osteoarthritis - wikipedia, the free encyclopedia.pdf

8/22/2019 Osteoarthritis - Wikipedia, the free encyclopedia.pdf

1/13

Osteoarthritis

Classification and external resources

ICD-10 M15 (http://apps.who.int

/classifications/icd10/browse

/2010/en#/M15)-M19

(http://apps.who.int/classifications

/icd10/browse/2010/en#/M19), M47

(http://apps.who.int/classifications

/icd10/browse/2010/en#/M47)

ICD-9 715 (http://www.icd9data.com

/getICD9Code.ashx?icd9=715)

OMIM 165720 (http://omim.org/entry

/165720)

DiseasesDB 9313

(http://www.diseasesdatabase.com

/ddb9313.htm)

MedlinePlus 000423 (http://www.nlm.nih.gov

/medlineplus/ency/article

/000423.htm)

eMedicine med/1682

(http://www.emedicine.com

/med/topic1682.htm) orthoped/427

(http://www.emedicine.com/orthoped

/topic427.htm#) pmr/93

(http://www.emedicine.com

/pmr/topic93.htm#) radio/492

(http://www.emedicine.com/radio

/topic492.htm#)

OsteoarthritisFrom Wikipedia, the free encyclopedia

Osteoarthritis (OA) also known as degenerative arthritis

ordegenerative joint disease orosteoarthrosis, is a group

of mechanical abnormalities involving degradation of

oints,[1] including articular cartilage and subchondral bone.

Symptoms may include joint pain, tenderness, stiffness,

locking, and sometimes an effusion. A variety of causes

hereditary, developmental, metabolic, and mechanical

deficitsmay initiate processes leading to loss of cartilage.

When bone surfaces become less well protected by cartilage,

bone may be exposed and damaged. As a result of decreased

movement secondary to pain, regional muscles may atrophy,

and ligaments may become more lax.[2]

Treatment generally involves a combination of exercise,

lifestyle modification, and analgesics. If pain becomesdebilitating, joint replacement surgery may be used to

improve the quality of life. OA is the most common form of

arthritis,[2] and the leading cause of chronic disability in the

United States.[3]

It affects about 8 million people in the

United Kingdom and nearly 27 million people in the United

States.[4]

arthritis - Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Oste

3 8/3/2013


2/13

MeSH D010003 (http://www.nlm.nih.gov

/cgi/mesh/2013/MB_cgi?field=uid&

term=D010003)

Bouchard's nodes and Heberden's

nodes may form in osteoarthritis

Contents

1 Signs and symptoms

2 Causes

2.1 Primary

2.2 Secondary

3 Pathophysiology

4 Diagnosis

4.1 Classification

5 Management

5.1 Lifestyle modification

5.2 Physical measures

5.3 Medication

5.4 Surgery

5.5 Alternative medicine

6 Epidemiology

7 Etymology

8 History

9 Research

10 References

11 External links

Signs and symptoms

The main symptom is pain, causing loss of ability and often stiffness.

"Pain" is generally described as a sharp ache or a burning sensation in

the associated muscles and tendons. OA can cause a crackling noise

(called "crepitus") when the affected joint is moved or touched and

people may experience muscle spasms and contractions in the tendons.

Occasionally, the joints may also be filled with fluid.[5] Some people

report increased pain associated with cold temperature, high humidity,

and/or a drop in barometric pressure, but studies have had mixed

results.[6]

OA commonly affects the hands, feet, spine, and the large weight

bearing joints, such as the hips and knees, although in theory, any jointin the body can be affected. As OA progresses, the affected joints appear

larger, are stiff and painful, and usually feel better with gentle use but worse with excessive or prolonged use,

thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal

interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though

they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to

the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they

experience any pain.


3 8/3/2013


3/13

Primary osteoarthritis of the left knee.

Note the osteophytes, narrowing of

the joint space (arrow), and increased

subchondral bone density (arrow).

OA is the most common cause of a joint effusion of the knee.[7]

Causes

Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of

osteoarthritis.[8] Sources of this stress may include: misalignments of bones caused by congenital or pathogenic

causes; mechanical injury; excess body weight; loss of strength in the muscles supporting a joint; and

impairment of peripheral nerves, leading to sudden or uncoordinated movements.[8] However exercise,

including running in the absence of injury, has not been found to increase the risk.[9] Nor has cracking one's

knuckles been found to play a role.[10]

Primary

A number of studies have shown that there is a greater prevalence of the

disease among siblings and especially identical twins, indicating a

hereditary basis.[11] Although a single factor is not generally sufficient

to cause the disease, about half of the variation in susceptibility has been

assigned to genetic factors.[12]

The development of OA is correlated with a history of previous joint

injury and with obesity, especially with respect to knees.[13] Since the

correlation with obesity has been observed not only for knees but also

for non-weight bearing joints and the loss of body fat is more closely

related to symptom relief than the loss of body weight, it has been

suggested that there may be a metabolic link to body fat as opposed to

ust mechanical loading.[14]

Changes in sex hormone levels may play a role in the development ofOA as it is more prevalent among post-menopausal women than among

men of the same age.[15][16] A study of mice found natural female

hormones to be protective while injections of the male hormone

dihydrotestosterone reduced protection.[17]

Secondary

This type of OA is caused by other factors but the resulting pathology is the same as for primary OA:

AlkaptonuriaCongenital disorders of joints

Diabetes

Ehlers-Danlos Syndrome

Hemochromatosis and Wilson's disease

Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g.

costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to

degenerate at a faster pace.

Injury to joints or ligaments (such as the ACL), as a result of an accident or orthopedic operations.

