Osteoarthritis: Difference between revisions

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imported>Robert Badgett
imported>Robert Badgett
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==Diagnosis==
===Signs and symptoms===
====Knee osteoarthritis====
Osteoarthritis of the knees is associated with buckling, or sudden giving way, of the knees.<ref name="pmidpending">Felson, David T., Jingbo Niu, Christine McClennan, Burton Sack, Piran Aliabadi, David J. Hunter, et al. 2007. Knee Buckling: Prevalence, Risk Factors, and Associated Limitations in Function. Ann Intern Med 147, no. 8 (October 16): 534-540. http://www.annals.org/cgi/content/abstract/147/8/534 (accessed October 16, 2007). </ref> This is more likely if the [[quadriceps]] muscle is weak.
A screening survey is positive if any one of the following is answered yes:<ref name="pmidpending">Christian H Roux et al., “Screening for hip and knee osteoarthritis in the general population: predictive value of a questionnaire and prevalence estimates,” Ann Rheum Dis (December 12, 2007), http://ard.bmj.com/cgi/content/abstract/ard.2007.075952v1 (accessed December 13, 2007).</ref>
* During the last 4 weeks, have you had knee pain on most days?
* During the last 4 weeks, have you had knee pain while climbing down stairs or walking down slopes?
* During the last 4 weeks, have you had swelling in one or both knees?
* Do you have knee OA? (If you do, was the diagnosis made by a rheumatologist or a general practitioner?)
* [[sensitivity (tests)|sensitivity]] = 87%
* [[specificity (tests)|specificity]] = 92%
Using the prevalence of disease in this study (5% to 8%), the predictive values are:
* [[positive predictive value]] = 51%
* [[negative predictive value]] = 98%
====Hip osteoarthritis====
A screening survey is positive if any one of the following is answered yes:<ref name="pmidpending">Christian H Roux et al., “Screening for hip and knee osteoarthritis in the general population: predictive value of a questionnaire and prevalence estimates,” Ann Rheum Dis (December 12, 2007), http://ard.bmj.com/cgi/content/abstract/ard.2007.075952v1 (accessed December 13, 2007).</ref>
* During the last 4 weeks, have you had hip pain (groin or upper thigh) on most days?
* During the last 4 weeks, have you had hip pain while climbing down stairs or walking down slopes?
* During the last 4 weeks, have you noticed any limitation in the range of motion of one or both hips?
* Do you have hip osteoarthritis? (If you do, was the diagnosis made by a rheumatologist or a general practitioner?)
* [[sensitivity (tests)|sensitivity]] = 93%
* [[specificity (tests)|specificity]] = 95%
Using the prevalence of disease in this study (5% to 8%), the predictive values are:
* [[positive predictive value]] = 56%
* [[negative predictive value]] = 99%
==Treatment==
===Medications===
====Acetaminophen====
A [[randomized controlled trial]] comparing [[acetaminophen]] to [[ibuprofen]] in x-ray proven mild to moderate osteoarthritis of the hip or knee found that equal benefit.<ref name="pmid2052056">{{cite journal |author=Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI |title=Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee |journal=N. Engl. J. Med. |volume=325 |issue=2 |pages=87-91 |year=1991 |pmid=2052056 |doi=}}</ref> However, [[acetaminophen]] at a dose of 4 grams per day can increase [[liver function test]]s.<ref name="pmid16820551">{{cite journal |author=Watkins PB, Kaplowitz N, Slattery JT, ''et al'' |title=Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial |journal=JAMA |volume=296 |issue=1 |pages=87-93 |year=2006 |pmid=16820551 |doi=10.1001/jama.296.1.87}}</ref>
===Supplements===
[[Dietary supplement]]s have been studied.
====Chondroitin====
====Chondroitin====
