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. 2003 Jul;79(933):377–383. doi: 10.1136/pmj.79.933.377

Osteoarthritis

I Haq 1, E Murphy 1, J Dacre 1
PMCID: PMC1742743  PMID: 12897215

Abstract

Osteoarthritis is a chronic degenerative disorder characterised by cartilage loss. It is extremely prevalent in society and is a major cause of disability. It is important to treat osteoarthritis effectively using a multidisciplinary approach tailored to the patient's needs. This paper reviews current thinking on the aetiology, pathogenesis, investigations, and management of osteoarthritis. The paper also discusses the challenges for developing good quality outcome measures for use in large scale multicentre clinical trials for new osteoarthritis treatments, especially disease modifying osteoarthritis drugs.

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Selected References

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  1. Altman R. D. Criteria for classification of clinical osteoarthritis. J Rheumatol Suppl. 1991 Feb;27:10–12. [PubMed] [Google Scholar]
  2. Angst F., Aeschlimann A., Steiner W., Stucki G. Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis. 2001 Sep;60(9):834–840. [PMC free article] [PubMed] [Google Scholar]
  3. Ayral X. Injections in the treatment of osteoarthritis. Best Pract Res Clin Rheumatol. 2001 Oct;15(4):609–626. doi: 10.1053/berh.2001.0177. [DOI] [PubMed] [Google Scholar]
  4. Bellamy N., Buchanan W. W., Goldsmith C. H., Campbell J., Stitt L. W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–1840. [PubMed] [Google Scholar]
  5. Bombardier C., Laine L., Reicin A., Shapiro D., Burgos-Vargas R., Davis B., Day R., Ferraz M. B., Hawkey C. J., Hochberg M. C. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med. 2000 Nov 23;343(21):1520-8, 2 p following 1528. doi: 10.1056/NEJM200011233432103. [DOI] [PubMed] [Google Scholar]
  6. Brand C., Snaddon J., Bailey M., Cicuttini F. Vitamin E is ineffective for symptomatic relief of knee osteoarthritis: a six month double blind, randomised, placebo controlled study. Ann Rheum Dis. 2001 Oct;60(10):946–949. doi: 10.1136/ard.60.10.946. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Brandt K. D., Bradley J. D. Should the initial drug be used to treat osteoarthritis pain be a nonsteroidal antiinflammatory drug? J Rheumatol. 2001 Mar;28(3):467–473. [PubMed] [Google Scholar]
  8. Brandt Kenneth D., Mazzuca Steven A., Conrozier Thierry, Dacre Jane E., Peterfy Charles G., Provvedini Diego, Ravaud Phillipe, Taccoen Alain, Vignon Eric. Which is the best radiographic protocol for a clinical trial of a structure modifying drug in patients with knee osteoarthritis? J Rheumatol. 2002 Jun;29(6):1308–1320. [PubMed] [Google Scholar]
  9. Bruyere Olivier, Honore Aline, Rovati Lucio C., Giacovelli Giampaolo, Henrotin Yves E., Seidel Laurence, Reginster Jean-Yves L. Radiologic features poorly predict clinical outcomes in knee osteoarthritis. Scand J Rheumatol. 2002;31(1):13–16. doi: 10.1080/030097402317255309. [DOI] [PubMed] [Google Scholar]
  10. Buckland-Wright J. C. Quantitative radiography in osteoarthritis: microfocal radiography. Baillieres Clin Rheumatol. 1996 Aug;10(3):415–420. doi: 10.1016/s0950-3579(96)80040-9. [DOI] [PubMed] [Google Scholar]
  11. Cicuttini F. M., Baker J., Hart D. J., Spector T. D. Association of pain with radiological changes in different compartments and views of the knee joint. Osteoarthritis Cartilage. 1996 Jun;4(2):143–147. doi: 10.1016/s1063-4584(05)80323-1. [DOI] [PubMed] [Google Scholar]
  12. Courtney P., Doherty M. Key questions concerning paracetamol and NSAIDs for osteoarthritis. Ann Rheum Dis. 2002 Sep;61(9):767–773. doi: 10.1136/ard.61.9.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Creamer P., Hochberg M. C. Osteoarthritis. Lancet. 1997 Aug 16;350(9076):503–508. doi: 10.1016/S0140-6736(97)07226-7. [DOI] [PubMed] [Google Scholar]
  14. Dacre J. E., Huskisson E. C. The automatic assessment of knee radiographs in osteoarthritis using digital image analysis. Br J Rheumatol. 1989 Dec;28(6):506–510. doi: 10.1093/rheumatology/28.6.506. [DOI] [PubMed] [Google Scholar]