Ligamentous deterioration or instability may be a factor.


3 8/3/2013


4/13

Marfan syndrome

Obesity

Septic arthritis (infection of a joint)

Pathophysiology

Primary OA is a chronic degenerative disorder related to but not caused by aging, as there are people well into

their nineties who have no clinical or functional signs of the disease. As a person ages, the water content of thecartilage decreases[18] as a result of a reduced proteoglycan content, thus causing the cartilage to be less

resilient. The water content of healthy cartilage is finely balanced by compressive force driving water out &

swelling pressure drawing water in.[19]

Collagen fibres exert the compressive force, whereas the Gibbs-Donnan

effect & cartilage proteoglycans create osmotic pressure which tends to draw water in.[19] However during

onset of OA there is an increase in cartilage water content. [20][21][22][23][24] This increase occurs because whilst

there is an overall loss of proteoglycans,[21][25] it is outweighed by a loss of collagen.[19][25] Without the

protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to

degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur,

though often mild (compared to what occurs in rheumatoid arthritis). This can happen as breakdown products

from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them.

New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an

attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the

inflammation, can be both painful and debilitating.

Diagnosis

Diagnosis is made with reasonable certainty based on history and clinical examination.[26][27]

X-rays may

confirm the diagnosis. The typical changes seen on X-ray include: joint space narrowing, subchondral sclerosis

(increased bone formation around the joint), subchondral cyst formation, and osteophytes.[28]

Plain films may

not correlate with the findings on physical examination or with the degree of pain.[29] Usually other imaging

techniques are not necessary to clinically diagnose OA.

In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of

criteria for the diagnosis of hand OA based on hard tissue enlargement and swelling of certain joints.[30] These

criteria were found to be 92% sensitive and 98% specific for hand OA versus other entities such as rheumatoid

arthritis and spondyloarthropathies.[31]

Related pathologies whose names may be confused with OA include pseudo-arthrosis. This is derived from the

Greek words pseudo, meaning "false", and arthrosis, meaning "joint." Radiographic diagnosis results in

diagnosis of a fracture within a joint, which is not to be confused with OA which is a degenerative pathologyaffecting a high incidence of distal phalangeal joints of female patients. A polished ivory-like appearance may

also develop on the bones of the affected joints, reflecting a change called eburnation.[32]


3 8/3/2013


5/13

Damaged cartilage from

sows. (a) cartilage

erosion (b)cartilage

ulceration (c)cartilage

repair (d)osteophyte

(bone spur) formation.

Histopathology of

osteoarthrosis of a knee

joint in an elderly

female.

Histopathology of

osteoarthrosis of a knee

joint in an elderly

female.

Severe osteoarthritis

and osteopenia of the

carpal joint and 1st

carpometacarpel joint.

Classification

OA can be classified into either primary or secondary depending on whether or not there is an identifiable

underlying cause.

Both primary generalized nodal OA and erosive OA (EOA. also called inflammatory OA) are sub-sets of

primary OA. EOA is a much less common, and more aggressive inflammatory form of OA which often affects

the distal interphalangeal joints and has characteristic changes on x-ray.

Management

Lifestyle modification (such as weight loss and exercise) and analgesics are the mainstay of treatment.

Acetaminophen / paracetamol is used first line and NSAIDs are only recommended as add on therapy if pain

relief is not sufficient.[33] This is due to the relative greater safety of acetaminophen.[33]

Lifestyle modification

For overweight people, weight loss may be an important factor. Patient education has been shown to be helpful

in the self-management of arthritis. It decreases pain, improves function, reduces stiffness and fatigue, and

reduces medical usage.[34] A meta-analysis has shown patient education can provide on average 20% more pain

relief when compared to NSAIDs alone in patients with hip OA. [34]

Physical measures

Moderate exercise is beneficial with respect to pain and function in those with osteoathritis of the knee and

possibly hip.[35] While some evidence supports certain physical therapies evidence for a combined program is

limited.[36] There is not enough evidence to determine the effectiveness of massage therapy.[37]

The use of orthoses (commonly referred to as splints, braces or insoles as applicable) can reduce the symptoms

of OA. In the lower limb, orthoses are used for the foot and ankle[38] and knee.[39] Knee braces may be

useful.[40] In the upper limb, splinting of the base of the thumb leads to improvements after one year.[41]


3 8/3/2013


6/13

The evidence for manual therapy is inconclusive.[42] Functional, gait, and balance training has been

recommended to address impairments of position sense, balance, and strength in individuals with lower

extremity arthritis as these can contribute to higher falls in older individuals.[43]

Medication

The analgesic paracetamol (INN; acetaminophen is the USA) is the first line treatment for OA.[33][44] For mild

to moderate symptoms effectiveness is similar to non-steroidal anti-inflammatory drugs (NSAIDs), though formore severe symptoms NSAIDs may be more effective.[33] NSAIDs such as ibuprofen while more effective in

severe cases are associated with greater side effects such as gastrointestinal bleeding.[33] Another class of

NSAIDs, COX-2 selective inhibitors (such as celecoxib) are equally effective to NSAIDs with lower rates of

adverse gastrointestinal effects but higher rates of cardiovascular disease such as myocardial infarction.[45]

They are also much more expensive. Oral steroids are not recommended in the treatment of OA because of their

modest benefit and high rate of adverse effects.[citation needed]

There are several NSAIDs available for topical use including diclofenac. They have fewer systemic side-effects

and at least some therapeutic effect.[46] A Cochrane review concluded that opioid analgesics such as morphine

and fentanyl reduce pain, but this benefit is outweighed by frequent adverse events and thus they should notroutinely be used.[47] Topical capsaicin is controversial with a 2011 review[48] finding effectiveness and a 2009

review not.[46]

Injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few

weeks and a few months.[49] Joint injections of hyaluronic acid have not been found to lead to significant

improvement.[46][50] Hyaluronic acid injects have been associated with significant harm.[50]

Surgery

If disability is significant and more conservative management is ineffective, joint replacement surgery orresurfacing may be recommended. Evidence supports joint replacement for both knees and hips.[51] For the

knee it improves both pain and functioning.[52] Arthroscopic surgical intervention for OA of the knee however

has been found to be no better than placebo at relieving symptoms.[53]

Alternative medicine

Dietary supplements

Many dietary supplements are sold as treatments for OA and some of them have been found to be effective.

