of Specific Protein/Markers in Patients With Osteoarthritis of the Knee Having a Total Knee Replacement

(Status: Completed)

Group Physical Therapy for Knee Osteoarthritis

(Status: Completed)

Observational Study Investigating the Effectiveness of Fentanyl Matrix in Relieving Pain and Improving Function in Patients With Osteoarthritis of the Knee or Hip

(Status: Completed)

Durolane Versus Phosphate Buffered Saline (PBS) in Knee Osteoarthritis

(Status: Recruiting)

A Safety and Tolerability Study of JNJ-42160443 in Patients With Moderate to Severe, Chronic Knee Pain From Osteoarthritis

(Status: Terminated)

A Study To Investigate Whether PF-04457845 Is Effective In Treating Pain, Is Safe And Tolerable In Patients With Osteoarthritis Of The Knee

(Status: Completed)

Structured Non-operative Treatment of Knee Osteoarthritis

(Status: Recruiting)

20 Clinical Trials Returned

Carotenoids, Vitamin E and Osteophytes

ChiroACCESS Editorial Staff

For the first time, lumbar spine osteophyte formation has been linked to levels of carotenoids and vitamin E.

ChiroACCESS |

January 12, 2012

Ultrasound Therapy: 2010 Research Support

ChiroACCESS Editorial Staff

Typically physical therapy modalities have had very poor evidence to support their use. Despite the historical lack of evidence 63% of chiropractors use ultrasound for therapy. Positive results account for this significant segment of the profession using ultrasound therapy (UT) but without evidence reimbursement has become a challenge. Fortunately more emphasis is now being placed on examining the efficacy of UT and there have been a significant number of research studies published in 2010 that support its use. Two different papers recommend UT for myofascial pain syndromes. It is characterized as both safe and cost-effective for trigger points. In another small (N=26) single blind trigger point study the conclusion was that “Thermal ultrasound over latent trigger points is comfortable and can decrease stiffness of a trigger point”.

ChiroACCESS |

October 11, 2010

Weather Changes, Atmospheric Pressure and Joint Pain

ChiroACCESS Editorial Staff

It is common to have patients comment that they feel increased pain and stiffness accompanying changes in the weather. Some claim to be virtual weather stations with accuracy surpassing the local meteorologist. But is there any science to support these comments? The answer is “yes”.

ChiroACCESS |

July 14, 2010

Evidence Supports the Use of Therapeutic Ultrasound for Joint Osteoarthritis

ChiroACCESS Editorial Staff

Despite the historical use of many physical therapy modalities in health care, most have little evidence supporting their use. Ultrasound is one of the most commonly used of these therapeutic modalities. Based upon the Job Analysis of Chiropractic (NBCE 2005), 66.1% of U.S. chiropractors utilize ultrasound in their practices and nearly a third (31%) of all of their patients received ultrasound therapy.

ChiroACCESS |

June 7, 2010

Cat’s Claw and Other Dietary Anti-Inflammatory Aids for Arthritis

ChiroACCESS Editorial Staff

Osteoarthritis (degenerative joint disease) is one of the top five conditions seen in chiropractic clinics (Job Analysis of Chiropractic 2005). The use of glucosamine, chondroitin and MSM are common in many chiropractic practices to assist with the management of these and other arthritic conditions.

ChiroACCESS |

May 13, 2010

Prolotherapy, Where Does It Stand Today?

Dwain M. Daniel, D.C.

Prolotherapy is a somewhat controversial intervention for a variety of musculoskeletal complaints. The treatment consists of a series of injections of an irritant, usually a dextrose based compound, into painful soft tissues. In theory the injection begins a controlled inflammatory response. This in turn causes connective tissue growth and collagen tissue formation resulting in a more stable, less painful joint or strengthened tendons or ligaments.

ChiroACCESS |

April 19, 2010

Money and Spinal Surgery: What Happened to the Patient?

ChiroACCESS Editorial Staff

There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions.

ChiroACCESS |

April 8, 2010

Leg Length and Osteoarthritis

ChiroACCESS Editorial Staff

Two recent publications examining the possible relationship between leg length inequality and osteoarthritis have resulted from the Multicenter Osteoarthritis Study (MOST).

ChiroACCESS |

March 3, 2010

An Evidenced-Based Intervention for Osteoarthritis: Avocado-soybean Unsaponifiables

ChiroACCESS Editorial Staff

Avocado soybean unsaponifiables (ASU) is a largely ignored supplement in the popular media and in doctor’s offices. In spite of a lack of recognition it has possibly the highest level of evidence supporting its effectiveness of all the herbal or nutritional supplements.

ChiroACCESS |

November 23, 2009

Acupuncture

(Osteoarthritis: Therapy)

Although acceptance of acupuncture as a treatment for OA has been supported in two recent systematic reviews (13;14), a degree of controversy is still present. A review of reviews was published in....

Published On

February 28, 2007

Avocado/Soybean Unsaponifiables

(Osteoarthritis: Therapy)

The reason avocado/soybean unsaponifiables (ASU) did not achieve an “A” rating was due to the limited number of studies performed. A Cochrane review performed in 2001 found the evidence for the....

