David T. Felson, MD, MPH; Reva C. Lawrence, MPH; Marc C. Hochberg, MD, MPH; Timothy McAlindon, MD, MPH; Paul A. Dieppe, MD; Marian A. Minor, PT, PhD; Steven N. Blair, PED; Brian M. Berman, MD; James F. Fries, MD; Morris Weinberger, PhD; Kate R. Lorig, RN, DrPH; Joshua J. Jacobs, MD; Victor Goldberg, MD
Felson DT, Lawrence RC, Hochberg MC, McAlindon T, Dieppe PA, Minor MA, et al. Osteoarthritis: New Insights. Part 2: Treatment Approaches. Ann Intern Med. 2000;133:726-737. doi: 10.7326/0003-4819-133-9-200011070-00015
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Published: Ann Intern Med. 2000;133(9):726-737.
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors, such as genetics, diet, estrogen use, and bone density, and local biomechanical factors, such as muscle weakness, obesity, and joint laxity. These risk factors are particularly important in the weight-bearing joints, and modifying them may help prevent osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 2 of a two-part summary of a National Institutes of Health conference that brought together experts in osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 2 focuses on treatment approaches; evidence for the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is presented. Biomechanical interventions, such as exercise and bracing, and behavioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnology-oriented approaches to treatment are suggested.
The white circles represent the effect size of each glucosamine trial; 0 represents no effect relative to placebo. Horizontal lines represent 95% CIs. The white diamond represents aggregate results (with 95% CI) for glucosamine trials. The black circles and diamonds represent the same features for chondroitin. Data from reference 48.
Pain was measured by using a visual analogue scale in which patients were asked to quantify their current pain. The depression score is derived from Center for Epidemiologic Studies–Depression symptoms scale. Data from reference 107.
Selected Preliminary Clinical Results of Cartilage Transplantation
From Boston University School of Medicine, Boston, Massachusetts; National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; MRC Health Services Research Collaboration, University of Bristol, Bristol, United Kingdom; University of Missouri, Columbia, Missouri; Cooper Institute for Aerobics Research, Dallas, Texas; Stanford University School of Medicine, Palo Alto, California; Indiana University, Indianapolis, Indiana; Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; and Case Western Reserve University, Cleveland, Ohio.
An edited summary of a Scientific Conference held on 23–24 July 1999 at the National Institutes of Health, Bethesda, Maryland.
Authors who wish to cite a section of the conference and specifically indicate its author may use this example for the form of the reference: Hochberg MC, McAlindon T, Felson DT. Systemic and topical treatments. In: Felson DT, conference chair. Osteoarthritis: new insights. Part 2: Treatment approaches. Ann Intern Med. 2000; 133:726-729.
Disclosure: Dr. Hochberg receives research support from and is a consultant to Merck and Co. Dr. Blair is a consultant to Knoll Pharmaceuticals and Roche Laboratories; has science or research contracts with Polar Electro Oy, McNeil Consumer Products, and Roche Laboratories; and is on the Scientific Advisory Boards of Life Fitness International, Polar Electro Oy, E-Med, Jenny Craig, Bally Total Fitness Sports Medicine, and Sherbrooke Capital. Dr. Jacobs is a consultant to Zimmer, Inc., and receives research support from Zimmer, Inc., Merck and Co., and Wright Medical.
Acknowledgments: The authors thank the conference moderators who helped synthesize the thoughts presented here: Allan Gelber, MD; Margaret Lethbridge-Cejku, PhD; Joanne M. Jordan, MD, MPH; Roland W. Moskowitz, MD; Kenneth D. Brandt, MD; Van C. Mow, PhD; and Stephen B. Trippel, MD. They also thank Cori Vanchieri, Constance Raab, and Susan Stark for editorial assistance.
Grant Support: The conference was initiated, organized, and funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH), which also coordinated and funded the reporting of the proceedings. Cofunding for the conference was provided by the NIH Office of Disease Prevention, NIH National Center for Complementary and Alternative Medicine, NIH Office of Research on Women's Health, NIH Office of Behavioral and Social Sciences Research, NIH National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, Centers for Disease Control and Prevention, Arthritis Foundation, and American Academy of Orthopaedic Surgeons.
Requests for Single Reprints: Reva C. Lawrence, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 45, Room 5AS-37G, Bethesda, MD 20892-6500.
Current Author Addresses: Drs. Felson and McAlindon: Boston University School of Medicine, 715 Albany Street, Room A203, Boston, MA 02118.
Ms. Lawrence: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 45, Room 5AS-37G, Bethesda, MD 20892-6500.
Dr. Hochberg: University of Maryland School of Medicine, 10 South Pine Street, MSTF 8-34, Baltimore, MD 21201.
Dr. Dieppe: MRC Health Services Research Collaboration, University of Bristol, Canynge Hall, Whiteladies Road, BS8 2PR, Bristol, United Kingdom.
Dr. Minor: Department of Physical Therapy, University of Missouri, 106 Lewis Hall, Columbia, MO 65211.
Dr. Blair: Cooper Institute for Aerobics Research, 12330 Preston Road, Dallas, TX 75230.
Dr. Berman: University of Maryland School of Medicine, Complementary Medicine Program, 2200 Kernan Drive, 3rd Floor Mansion, Baltimore, MD 21207.
Dr. Fries: Stanford University School of Medicine, 1000 Welch Road, Suite 203, Palo Alto, CA 94304-5755.
Dr. Weinberger: Indiana University, 1001 West 10th Street, Indianapolis, IN 46202.
Dr. Lorig: Stanford Patient Education Research Center, Stanford University School of Medicine, 1000 Welch Road, Suite 204, Palo Alto, CA 94304.
Dr. Jacobs: Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833.
Dr. Goldberg: Department of Orthopaedics, School of Medicine, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106.
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