Phytodolor,[48] SAMe,[54] and SKI 306X (a Chinese herbal mixture)[55] may be effective in improving pain,

and there is some evidence to support the use of cat's claw as an anti-inflammatory.[56] There is tentative

evidence to support avocado/soybean unsaponifiables,[57]Boswellia serrata extracts (frankincense),[58][59]

MSM[48] and rose hip.[48]

The effectiveness of glucosamine is controversial.[60][61] A 2010 meta-analysis found that it is no better than

placebo.[62] Some older reviews conclude that glucosamine sulfate was an effective treatment[63][64] while

some others have found it ineffective.[65] A difference may exist between glucosamine sulfate and glucosamine

hydrochloride, with glucosamine sulfate showing a benefit and glucosamine hydrochloride not.[66] The


3 8/3/2013


7/13

Disability-adjusted life year for OA

per 100,000 inhabitants in 2004.[74]

no data

200

200220

220240

240260

260280

280300

300320

320340

340360

360380

380400

400

Osteoarthritis Research Society International recommends that glucosamine be discontinued if no effect is

observed after six months[67] and the National Institute of Clinical Excellence no longer recommends its use.[68

If there is a benefit it is at best slight.[69]

There is little evidence supporting benefits for some supplements, including: the Ayurvedic herbal preparations

with brand names Articulin F and Eazmov, collagen, devils claw, Duhuo Jisheng Wan (a Chinese herbal

preparation), fish liver oil, ginger, the herbal preparation Gitadyl, glucosamine, hyaluronic acid, omega-3 fatty

acids, the brand-name product Reumalax, stinging nettle, turmeric, vitamins A, C, and E in combination,

vitamin E alone, vitamin K and willow bark. There is insufficient evidence to make a recommendation about

the safety and efficacy of these treatments.[48][56] Chondroitin is not recommended as a treatment for OA.[70]

Manual therapies

While acupuncture leads to a statistically significant improvement in pain relief, this improvement is small and

may be of questionable clinical significance. Waiting list-controlled trials for peripheral joint osteoarthritis do

show clinically relevant benefits, but these may be due to placebo effects.[71] Acupuncture does not seem to

produce long-term benefits.[72] While electrostimulation techniques such as TENS have been used for twenty

years to treat osteoarthritis in the knee, there is no conclusive evidence to show that it reduces pain ordisability.[73]

Epidemiology

Globally approximately 250 million people have osteoarthritis of the

knee (3.6% of the population).[75]

OA affects nearly 27 million people in

the United States, accounting for 25% of visits to primary care

physicians, and half of all NSAID prescriptions. It is estimated that 80%

of the population have radiographic evidence of OA by age 65, although

only 60% of those will have symptoms.[76] In the United States,hospitalizations for OA increased from 322,000 in 1993 to 735,000 in

2006.[77]

Globally OA causes moderate to severe disability in 43.4 million people

as of 2004.[78]

Etymology

OA is derived from the Greek word part osteo-, meaning "of the bone",

combined with arthritis: arthr-, meaning "joint", and -itis, the meaningof which has come to be associated with inflammation. The -itis of OA

could be considered misleading as inflammation is not a conspicuous feature. Some clinicians refer to this

condition as osteoarthosis to signify the lack of inflammatory response.

History

Evidence for OA found in the fossil record is studied by paleopathologists, specialists in ancient disease and

injury. OA has been reported in fossils of the large carnivorous dinosaurAllosaurus fragilis.[79]


3 8/3/2013


8/13

Research

There are ongoing efforts to determine if there are agents that modify outcomes in OA. Sprifermin is one

candidate drug. There is also tentative evidence that strontium ranelate may decrease degeneration in OA and

improve outcomes.[80][81]

References^ "osteoarthritis (http://web.archive.org

/web/20090616022448/http://www.mercksource.com

/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs

/us/common/dorlands/dorland/six/000076356.htm)"

atDorland's Medical Dictionary

1.

^ a b Conaghan, Phillip. "Osteoarthritis National

clinical guideline for care and management in adults"

(http://www.nice.org.uk/nicemedia

/pdf/CG059FullGuideline.pdf) (PDF). Retrieved

2008-04-29.

2.

^ Centers for Disease Control and Prevention (CDC)(February 2001). "Prevalence of disabilities and

associated health conditions among adultsUnited

States, 1999".MMWR Morb Mortal Wkly Rep. 50 (7):

1205. PMID 11393491 (//www.ncbi.nlm.nih.gov

/pubmed/11393491).

3.

^ Van Manen, MD; Nace, J; Mont, MA (November

2012). "Management of primary knee osteoarthritis

and indications for total knee arthroplasty for general

practitioners." (http://www.ncbi.nlm.nih.gov/pubmed

/23139341). The Journal of the American Osteopathic

Association 112 (11): 709715. PMID 23139341

(//www.ncbi.nlm.nih.gov/pubmed/23139341).

