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Upon completion of the chapter, the reader will be able to:

  1. Explain the pathophysiologic mechanisms involved in the development of osteoarthritis (OA).

  2. Identify risk factors associated with OA.

  3. Recognize the clinical presentation of OA.

  4. Determine the goals of therapy for individual patients with OA.

  5. Formulate a rational nonpharmacologic plan for patients with OA.

  6. Recommend a pharmacologic plan for treating OA, taking into consideration patient-specific factors.

  7. Modify an unsuccessful treatment strategy for OA.

  8. Develop monitoring parameters to assess effectiveness and adverse effects of pharmacotherapy for OA.

  9. Deliver effective disease-state counseling, including lifestyle modifications and drug therapy, to facilitate effective and safe management of OA.




  • Image not available. Osteoarthritis (OA) is the most common form of arthritis and is most prevalent in the middle to later years of life.

  • Image not available. The most common symptoms are joint pain, reduced range of motion, and brief joint stiffness after periods of inactivity.

  • Image not available. Treatment goals are to educate the patient and caregivers, relieve pain, maintain or restore mobility, minimize functional impairment, preserve joint integrity, and improve quality of life.

  • Image not available. Nonpharmacologic therapy is the cornerstone of treatment; education, exercise, weight loss, and cognitive behavioral intervention are integral components.

  • Image not available. Acetaminophen is the initial drug of choice; an adequate dose and duration of therapy should be used before resorting to other drug classes.

  • Image not available. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be initiated if acetaminophen therapy fails. At equipotent doses, all NSAIDs elicit similar analgesic and anti-inflammatory responses. Selection is based on patient preference, previous response, dosing frequency, tolerability, and cost.

  • Image not available. Patients who do not respond adequately to one NSAID may respond to a different NSAID.

  • Image not available. NSAIDs are associated with adverse GI, renal, hepatic, cardiovascular, and CNS effects and may increase blood pressure.

  • Image not available. NSAIDs that are selective for the cyclooxygenase-2 (COX-2) enzyme are less likely to cause GI complications but may increase the risk of cardiovascular events. COX-2 inhibitors are no more effective than nonselective NSAIDs and should be reserved for patients at high risk of GI complications and low risk for cardiovascular events.

  • Image not available. Glucosamine, tramadol, opioids, topical capsaicin, topical NSAIDs, intraarticular corticosteroids, hyaluronic acid, and surgery may be beneficial in certain situations.




Image not available. Osteoarthritis (OA) is the most common form of arthritis. Weight-bearing joints (e.g., hips and knees) are most susceptible, but non–weight-bearing joints, especially the hands, may also be involved. Because of its high prevalence and involvement of joints critical for daily functioning, the disease causes tremendous morbidity and financial burden.1 OA is the leading cause of chronic mobility disability and the most common reason for total-hip and total-knee replacement.2 Image not available. OA is strongly related to age; thus its incidence and the cost of care will increase dramatically in the coming years due to a burgeoning senior citizenry.




The National Arthritis Data Workgroup estimates that 27 million Americans have signs and symptoms of OA....

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