Osteoarthritis

Abstract

Once thought to be a degenerative joint condition limited to the degeneration of cartilage, osteoarthritis (OA) is now known to be a complex combination of genetic, metabolic, biomechanical, and biochemical changes involving the entire joint and surrounding tissues. OA generally has a predilection for larger weight-bearing joints such as knees, hips, and the spine. Risk factors include age, female gender, genetics, bone density, and body weight. Most treatment for OA involves pain relief, maximizing joint function, and maintaining quality of life through pharmacologic and nonpharmacologic means. No pharmacologic intervention has conclusively been shown to alter disease progression. Oral and topical medications can alleviate symptoms, with acetaminophen often used as a first-line treatment and an emerging trend toward increased use of topical agents earlier and more often in the course of OA. A comprehensive rehabilitative approach to OA is preferred for disease management, including self-management interventions. Lifestyle changes such as exercise and weight loss have both been shown to be effective. Exercise should consist of joint protection techniques, stretching, strengthening, and aerobic training. Intra-articular corticosteroid injections are often used when oral/topical medications are ineffective. Procedures such as the intra-articular injection of botulinum toxin, platelet-rich plasma, and mesenchymal stem cell injections are becoming more widely used, but further research is needed.