A [[meta-analysis]] of [[randomized controlled trial]]s found no benefit from [[chondroitin]].<ref name="pmid17438317">{{cite journal |author=Reichenbach S, Sterchi R, Scherer M, ''et al'' |title=Meta-analysis: chondroitin for osteoarthritis of the knee or hip |journal=Ann. Intern. Med. |volume=146 |issue=8 |pages=580-90 |year=2007 |pmid=17438317 |doi=}}</ref> This [[meta-analysis]] included the large [[randomized controlled trial]] of Clegg.<ref name="pmid16495392">{{cite journal |author=Clegg DO, Reda DJ, Harris CL, ''et al'' |title=Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis |journal=N. Engl. J. Med. |volume=354 |issue=8 |pages=795–808 |year=2006 |month=February |pmid=16495392 |doi=10.1056/NEJMoa052771 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=16495392&promo=ONFLNS19 |issn=}}</ref>
A [[meta-analysis]] of [[randomized controlled trial]]s found no benefit from [[chondroitin]].<ref name="pmid17438317">{{cite journal |author=Reichenbach S, Sterchi R, Scherer M, ''et al'' |title=Meta-analysis: chondroitin for osteoarthritis of the knee or hip |journal=Ann. Intern. Med. |volume=146 |issue=8 |pages=580-90 |year=2007 |pmid=17438317 |doi=}}</ref> This [[meta-analysis]] included the large [[randomized controlled trial]] of Clegg.<ref name="pmid16495392">{{cite journal |author=Clegg DO, Reda DJ, Harris CL, ''et al'' |title=Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis |journal=N. Engl. J. Med. |volume=354 |issue=8 |pages=795–808 |year=2006 |month=February |pmid=16495392 |doi=10.1056/NEJMoa052771 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=16495392&promo=ONFLNS19 |issn=}}</ref>
====Glucosamine====
Neither glucosamine sulfate<ref name="pmid18283204">{{cite journal |author=Rozendaal RM, Koes BW, van Osch GJ, ''et al'' |title=Effect of glucosamine sulfate on hip osteoarthritis: a randomized trial |journal=Ann. Intern. Med. |volume=148 |issue=4 |pages=268–77 |year=2008 |month=February |pmid=18283204 |doi= |url= |issn=}}</ref> nor glucosamine hydrochloride<ref name="pmid16495392">{{cite journal |author=Clegg DO, Reda DJ, Harris CL, ''et al'' |title=Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis |journal=N. Engl. J. Med. |volume=354 |issue=8 |pages=795–808 |year=2006 |month=February |pmid=16495392 |doi=10.1056/NEJMoa052771 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=16495392&promo=ONFLNS19 |issn=}}</ref> is effective for osteoarthritis.
A molecule derived from [[glucosamine]] is used by the body to make some of the components of cartilage and synovial fluid.  An initial [[meta-analysis]] found that supplemental glucosamine may improve symptoms of OA and delay its progression.<ref name="pmid15855241">{{cite journal |author=Poolsup N, Suthisisang C, Channark P, Kittikulsuth W |title=Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials |journal=The Annals of pharmacotherapy |volume=39 |issue=6 |pages=1080-7 |year=2005 |pmid=15855241 |doi=10.1345/aph.1E576}}</ref> However, a large study suggests that glucosamine is not effective in treating OA of the knee.<ref name="pmid15501201">{{cite journal |author=McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K |title=Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial |journal=Am. J. Med. |volume=117 |issue=9 |pages=643–9 |year=2004 |pmid=15501201 |doi=10.1016/j.amjmed.2004.06.023}}</ref> A subsequent [[meta-analysis]] that includes this trial concluded that glucosamine hydrochloride is not effective and that the effect of glucosamine sulfate is uncertain.<ref name="pmid17599746">{{cite journal |author=Vlad SC, Lavalley MP, McAlindon TE, Felson DT |title=Glucosamine for pain in osteoarthritis: Why do trial results differ? |journal=Arthritis Rheum |volume=56 |issue=7 |pages=2267-2277 |year=2007 |pmid=17599746 |doi=10.1002/art.22728}}</ref> This meta-analysis was followed by a [[randomized controlled trial]] that found no benefit from glucosamine sulfate.<ref name="pmid18283204">{{cite journal |author=Rozendaal RM, Koes BW, van Osch GJ, ''et al'' |title=Effect of glucosamine sulfate on hip osteoarthritis: a randomized trial |journal=Ann. Intern. Med. |volume=148 |issue=4 |pages=268–77 |year=2008 |month=February |pmid=18283204 |doi= |url= |issn=}}</ref>
