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Last Updated: 3/7/2014  

Osteoarthritis

Diagnosis
  • Recognize the characteristic symptoms of osteoarthritis, including the insidious onset of pain with minimal stiffness.

  • Recognize the characteristic signs of osteoarthritis including joint line tenderness, crepitus, and limited range of motion.

  • Be aware of the ACR criteria for the diagnosis of hip, knee, and hand osteoarthritis, which include clinical criteria, low ESR, and radiographic abnormalities.

  • Perform radiographs to diagnose osteoarthritis of the hip and consider their use for other joints, recognizing their limited sensitivity.

Therapy
  • Recommend exercise for patients with osteoarthritis of the knee and hip for muscle strengthening and aerobic fitness and consider referral to physical therapy.

  • Recommend weight loss in overweight patients with knee and hip osteoarthritis.

  • Treat patients with painful hip and knee osteoarthritis with acetaminophen as a first-line medication.

  • Treat patients with osteoarthritis pain who have inadequate response to acetaminophen with topical or oral NSAIDs.

  • Consider intra-articular glucocorticoids for short term relief of knee and hip osteoarthritis pain.

  • Use narcotic analgesics and tramadol to treat severe osteoarthritis pain which cannot be controlled with other agents.

  • Consider topical capsaicin in the treatment of osteoarthritis-related pain of the hand .

  • Consider intra-articular hyaluronic acid only in select patients with osteoarthritis of the knee who have no response to other therapies.

  • Refer patients with osteoarthritis pain that has not responded to standard therapy to a surgeon for evaluation for arthroplasty of the hip or knee.

  • Consider assistive technology, including canes, knee braces, and hand splints, for certain patients with osteoarthritis.

DOI: 10.7326/d206
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Steven T. Hugenberg, MD received grants from Merck, Novartis, Q-Med, Amgen, Hoffman-LaRoche, owns stocks in Eli Lilly and Co., Bristol-Myers, Johnson & Johnson, Sanofi, Novartis, Glaxo, Procter and Gamble, Boston Scientific, Amgen, NovoNordisk, Pfizer. Louis Flaspohler, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Baldeep Singh, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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