4.

^ MedlinePlus Encyclopedia Osteoarthritis

(http://www.nlm.nih.gov/medlineplus/ency/article

/000423.htm)

5.

^ de Figueiredo EC, Figueiredo GC, Dantas RT (2011

Dec). "Influence of meteorological elements on

osteoarthritis pain: a review of the literature".Rev

Bras Reumatol. 51 (6): 6228. PMID 22124595


6.

^ Water on the knee (http://www.mayoclinic.com

/health/water-on-the-knee/DS00662),

MayoClinic.com

7.

^ a b Brandt KD, Dieppe P, Radin E (January 2009).

"Etiopathogenesis of osteoarthritis".Med. Clin. North

Am. 93 (1): 124, xv.

doi:10.1016/j.mcna.2008.08.009 (http://dx.doi.org

/10.1016%2Fj.mcna.2008.08.009). PMID 19059018


8.

^ Bosomworth NJ (September 2009). "Exercise and

knee osteoarthritis: benefit or hazard?"

(http://www.ncbi.nlm.nih.gov/pmc/articles

/PMC2743580). Can Fam Physician 55 (9): 8718.

9.

PMC 2743580 (//www.ncbi.nlm.nih.gov/pmc/articles

/PMC2743580). PMID 19752252


^ Deweber, K; Olszewski, M, Ortolano, R (Mar-Apr

2011). "Knuckle cracking and hand osteoarthritis".

Journal of the American Board of Family Medicine :

JABFM24 (2): 16974.

doi:10.3122/jabfm.2011.02.100156 (http://dx.doi.org

/10.3122%2Fjabfm.2011.02.100156).

PMID 21383216 (//www.ncbi.nlm.nih.gov/pubmed

/21383216).

10.

^ Valdes AM, Spector TD (August 2008). "The

contribution of genes to osteoarthritis".Rheum Dis

Clin North Am. 34 (3): 581603.

doi:10.1016/j.rdc.2008.04.008 (http://dx.doi.org

/10.1016%2Fj.rdc.2008.04.008). PMID 18687274


11.

^ Spector TD, MacGregor AJ (2004). "Risk factors

for osteoarthritis: genetics"

(http://www.ncbi.nlm.nih.gov/pubmed/14698640).

OsteoArthritis and Cartilage 12: S3944.

doi:10.1016/j.joca.2003.09.005 (http://dx.doi.org

/10.1016%2Fj.joca.2003.09.005). PMID 14698640


12.

^ Coggon D, Reading I (May 2001). "Knee

osteoarthritis and obesity"

(http://www.ncbi.nlm.nih.gov/pubmed/11360143).

International Journal of Obesity Related Metabolic

Disorders 25 (5): 622627.

doi:10.1038/sj.ijo.0801585 (http://dx.doi.org

/10.1038%2Fsj.ijo.0801585). PMID 11360143


13.

^ P Pottie, N Presle (2006). "Obesity and

osteoarthritis: more complex than predicted!"

(http://ard.bmj.com/content/65/11/1403.full).Annals

of the Rheumatic Diseases 65 (11): 14031405.

doi:10.1136/ard.2006.061994 (http://dx.doi.org

/10.1136%2Fard.2006.061994). PMC 1798356

(//www.ncbi.nlm.nih.gov/pmc/articles/PMC1798356)


/17038451).

14.

^ Linn, Sarah; Murtaugh, Bryan; Casey, Ellen (May

2012). "Role of Sex Hormones in the Development of

Osteoarthritis".Physical Medicine and Rehabilitation

4 (5): 169173. doi:10.1016/j.pmrj.2012.01.013

15.


3 8/3/2013


9/13

(http://dx.doi.org/10.1016%2Fj.pmrj.2012.01.013).

^ Tanamas, SK; Wijethilake, Pushpika; Wluka, Anita

E.; Davies-Tuck, Miranda L.; Urquhart, Donna M.;

Wang, Yuanyuan; Cicuttini, Flavia M. (June 2011).

"Sex hormones and structural changes in

osteoarthritis: a systematic review".Maturitas 69 (2):

141156. doi:10.1016/j.maturitas.2011.03.019

(http://dx.doi.org

/10.1016%2Fj.maturitas.2011.03.019).


/21481553).

16.

^ Ma, H.L.; Blanchet, T.J.; Peluso, D.; Hopkins, B.;

Morris, E.A.; Glasson, S.S. (June 2007).

"Osteoarthritis severity is sex dependent in a surgical

mouse model". OsteoArthritis and Cartilage 15 (6):

695700. doi:10.1016/j.joca.2006.11.005

(http://dx.doi.org/10.1016%2Fj.joca.2006.11.005).


/17207643).

17.

^ Simon, H; Zieve D (2005-05-08). "Osteoarthritis"

(http://www.umm.edu/patiented/articles/what_osteoarthritis_000035_1.htm). University of

Maryland Medical Center. Retrieved 2009-04-25.

18.

^ a b c Maroudas, A. (1976). "Balance between

swelling pressure and collagen tension in normal and

degenerate cartilage".Nature 260 (5554): 808809.

doi:10.1038/260808a0 (http://dx.doi.org

/10.1038%2F260808a0). PMID 1264261


19.

^ Bollet, A. J.; Nance, J. L. (1966). "Biochemical

Findings in Normal and Osteoarthritic Articular

Cartilage. II. Chondroitin Sulfate Concentration and

Chain Length, Water, and Ash Content*"(http://www.ncbi.nlm.nih.gov/pmc/articles

/PMC292789).Journal of Clinical Investigation 45

(7): 11701177. doi:10.1172/JCI105423

(http://dx.doi.org/10.1172%2FJCI105423).


