Evaluation and Treatment of the Patient with Osteoarthritis

Other Recommendations

On the basis of lower-quality studies, the American College of Rheumatology also recommends the following for individual patients: a weight-loss program, an occupational therapy evaluation, bracing and footwear, joint lavage of the knee, arthroscopic debridement of the knee, and osteotomy of the knee or hip.^45,52 The benefits from these interventions have not been well studied. The costs and benefits of these interventions must be weighed before recommending them to individual patients. Most trials have been conducted in patients with OA of the knee or hip. We do not know if applying treatment modalities to other joints (back and hands) will produce similar results. Also, most trials have been placebo controlled, and we do not know whether some treatments would add benefit to the first-line therapy of acetaminophen and NSAIDs.

Prognosis

OA is a chronic progressive disease of the joints that leads to increased pain and decreased functioning. Two longitudinal studies examined the natural course of OA of the knee in 191 patients. They showed that 56% of patients had no change, and 44% worsened over 15 years.^53-55 A study of OA of the hip showed similar trends except that a small group (7%) experienced improvement over 10 years.⁵⁶ We do not know whether current treatment options can improve the long-term prognosis of OA. Epidemiologic studies suggest that increasing age, obesity, family history, occupation, and joint injury are risk factors for OA.^6,53 Whether modifying these risk factors will decrease symptoms or slow the course of the disease is not known. The progressive nature of OA makes treatment a challenge for the patient and clinician.