===Injections===
Injections of the [[hip]] joint for labral tears may not be effective.<ref name="pmid18760208">{{cite journal |author=Martin RL, Irrgang JJ, Sekiya JK |title=The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates |journal=Arthroscopy |volume=24 |issue=9 |pages=1013–8 |year=2008 |month=September |pmid=18760208 |doi=10.1016/j.arthro.2008.04.075 |url=http://linkinghub.elsevier.com/retrieve/pii/S0749-8063(08)00358-7 |issn=}}</ref>
===Surgery===
[[Arthroscopic surgery]] for osteoarthritis of the knee is not effective according among patients with moderate or severe disease to two [[randomized controlled trial]]s. However, a number of patients including those with severe disease of two or more compartments of the knee, were excluded.<ref name="pmid18784099">{{cite journal |author=Kirkley A, Birmingham TB, Litchfield RB, ''et al'' |title=A randomized trial of arthroscopic surgery for osteoarthritis of the knee |journal=N. Engl. J. Med. |volume=359 |issue=11 |pages=1097–107 |year=2008 |month=September |pmid=18784099 |doi=10.1056/NEJMoa0708333 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18784099&promo=ONFLNS19 |issn=}}</ref><ref name="pmid12110735">{{cite journal |author=Moseley JB, O'Malley K, Petersen NJ, ''et al'' |title=A controlled trial of arthroscopic surgery for osteoarthritis of the knee |journal=N. Engl. J. Med. |volume=347 |issue=2 |pages=81–8 |year=2002 |pmid=12110735 |doi=10.1056/NEJMoa013259}}</ref>
==Prognosis==
===Knee===
The strongest predictors of poor functional outcome are age, body mass index, anxiety and pain severity.<ref>Elaine Thomas et al., “Predicting the course of functional limitation among older adults with knee pain: do local signs, symptoms and radiographs add anything to general indicators?,” Ann Rheum Dis (February 4, 2008): ard.2007.080945. </ref>
===Hip===
Among patients presenting with hip pain to their general practitioner, the rates of total hip replacement are:<ref name="pmid18050175">{{cite journal |author=Lievense AM, Koes BW, Verhaar JA, Bohnen AM, Bierma-Zeinstra SM |title=Prognosis of hip pain in general practice: A prospective followup study |journal=Arthritis Rheum |volume=57 |issue=8 |pages=1368–1374 |year=2007 |pmid=18050175 |doi=10.1002/art.23094}}</ref>
* 12% of patients at 3 years
* 22% after 6 years
Predictors of the need for a total hip replacement are:<ref name="pmid18050175"/>
* age >/=60 years, morning stiffness
* pain in the groin/medial thigh
* decreased extension/adduction
* painful internal rotation
* body mass index </=30 kg/m(2)
* Kellgren/Lawrence grade of 2 or higher
==References==
<references/>

Revision as of 15:39, 9 February 2009

Chondroitin

A meta-analysis of randomized controlled trials found no benefit from chondroitin.[1] This meta-analysis included the large randomized controlled trial of Clegg.[2]

  1. ↑ Reichenbach S, Sterchi R, Scherer M, et al (2007). "Meta-analysis: chondroitin for osteoarthritis of the knee or hip". Ann. Intern. Med. 146 (8): 580-90. PMID 17438317. [e]
  2. ↑ Clegg DO, Reda DJ, Harris CL, et al (February 2006). "Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis". N. Engl. J. Med. 354 (8): 795–808. DOI:10.1056/NEJMoa052771. PMID 16495392. Research Blogging.
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