/PMC292789). PMID 16695915


20.

^a b

Brocklehurst, R.; Bayliss, M. T.; Maroudas, A.;

Coysh, H. L.; Freeman, M. A.; Revell, P. A.; Ali, S.

Y. (1984). "The composition of normal and

osteoarthritic articular cartilage from human kneejoints. With special reference to unicompartmental

replacement and osteotomy of the knee". The Journal

of bone and joint surgery. American volume 66 (1):


/pubmed/6690447).

21.

^ Chou, M. -C.; Tsai, P. -H.; Huang, G. -S.; Lee, H.

-S.; Lee, C. -H.; Lin, M. -H.; Lin, C. -Y.; Chung, H.

-W. (2009). "Correlation between the MR T2 value at

4.7 T and relative water content in articular cartilage

in experimental osteoarthritis induced by ACL

transection". Osteoarthritis and Cartilage 17 (4):

22.

441447. doi:10.1016/j.joca.2008.09.009



/18990590).

^ Grushko, G.; Schneiderman, R.; Maroudas, A.

(1989). "Some biochemical and biophysical

parameters for the study of the pathogenesis of

osteoarthritis: A comparison between the processes of

ageing and degeneration in human hip cartilage".

Connective tissue research 19 (24): 149176.

doi:10.3109/03008208909043895 (http://dx.doi.org

/10.3109%2F03008208909043895). PMID 2805680


23.

^ Mankin, H. J.; Thrasher, A. Z. (1975). "Water

content and binding in normal and osteoarthritic

human cartilage". The Journal of bone and joint

surgery. American volume 57 (1): 7680.


/1123375).

24.

^ a b Venn, M.; Maroudas, A. (1977). "Chemical

composition and swelling of normal andosteoarthrotic femoral head cartilage. I. Chemical

composition" (http://www.ncbi.nlm.nih.gov

/pmc/articles/PMC1006646).Annals of the Rheumatic

Diseases 36 (2): 121129. doi:10.1136/ard.36.2.121

(http://dx.doi.org/10.1136%2Fard.36.2.121).


/PMC1006646). PMID 856064


25.

^ Zhang W, Doherty M, Peat G et al. (March 2010).

"EULAR evidence-based recommendations for the

diagnosis of knee osteoarthritis".Ann. Rheum. Dis. 69

(3): 4839. doi:10.1136/ard.2009.113100(http://dx.doi.org/10.1136%2Fard.2009.113100).


/19762361).

26.

^ Bierma-Zeinstra SM, Oster JD, Bernsen RM,

Verhaar JA, Ginai AZ, Bohnen AM (August 2002).

"Joint space narrowing and relationship with

symptoms and signs in adults consulting for hip pain

in primary care" (http://www.jrheum.org

/cgi/pmidlookup?view=long&pmid=12180735).J.

Rheumatol. 29 (8): 17138. PMID 12180735


27.

^ Osteoarthritis (OA): Joint Disorders

(http://www.merck.com/mmpe/sec04/ch034

/ch034e.html) at Merck Manual of Diagnosis and

Therapy Professional Edition

28.

^ Phillips CR, Brasington RD (2010). "Osteoarthritis

treatment update: Are NSAIDs still in the picture?"

(http://www.musculoskeletalnetwork.com/display

/article/1145622/1517357).Journal of

Musculoskeletal Medicine 27 (2).

29.

^ Kalunian, Kenneth C (2013). "Patient information:

Osteoarthritis symptoms and diagnosis (Beyond the

30.


3 8/3/2013


10/13

Basics)" (http://www.uptodate.com/patients/content

/topic.do?topicKey=~77ll0j9jfS9fuD). UpToDate.

Retrieved 15 February 2013.

^ Altman R, Alarcn G, Appelrouth D et al. (1990).

"The American College of Rheumatology criteria for

the classification and reporting of osteoarthritis of the

hand".Arthritis Rheum. 33 (11): 160110.

doi:10.1002/art.1780331101 (http://dx.doi.org

/10.1002%2Fart.1780331101). PMID 2242058


31.

^Neil Vasan; Le, Tao; Bhushan, Vikas (2010).First

Aid for the USMLE Step 1, 2010 (First Aid USMLE)

(http://books.google.se/books?id=eVAtPktgw0UC&

pg=PA169). McGraw-Hill Medical. p. 378.

ISBN 0-07-163340-5.

32.

^ a b c d e Flood J (March 2010). "The role of

acetaminophen in the treatment of osteoarthritis"

(http://www.ajmc.com/publications/supplement

/2010/A278_10mar_Pain/A278_2010mar_Flood/).

Am J Manag Care 16 (Suppl Management): S4854.

PMID 20297877 (//www.ncbi.nlm.nih.gov/pubmed/20297877).

33.

^ a b Cibulka MT, White DM, Woehrle J, et al. (April

2009). "Hip pain and mobility deficitship

osteoarthritis: clinical practice guidelines linked to the

international classification of functioning, disability,

and health from the orthopaedic section of the

American Physical Therapy Association".J Orthop

Sports Phys Ther39 (4): A125.

doi:10.2519/jospt.2009.0301 (http://dx.doi.org

/10.2519%2Fjospt.2009.0301). PMID 19352008


34.

^ Hagen, KB; Dagfinrud, H; Moe, RH; sters, N;

Kjeken, I; Grotle, M; Smedslund, G (2012 Dec 19).

"Exercise therapy for bone and muscle health: an

overview of systematic reviews.".BMC medicine 10:


/pubmed/23253613).

35.