  15. DeGroot Jeroen, Bank Ruud A., Tchetverikov Ilja, Verzijl Nicole, TeKoppele Johan M. Molecular markers for osteoarthritis: the road ahead. Curr Opin Rheumatol. 2002 Sep;14(5):585–589. doi: 10.1097/00002281-200209000-00019. [DOI] [PubMed] [Google Scholar]
  16. Deal C. L., Schnitzer T. J., Lipstein E., Seibold J. R., Stevens R. M., Levy M. D., Albert D., Renold F. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther. 1991 May-Jun;13(3):383–395. [PubMed] [Google Scholar]
  17. Deeks Jonathan J., Smith Lesley A., Bradley Matthew D. Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomised controlled trials. BMJ. 2002 Sep 21;325(7365):619–619. doi: 10.1136/bmj.325.7365.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Dieppe P., Cushnaghan J., Young P., Kirwan J. Prediction of the progression of joint space narrowing in osteoarthritis of the knee by bone scintigraphy. Ann Rheum Dis. 1993 Aug;52(8):557–563. doi: 10.1136/ard.52.8.557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Disler D. G., Recht M. P., McCauley T. R. MR imaging of articular cartilage. Skeletal Radiol. 2000 Jul;29(7):367–377. doi: 10.1007/s002560000222. [DOI] [PubMed] [Google Scholar]
  20. Dougados M., Nguyen M., Berdah L., Maziéres B., Vignon E., Lequesne M., ECHODIAH Investigators Study Group Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the Chondromodulating Effect of Diacerein in OA of the Hip. Arthritis Rheum. 2001 Nov;44(11):2539–2547. doi: 10.1002/1529-0131(200111)44:11<2539::aid-art434>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  21. Felson D. T., Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998 Aug;41(8):1343–1355. doi: 10.1002/1529-0131(199808)41:8<1343::AID-ART3>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
  22. Felson D. T., Zhang Y., Hannan M. T., Naimark A., Weissman B. N., Aliabadi P., Levy D. The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1995 Oct;38(10):1500–1505. doi: 10.1002/art.1780381017. [DOI] [PubMed] [Google Scholar]
  23. Fernandes J. C., Martel-Pelletier J., Pelletier J. P. Gene therapy for osteoarthritis: new perspectives for the twenty-first century. Clin Orthop Relat Res. 2000 Oct;(379 Suppl):S262–S272. [PubMed] [Google Scholar]
  24. Halbert J., Crotty M., Weller D., Ahern M., Silagy C. Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms. Arthritis Rheum. 2001 Jun;45(3):228–234. doi: 10.1002/1529-0131(200106)45:3<228::AID-ART253>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  25. Hart D. J., Spector T. D. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol. 1993 Feb;20(2):331–335. [PubMed] [Google Scholar]
  26. Hochberg M. C. Quantitative radiography in osteoarthritis: analysis. Baillieres Clin Rheumatol. 1996 Aug;10(3):421–428. doi: 10.1016/s0950-3579(96)80041-0. [DOI] [PubMed] [Google Scholar]
  27. Hughes R., Carr A. A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Rheumatology (Oxford) 2002 Mar;41(3):279–284. doi: 10.1093/rheumatology/41.3.279. [DOI] [PubMed] [Google Scholar]
  28. Hunter D. J., March L., Sambrook P. N. Knee osteoarthritis: the influence of environmental factors. Clin Exp Rheumatol. 2002 Jan-Feb;20(1):93–100. [PubMed] [Google Scholar]
  29. Loughlin John. Genome studies and linkage in primary osteoarthritis. Rheum Dis Clin North Am. 2002 Feb;28(1):95–109. doi: 10.1016/s0889-857x(03)00071-1. [DOI] [PubMed] [Google Scholar]
  30. Massardo L., Watt I., Cushnaghan J., Dieppe P. Osteoarthritis of the knee joint: an eight year prospective study. Ann Rheum Dis. 1989 Nov;48(11):893–897. doi: 10.1136/ard.48.11.893. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. McAlindon T. E., Cooper C., Kirwan J. R., Dieppe P. A. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993 Apr;52(4):258–262. doi: 10.1136/ard.52.4.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. McAlindon T. E., LaValley M. P., Gulin J. P., Felson D. T. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000 Mar 15;283(11):1469–1475. doi: 10.1001/jama.283.11.1469. [DOI] [PubMed] [Google Scholar]
