Dr. Seed is assistant professor, pharmacy practice, Massachusetts College of Pharmacy and Health Science, Worcester, Massachusetts.

Dr. Dunican is assistant professor, pharmacy practice, Massachusetts College of Pharmacy and Health Science.

Dr. Lynch is associate professor, pharmacy practice, Massachusetts College of Pharmacy and Health Science.

ABSTRACT

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability in the United States, especially among older adults. Treatment options have primarily focused on alleviating the pain often associated with this condition. Acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) are often employed for relief of mild-to-moderate pain associated with OA. NSAIDs are typically more effective than acetaminophen; however, because of adverse effects associated with long-term use of NSAIDs, acetaminophen is considered first-line therapy. Safety concerns over traditional pharmacotherapeutic agents used in the management of OA, such as NSAIDs and opioids, have led healthcare professionals to seek other options. Trials of diseasemodulating agents that focus on preventing further damage to the joints have the potential to change how this disease state is managed. This article reviews nonpharmacologic and pharmacologic approaches to management of OA of the knee and hip.

Seed SM, Dunican KC, Lynch AM. Osteoarthritis: A review of treatment options. Geriatrics. 2009;64(10):20-29.

Key words: arthritis, degenerative joint disease, functionality, inflammation, joint width, synovial joint

Osteoarthritis (OA), also known as degenerative joint disease (DJD), is the most common form of arthritis in the United States.¹ Although OA can occur in any synovial joint in the body, it most commonly affects the knees, hips, and hands. OA is the leading cause of disability in elderly persons and affects approximately 14% of all adults aged ≥25 years; >12 million of those affected are aged ≥65 years. Women are more commonly affected than men.² OA is associated with remarkable personal, health, and economic costs, including 400,000 hospitalizations and an estimated $8 billion for knee and hip replacements annually.¹ The prevalence of OA is expected to increase in the coming years as risk factors, such as an aging population and obesity, become more prevalent.

Etiology

The development of OA involves multiple factors that contribute to excessive joint loading, repetitive motion or injury, and inflammation. The most common risk factors in the etiology of OA include advanced age, obesity, past occupation, participation in certain sports, joint trauma, and family history.^1–3

Genetic factors are also thought to play a role in the development of OA, and different genes may be implicated in different types of arthritis.³ Heberden nodes, bony enlargements of the distal interphalangeal joints of the hand, are 10-fold more prevalent in women than in men, and they occur twice as often in women whose mothers developed these nodes. Genetic factors have been linked to generalized OA, as well as OA of the first metatarsophalangeal joint. This genetic link has been substantiated in twin studies, which have demonstrated a 60% correlation in hip OA and a 70% correlation in spine OA between twins.⁴

To date, many intracellular regulators have been identified as potential markers for the expression of OA pathologies. These identified markers include interleukin-1 (IL-1), interleukin-4 (IL-4), and genes that code for asporin, an extracellular matrix protein, and calmodulin, an intracellular regulator.⁵