^ Wang, SY; Olson-Kellogg, B; Shamliyan, TA;

Choi, JY; Ramakrishnan, R; Kane, RL (2012 Nov 6).

"Physical therapy interventions for knee pain

secondary to osteoarthritis: a systematic review".

Annals of internal medicine 157 (9): 63244.

doi:10.7326/0003-4819-157-9-201211060-00007(http://dx.doi.org

/10.7326%2F0003-4819-157-9-201211060-00007).


/23128863).

36.

^ De Luigi, AJ (2012 May). "Complementary and

alternative medicine in osteoarthritis.".PM & R : the

journal of injury, function, and rehabilitation 4 (5

Suppl): S12233. PMID 22632691


37.

^ http://www.japmaonline.org/content/82/3/136.short38.

^ http://onlinelibrary.wiley.com/doi/10.100239.

/14651858.CD004020.pub2/pdf/standard

^ Page CJ, Hinman RS, Bennell KL (2011).

"Physiotherapy management of knee osteoarthritis".

Int J Rheum Dis 14 (2): 145152.

doi:10.1111/j.1756-185X.2011.01612.x

(http://dx.doi.org

/10.1111%2Fj.1756-185X.2011.01612.x).


/21518313).

40.

^ Rannou F, Dimet J, Boutron I, et al. (May 2009).

"Splint for base-of-thumb osteoarthritis: a randomized

trial" (http://www.annals.org

/article.aspx?volume=150&page=661).Ann. Intern.

Med. 150 (10): 6619.

doi:10.7326/0003-4819-150-10-200905190-00003

(http://dx.doi.org

/10.7326%2F0003-4819-150-10-200905190-00003).


/19451573).

41.

^ French HP, Brennan A, White B, Cusack T (2011).

"Manual therapy for osteoarthritis of the hip or knee a systematic review".Man Ther16 (2): 109117.

doi:10.1016/j.math.2010.10.011 (http://dx.doi.org

/10.1016%2Fj.math.2010.10.011). PMID 21146444


42.

^ Sturnieks DL, Tiedemann A, Chapman K, Munro

B, Murray SM, Lord SR (November 2004).

"Physiological risk factors for falls in older people

with lower limb arthritis" (http://www.jrheum.org

/cgi/pmidlookup?view=long&pmid=15517643).J.

Rheumatol. 31 (11): 22729. PMID 15517643


43.

^ Zhang W, Moskowitz RW, Nuki G et al.(September 2007). "OARSI recommendations for the

management of hip and knee osteoarthritis, part I:

critical appraisal of existing treatment guidelines and

systematic review of current research evidence".

Osteoarthr. Cartil. 15 (9): 9811000.

doi:10.1016/j.joca.2007.06.014 (http://dx.doi.org

/10.1016%2Fj.joca.2007.06.014). PMID 17719803


44.

^ Chen, YF; Jobanputra, P; Barton, P; Bryan, S;

Fry-Smith, A; Harris, G; Taylor, RS (April 2008).

"Cyclooxygenase-2 selective non-steroidal

anti-inflammatory drugs (etodolac, meloxicam,

celecoxib, rofecoxib, etoricoxib, valdecoxib and

lumiracoxib) for osteoarthritis and rheumatoid

arthritis: a systematic review and economic

evaluation".Health technology assessment12 (11):

1278, iii. PMID 18405470 (//www.ncbi.nlm.nih.gov

/pubmed/18405470).

45.

^ a b c Altman R, Barkin RL (March 2009). "Topical

therapy for osteoarthritis: clinical and pharmacologic

perspectives".Postgrad Med121 (2): 13947.

doi:10.3810/pgm.2009.03.1986 (http://dx.doi.org

46.


13 8/3/2013


11/13

/10.3810%2Fpgm.2009.03.1986). PMID 19332972


^Nesch E, Rutjes AW, Husni E, Welch V, Jni P

(2009). "Oral or transdermal opioids for osteoarthritis

of the knee or hip". In Nesch, Eveline. Cochrane

Database Syst Rev (4): CD003115.

doi:10.1002/14651858.CD003115.pub3

(http://dx.doi.org

/10.1002%2F14651858.CD003115.pub3).


/19821302).

47.

^ a b c d e De Silva, V; El-Metwally, A; Ernst, E;

Lewith, G; Macfarlane, GJ; Arthritis Research UK

Working Group on Complementary and Alternative,

Medicines (2011 May). "Evidence for the efficacy of

complementary and alternative medicines in the

management of osteoarthritis: a systematic review.".

Rheumatology (Oxford, England) 50 (5): 91120.


/21169345).

48.

^ Arroll B, Goodyear-Smith F (April 2004)."Corticosteroid injections for osteoarthritis of the

knee: meta-analysis" (http://www.ncbi.nlm.nih.gov

/pmc/articles/PMC387479).BMJ328 (7444): 869.

doi:10.1136/bmj.38039.573970.7C (http://dx.doi.org

/10.1136%2Fbmj.38039.573970.7C). PMC 387479

(//www.ncbi.nlm.nih.gov/pmc/articles/PMC387479).


/15039276).

49.

^ a b Rutjes AW, Jni P, da Costa BR, Trelle S,

Nesch E, Reichenbach S (August 2012).

"Viscosupplementation for osteoarthritis of the knee:

a systematic review and meta-analysis"

(http://www.annals.org/article.aspx?volume=157&

page=180).Ann. Intern. Med. 157 (3): 18091.

doi:10.7326/0003-4819-157-3-201208070-00473

(http://dx.doi.org

/10.7326%2F0003-4819-157-3-201208070-00473).


/22868835).

50.

