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Diagnosis & Treatment of Osteoarthritis Reviewed

Feb 22, 2021 12:35 pm

Katz, Arant and Loeser have published a comprehensive open-read overview of osteoarthritis (OA) of the hip and knee in JAMA; underscoring the impact, advances, disappointments and guidelines put forth. 

OA affects an estimated more than 240 million people worldwide, and more than 32 million in the US. As psteoarthritis is a major cause of pain, activity limitation and surgery, they addressed the diagnosis and treatment of hip and knee OA.

Notable takeaways from this review include:

  • Risk factors include age female sex, obesity, genetics, and major joint injury.
  • OA patients have more comorbidities, reduced physical activity and a 20% higher age-adjusted mortality. Nearly 31% OA patients have 5 or more comorbid conditions
  • The prevalence of symptomatic, radiographic hip OA is around 10%
  • ~30% of adults over 45 years of age have radiographic knee OA, but only half knee symptoms.
  • The most predictice clinical features are osteophytes or pain with osteophytes.
  • While bony enlargement are very sensitive (~90%), they have low specificity (55-58%)
  • Key radiographic findings include marginal osteophytes and joint space narrowing.
  • OA management must include exercises, weight loss if appropriate, and education and be complemented by medical therapies.
  • There was a short paragraph on NSAID efficacy and a very long paragraph on NSAID toxicities
  • Intra-articular steroid injections provide short-term pain relief, have no longer benefits and when used repeatedly may have untoward consequences.
  • Agents of limited efficacy include acetaminophen and duloxetine
  • Opiates should be avoided.
  • Societies generally advise against glucosamine and chondroitin sulfate, hyaluronic acid injections, growth factor and platelet rich plasma injections
  • Drugs studied to limit structural progression - include IL-1 inhibition, cathepsin K inhibitors, Wnt inhibitors, anabolic growth factors
  • Drug in development to reduce OA pain - includes nerve growth factor inhibitors
  • There are significant racial and ethnic disparities in joint replacement surgery
  • There is no role for arthroscopic debriedment or menisectomy in treating OA
  • In the USA, there are 700 000 primary TKRs and 330 000 primary THRs performed annually (>90% OA)
  • The 90 day mortality is less than 1%, and serious complications at 90 days occur in less than 5% (revision surgery over 20 years is 10% with TKRs and 20% with THRs). 

OA Treatment Recommendations from the ACR, EULAR, OARSI and AAOS (American Academy of Orthopedic Surgeons)

Summary of Osteoarthritis Treatment Guidelines From Major Professional Societies

Disclosures
The author has no conflicts of interest to disclose related to this subject

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