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Management of Osteoarthritis

Philip Courtney and Michael Doherty

Osteoarthritis (OA) is a major cause of pain and participation restriction. Recent evidence-based guidelines agree in terms of their core advice. Management of OA patients should be individualized and patient-centered, and non-pharmacological measures (including information access, exercise, weight reduction if overweight or obese, and reduction in adverse mechanical factors) are central to the management plan. There are a large number of additional interventions from which to select. In view of its efficacy, safety, and cost-effectiveness, paracetamol remains the preferred oral analgesic of choice in OA. Topical analgesics (e.g. nonsteroidal anti-inflammatory drugs or capsaicin) are safe and often effective. The addition of other systemic or intra-articular pharmacological agents and recommended non-pharmacological treatments should be considered, depending on individual patient factors. No drug is currently licensed as a disease-modifying agent. Patients who fail to respond adequately to conservative measures should be considered for surgery before there is established chronic pain and functional impairment. A holistic approach to the patient, and optimization of contextual responses, will improve the effectiveness of any intervention for OA.Int J Adv Rheumatol 2009;7(3):73–83.

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