^ Santaguida, PL; Hawker, GA, Hudak, PL, Glazier,

R, Mahomed, NN, Kreder, HJ, Coyte, PC, Wright, JG

(December 2008). "Patient characteristics affecting

the prognosis of total hip and knee joint arthroplasty:a systematic review" (http://www.ncbi.nlm.nih.gov

/pmc/articles/PMC2592576). Canadian journal of

surgery. Journal canadien de chirurgie 51 (6):

42836. PMC 2592576 (//www.ncbi.nlm.nih.gov

/pmc/articles/PMC2592576). PMID 19057730


51.

^ Carr, AJ; Robertsson, O; Graves, S; Price, AJ;

Arden, NK; Judge, A; Beard, DJ (7 April 2012).

"Knee replacement".Lancet379 (9823): 133140.

doi:10.1016/S0140-6736(11)60752-6

(http://dx.doi.org

52.

/10.1016%2FS0140-6736%2811%2960752-6).


/22398175).

^ Moseley JB, O'Malley K, Petersen NJ et al. (2002).

"A controlled trial of arthroscopic surgery for

osteoarthritis of the knee is proven to bring an

improvement lasting for about two years"

(http://content.nejm.org/cgi/content/full/347/2/81).

The New England Journal of Medicine 347 (2): 818.

doi:10.1056/NEJMoa013259 (http://dx.doi.org

/10.1056%2FNEJMoa013259). PMID 12110735


53.

^ Lopez, HL (2012 May). "Nutritional interventions

to prevent and treat osteoarthritis. Part II: focus on

micronutrients and supportive nutraceuticals.".PM &

R : the journal of injury, function, and rehabilitation 4

(5 Suppl): S15568. PMID 22632695


54.

^ . PMID 19856319 (//www.ncbi.nlm.nih.gov

/pubmed/19856319). Missing or empty |title=

(help)

55.

^ a b Rosenbaum CC, O'Mathna DP, Chavez M,

Shields K (2010). "Antioxidants and

antiinflammatory dietary supplements for

osteoarthritis and rheumatoid arthritis".Altern Ther

Health Med16 (2): 3240. PMID 20232616


56.

^ Pirotta, M (2010 Sep). "Arthritis disease - the use of

complementary therapies.".Australian family

physician 39 (9): 63840. PMID 20877766


57.

^ Ernst, E (2008 Dec 17). "Frankincense: systematic

review.".BMJ (Clinical research ed.) 337: a2813.PMID 19091760 (//www.ncbi.nlm.nih.gov/pubmed

/19091760).

58.

^ Rosenbaum, CC; O'Mathna, DP; Chavez, M;

Shields, K (2010 Mar-Apr). "Antioxidants and

antiinflammatory dietary supplements for

osteoarthritis and rheumatoid arthritis.".Alternative

therapies in health and medicine 16 (2): 3240.


/21553931).

59.

^ The effects of Glucosamine Sulphate on OA of the

knee joint (http://www.bestbets.org

/bets/bet.php?id=979). BestBets.

60.

^ Burdett, N; McNeil, JD (2012 Sep). "Difficulties

with assessing the benefit of glucosamine sulphate as

a treatment for osteoarthritis.".International journal

of evidence-based healthcare 10 (3): 2226.


/22925619).

61.

^ Wandel, S; Jni, P; Tendal, B; Nesch, E; Villiger,

PM; Welton, NJ; Reichenbach, S; Trelle, S (2010 Sep

16). "Effects of glucosamine, chondroitin, or placebo

in patients with osteoarthritis of hip or knee: network

62.


13 8/3/2013


12/13

meta-analysis.".BMJ (Clinical research ed.) 341:

c4675. PMID 20847017 (//www.ncbi.nlm.nih.gov

/pubmed/20847017).

^ Poolsup N, Suthisisang C, Channark P, Kittikulsuth

W (2005). "Glucosamine long-term treatment and the

progression of knee osteoarthritis: systematic review

of randomized controlled trials". The Annals of

pharmacotherapy 39 (6): 10807.

doi:10.1345/aph.1E576 (http://dx.doi.org

/10.1345%2Faph.1E576). PMID 15855241


63.

^ Black C, Clar C, Henderson R et al. (November

2009). "The clinical effectiveness of glucosamine and

chondroitin supplements in slowing or arresting

progression of osteoarthritis of the knee: a systematic

review and economic evaluation"

(http://www.hta.ac.uk/execsumm/summ1352.htm).

Health Technol Assess 13 (52): 1148.

doi:10.3310/hta13520 (http://dx.doi.org

/10.3310%2Fhta13520). PMID 19903416


64.

^ Vlad SC, Lavalley MP, McAlindon TE, Felson DT

(2007). "Glucosamine for pain in osteoarthritis: Why

do trial results differ?".Arthritis & Rheumatism 56

(7): 226777. doi:10.1002/art.22728 (http://dx.doi.org

/10.1002%2Fart.22728). PMID 17599746


65.

^ Rovati, LC; Girolami, F; Persiani, S (2012 Jun).

"Crystalline glucosamine sulfate in the management

of knee osteoarthritis: efficacy, safety, and

pharmacokinetic properties.". Therapeutic advances

in musculoskeletal disease 4 (3): 16780.

PMID 22850875 (//www.ncbi.nlm.nih.gov/pubmed/22850875).

66.

^ Zhang W, Moskowitz RW, Nuki G et al. (February

2008). "OARSI recommendations for the

management of hip and knee osteoarthritis, Part II:

OARSI evidence-based, expert consensus guidelines"

(http://www.oarsi.org

/pdfs/part_II_OARSI_recommendations_for_manage

ment_of_hipknee_OA_2007.pdf). Osteoarthr. Cartil.

