Allan C. Gelber, MD, MPH, PhD
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2581.
Requests for Single Reprints: Allan C. Gelber, MD, MPH, PhD, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Suite 4100, Baltimore, MD 21224; e-mail, email@example.com.
Gelber A.; Knee Pain and Osteoarthritis: Lessons Learned and Lessons to Be Learned. Ann Intern Med. 2011;155:786-787. doi: 10.7326/0003-4819-155-11-201112060-00011
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Published: Ann Intern Med. 2011;155(11):786-787.
Of all the forms of arthritis, osteoarthritis is the most common. An estimated 27 million U.S. adults have clinical osteoarthritis (1). Since the 1950s, the presence of osteoarthritis has been principally defined by its radiographic hallmarks, as articulated by Kellgren and Lawrence (2), who described the presence of an osteophyte (spur), joint space narrowing, subchondral cyst, and eburnation (or bony sclerosis) as key radiographic features of the disease. Although these radiographic findings continue to guide clinical evaluation of the patient presenting with joint pain, a diagnosis of osteoarthritis needs to take into account the clinical context, comorbid conditions, and functional capacity of the affected person.
Clive L., Sinoff, Physician
December 12, 2011
Possible explanation for increasing prevalence of osteoarthritis.
The article by Nguyen et al describes the inexorable rise in the prevalence of osteoarthritis of the knee. Ross Hauser, M.D., in two extensive reviews, convincingly shows the correlation of the prevalence of osteoarthritis with the use of anti-inflammatory agents, both NSAIDs and corticosteroid injections. He also provides strong basic science and animal experimental evidence of the probable mechanism to strengthen his thesis. In view of such evidence, the question arises why the "standard" treatment for musculo-skeletal conditions should so commonly involve these anti-inflammatory agents.
1. Hauser RA. The deterioration of articular cartilage in osteoarthritis by corticosteroid injections. J Prolotherapy 2009;1:107-123.
2. Hauser RA. The acceleration of articular cartilage degeneration in osteoarthritis by nonsteroidal anti-inflammatory drugs. J Prolotherapy 2010;2:305-322.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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