  33. McCarthy G. M., McCarty D. J. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol. 1992 Apr;19(4):604–607. [PubMed] [Google Scholar]
  34. Messier S. P., Loeser R. F., Mitchell M. N., Valle G., Morgan T. P., Rejeski W. J., Ettinger W. H. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. J Am Geriatr Soc. 2000 Sep;48(9):1062–1072. doi: 10.1111/j.1532-5415.2000.tb04781.x. [DOI] [PubMed] [Google Scholar]
  35. Oliveria S. A., Felson D. T., Reed J. I., Cirillo P. A., Walker A. M. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum. 1995 Aug;38(8):1134–1141. doi: 10.1002/art.1780380817. [DOI] [PubMed] [Google Scholar]
  36. Otterness I. G., Swindell A. C., Zimmerer R. O., Poole A. R., Ionescu M., Weiner E. An analysis of 14 molecular markers for monitoring osteoarthritis: segregation of the markers into clusters and distinguishing osteoarthritis at baseline. Osteoarthritis Cartilage. 2000 May;8(3):180–185. doi: 10.1053/joca.1999.0288. [DOI] [PubMed] [Google Scholar]
  37. Pai Y. C., Rymer W. Z., Chang R. W., Sharma L. Effect of age and osteoarthritis on knee proprioception. Arthritis Rheum. 1997 Dec;40(12):2260–2265. doi: 10.1002/art.1780401223. [DOI] [PubMed] [Google Scholar]
  38. Pendleton A., Arden N., Dougados M., Doherty M., Bannwarth B., Bijlsma J. W., Cluzeau F., Cooper C., Dieppe P. A., Günther K. P. EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2000 Dec;59(12):936–944. doi: 10.1136/ard.59.12.936. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000 Sep;43(9):1905–1915. doi: 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
  40. Reginster J. Y., Deroisy R., Rovati L. C., Lee R. L., Lejeune E., Bruyere O., Giacovelli G., Henrotin Y., Dacre J. E., Gossett C. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001 Jan 27;357(9252):251–256. doi: 10.1016/S0140-6736(00)03610-2. [DOI] [PubMed] [Google Scholar]
  41. Reginster J. Y. The prevalence and burden of arthritis. Rheumatology (Oxford) 2002 Apr;41(Suppl 1):3–6. [PubMed] [Google Scholar]
  42. Roos H., Laurén M., Adalberth T., Roos E. M., Jonsson K., Lohmander L. S. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998 Apr;41(4):687–693. doi: 10.1002/1529-0131(199804)41:4<687::AID-ART16>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  43. Silverstein F. E., Faich G., Goldstein J. L., Simon L. S., Pincus T., Whelton A., Makuch R., Eisen G., Agrawal N. M., Stenson W. F. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA. 2000 Sep 13;284(10):1247–1255. doi: 10.1001/jama.284.10.1247. [DOI] [PubMed] [Google Scholar]
  44. Spector T. D., Dacre J. E., Harris P. A., Huskisson E. C. Radiological progression of osteoarthritis: an 11 year follow up study of the knee. Ann Rheum Dis. 1992 Oct;51(10):1107–1110. doi: 10.1136/ard.51.10.1107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Spector T. D., Nandra D., Hart D. J., Doyle D. V. Is hormone replacement therapy protective for hand and knee osteoarthritis in women?: The Chingford Study. Ann Rheum Dis. 1997 Jul;56(7):432–434. doi: 10.1136/ard.56.7.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Thomas K. S., Muir K. R., Doherty M., Jones A. C., O'Reilly S. C., Bassey E. J. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. 2002 Oct 5;325(7367):752–752. doi: 10.1136/bmj.325.7367.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Vignon E., Garnero P., Delmas P., Avouac B., Bettica P., Boers M., Ehrich E., MacKillop N., Rovati L., Serni U. Recommendations for the registration of drugs used in the treatment of osteoarthritis: an update on biochemical markers. Osteoarthritis Cartilage. 2001 May;9(4):289–293. doi: 10.1053/joca.2000.0387. [DOI] [PubMed] [Google Scholar]
  48. Waldschmidt J. G., Braunstein E. M., Buckwalter K. A. Magnetic resonance imaging of osteoarthritis. Rheum Dis Clin North Am. 1999 May;25(2):451–465. doi: 10.1016/s0889-857x(05)70078-8. [DOI] [PubMed] [Google Scholar]
  49. Walker-Bone K., Javaid K., Arden N., Cooper C. Regular review: medical management of osteoarthritis. BMJ. 2000 Oct 14;321(7266):936–940. doi: 10.1136/bmj.321.7266.936. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]

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