16 (2): 13762. doi:10.1016/j.joca.2007.12.013



/18279766).

67.

^ Henrotin, Y; Mobasheri, A; Marty, M (2012 Jan

30). "Is there any scientific evidence for the use of

glucosamine in the management of human

osteoarthritis?".Arthritis research & therapy 14 (1):


/pubmed/22293240).

68.

^ Miller KL, Clegg DO (February 2011).

"Glucosamine and chondroitin sulfate".Rheum. Dis.

Clin. North Am. 37 (1): 10318.

doi:10.1016/j.rdc.2010.11.007 (http://dx.doi.org

69.

/10.1016%2Fj.rdc.2010.11.007). PMID 21220090

(//www.ncbi.nlm.nih.gov/pubmed/21220090). "The

best current evidence suggests that the effect of these

supplements, alone or in combination, on OA pain,

function, and radiographic change is marginal at

best."

^ Reichenbach S, Sterchi R, Scherer M et al. (2007).

"Meta-analysis: chondroitin for osteoarthritis of the

knee or hip".Ann. Intern. Med. 146 (8): 58090.


/17438317).

70.

^ Manheimer E, Cheng K, Linde K et al. (2010).

"Acupuncture for peripheral joint osteoarthritis"


/PMC3169099). In Manheimer, Eric. Cochrane


doi:10.1002/14651858.CD001977.pub2

(http://dx.doi.org

/10.1002%2F14651858.CD001977.pub2).


/PMC3169099). PMID 20091527(//www.ncbi.nlm.nih.gov/pubmed/20091527).

71.

^ Wang, S; Kain ZN; White PF (2008). "Acupuncture

Analgesia: II. Clinical Considerations"

(http://www.thecochranelibrary.com/.../file

/Acupuncture.../CD001977.pdf).Anesth Analg106

(2): 61121. doi:10.1213/ane.0b013e318160644d

(http://dx.doi.org

/10.1213%2Fane.0b013e318160644d).


/18227323).

72.

^ Rutjes AW, Nesch E, Sterchi R et al. (2009).

"Transcutaneous electrostimulation for osteoarthritisof the knee". In Rutjes, Anne WS. Cochrane


doi:10.1002/14651858.CD002823.pub2

(http://dx.doi.org

/10.1002%2F14651858.CD002823.pub2).


/19821296).

73.

^ "WHO Disease and injury country estimates"

(http://www.who.int/healthinfo

/global_burden_disease/estimates_country

/en/index.html). World Health Organization. 2009.

Retrieved Nov. 11, 2009.

74.

^ Vos, T (2012 Dec 15). "Years lived with disability

(YLDs) for 1160 sequelae of 289 diseases and

injuries 1990-2010: a systematic analysis for the

Global Burden of Disease Study 2010.".Lancet380

(9859): 216396. PMID 23245607


75.

^ Green GA (2001). "Understanding NSAIDs: from

aspirin to COX-2". Clin Cornerstone 3 (5): 5060.

doi:10.1016/S1098-3597(01)90069-9

(http://dx.doi.org

76.


13 8/3/2013


13/13

/10.1016%2FS1098-3597%2801%2990069-9).


/11464731).

^ Hospitalizations for Osteoarthritis Rising Sharply

(http://newswise.com/articles/view/544029/)

Newswise, Retrieved on September 4, 2008.

77.

^ The global burden of disease : 2004 update..

[Online-Ausg.] ed. Geneva, Switzerland: World

Health Organization; 2008. ISBN 9789241563710. p.

35.

78.

^ Molnar, R. E., 2001, Theropod paleopathology: a

literature survey: In: Mesozoic Vertebrate Life, edited

by Tanke, D. H., and Carpenter, K., Indiana

University Press, p. 337-363.

79.

^ Civjan, Natanya (2012). Chemical Biology:80.

Approaches to Drug Discovery and Development to

Targeting Disease (http://books.google.com

/books?id=ezXLFlwfJycC&pg=PA313). John Wiley

& Sons. p. 313. ISBN 9781118437674.

^ Bruyre, O; Burlet, N; Delmas, PD; Rizzoli, R;

Cooper, C; Reginster, JY (16 December 2008).

"Evaluation of symptomatic slow-acting drugs in

osteoarthritis using the GRADE system"


/PMC2627841).BMC musculoskeletal disorders 9:

165. doi:10.1186/1471-2474-9-165 (http://dx.doi.org

/10.1186%2F1471-2474-9-165). PMC 2627841

(//www.ncbi.nlm.nih.gov/pmc/articles/PMC2627841)


/19087296).

81.

External links

American College of Rheumatology Factsheet on OA (http://www.rheumatology.org/practice/clinical

/patients/diseases_and_conditions/osteoarthritis.asp)Osteoarthritis (http://www.arthritis.org/disease-center.php?disease_id=32) The Arthritis Foundation

Treatment Guidelines. (http://www.oarsi.org/index2.cfm?section=Publications_and_Newsroom&

content=OAGuidelines) Osteoarthritis Research Society International. Recommendations for the

management of hip and knee osteoarthritis. Part II OARSI Recommendations for Management of Hip &

Knee OA 2007. Part III Changes in Evidence 2010.

Retrieved from "http://en.wikipedia.org/w/index.php?title=Osteoarthritis&oldid=564458906"

Categories: Arthritis Skeletal disorders

This page was last modified on 16 July 2013 at 04:34.

Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may

apply. By using this site, you agree to the Terms of Use and Privacy Policy.

Wikipedia is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.


osteoarthritis - wikipedia, the free encyclopedia.pdf

Documents