Diagnosis & Treatment of Osteoarthritis Reviewed Save

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)