Published On

February 28, 2007

Biomechanical Factors

(Osteoarthritis: Prevention)

Biomechanical factors such as varus/valgus laxity (17) and quadriceps weakness (18) have been associated with OA, particularly in women.

Published On

February 28, 2007

Braces/Orthosis

(Osteoarthritis: Therapy)

Several different devices have been developed to treat knee OA. One is subtalar strapping with a lateral wedged insole (SSLWI). Toda et al. have published 9 studies relating to SSLWI. The most recent....

Published On

February 28, 2007

Chiropractic

(Osteoarthritis: Therapy)

One study was located that explored chiropractic treatment for back pain from OA. This study was a RCT of 258 patients that compared chiropractic care plus heat packs to heat packs alone.....

Published On

February 28, 2007

Corticosteroid Injection

(Osteoarthritis: Therapy)

There is evidence that corticosteroid injections (CI) have a short term benefit for the relief of pain and improved function in OA (65).

Published On

February 28, 2007

Education

(Osteoarthritis: Therapy)

Education plays an important role in the treatment of OA. The Arthritis Self-Management Program (ASMP) has been tested for effectiveness in at last two studies and demonstrated positive effects in....

Published On

February 28, 2007

Exercise

(Osteoarthritis: Therapy)

In 2004 an expert committee, after a thorough review of the literature, published a consensus document which concluded strengthening and aerobic exercise can reduce pain and improve function in hip....

Published On

February 28, 2007

Genetic Factors

(Osteoarthritis: Prevention)

A 1996 study of 250 twins found that between 39% and 65% of OA can be attributed to genetic factors (19). Although there is no prevention strategy for genetic factors, it is wise to identify those....

Published On

February 28, 2007

Glucosamine Sulfate/Chondroitin Sulfate

(Osteoarthritis: Therapy)

Glucosamine sulfate (GS) and chondroitin sulfate (CS) have been touted as effective for the treatment of OA in the lay press for many years. Studies supporting these claims have been criticized by....

Published On

February 28, 2007

Laser

(Osteoarthritis: Therapy)

The great difficulty in evaluating low level laser studies is the wide variety of wavelengths, output power, location of points treated and dosage of treatment. A recent Cochrane review located 7....

Published On

February 28, 2007

Manual Therapy

(Osteoarthritis: Therapy)

A RCT of 83 patients was performed which compared manual therapy and exercise to a placebo control group (subtherapeutic ultrasound) in the treatment of knee OA. Manual therapy was defined as passive....

Published On

February 28, 2007

Nutraceuticals

(Osteoarthritis: Therapy)

A large number of nutraceuticals have been identified as potentially effective treatment alternatives for OA. Unfortunately, except for GS/CS and ASU, only limited research, much of which is lower....

Published On

February 28, 2007

Nutritional Factors

(Osteoarthritis: Prevention)

Although it does not appear low intake and low levels of vitamin D are a risk factor in developing OA in a normal knee, there is a strong relationship between low intake and low levels of vitamin D....

Published On

February 28, 2007

Obesity

(Osteoarthritis: Prevention)

Obesity is considered the main preventable risk factor for OA (1). The effect of even modest weight gain can have significant impact on the development of OA. A 1993 twin study found a 9% - 13% risk....

Published On

February 28, 2007

Occupational Factors

(Osteoarthritis: Prevention)

A French study of 2834 subjects found that working in the cleaning or clothing industry was strongly related to onset of OA in women while in men OA was most closely related to mechanics,....

Published On

February 28, 2007

Pharmacologic Treatment

(Osteoarthritis: Therapy)

Acetaminophen is considered the drug of choice in OA due to its pain relieving properties and reduced side effects according to The American Family Physician (61) although in numerous studies NSAID’s....

Published On

February 28, 2007

Sodium Hyaluronate Injection

(Osteoarthritis: Therapy)

Bellamy et al. concluded in their review that sodium hyaluronate was as effective as CI but longer lasting in the treatment of knee OA (65).

Published On

February 28, 2007

Spa Therapy

(Osteoarthritis: Therapy)

For the purpose of this report spa therapy encompasses balneotherapy (mineral water therapy), mud-pack therapy, and massage. Some research has been published in English speaking journals but much of....

Published On

February 28, 2007

Sports Participation/Injury

(Osteoarthritis: Prevention)

Participation in sports can lead to OA due to injury to a joint or cumulative stress on a joint without injury. Sports that appear to increase risk are those that involve twisting of the joints, are....

Published On

February 28, 2007

Thermotherapy

(Osteoarthritis: Therapy)

This group includes modalities which raise or lower tissue temperature. As with so many interventions much of the research is lower quality and often strongly conflicting.

A.....
Published On
February 28, 2007

Total Knee Replacement

(Osteoarthritis: Therapy)

It is beyond the scope of this monograph to critically discuss joint replacement surgery. The American Family Physician considers it a valid option when severe symptoms persist in a patient despite....

Published On