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Osteoarthritis is the most common form of the more than one hundred conditions that are considered arthritis and other rheumatic conditions. In 1998, these conditions affected 43 million Americans, and they are among the most common chronic diseases. Arthritis is also a leading cause of disability—it limits activities for 7 million Americans. The costs of arthritis are enormous. In 1992, the costs of medical treatment and lost wages were estimated at $65 billion. The cost of osteoarthritis alone may currently exceed $15.5 billion.
Osteoarthritis affects as many people as all of the other types of arthritis combined. Almost 22 million Americans have osteoarthritis—almost one of every twelve people in the United States. Prevalence estimates of osteoarthritis will differ by how the data are collected or how the diagnosis is made. For example, people who have pain due to osteoarthritis may not show X-ray changes, and those with X-ray changes consistent with osteoarthritis may not have symptoms. The prevalence of osteoarthritis is high and will get even higher as the number of older Americans increases. In 2020, an estimated 60 million Americans will have arthritis—osteoarthritis alone is likely to affect over 30 million people. Osteoarthritis is a major cause of disability. Sixty to 80 percent of people with osteoarthritis are limited in their activities because of the disease.
There is no known cure for osteoarthritis, yet there are effective treatment and control strategies. Management of osteoarthritis is directed toward reducing pain, minimizing or preventing disability, and improving quality of life. Achieving these goals not only requires good clinical care, but also depends on the active involvement of the person with osteoarthritis in self-management strategies and proactive efforts by the public health system.
Clinical Care. The American College of Rheumatology (ACR) has published guidelines on the medical management of osteoarthritis of the hip and knee that outline the key components of appropriate management. The guidelines list therapeutic strategies, including medications, rehabilitation therapies, and surgery. Medical management of osteoarthritis primarily focuses on prescribing appropriate medications and recommending self-management strategies or making referrals to rehabilitation, self-management, or surgical services.
Medication recommendations for osteoarthritis are evolving. Nonsteroidal anti-inflammatory drugs (NSAID) were, until recently, the primary medication treatment for osteoarthritis. However, due to concerns about the gastrointestinal toxicity of NSAIDs, the 1995 ACR medical-management guidelines concluded that the first-line medication for symptomatic osteoarthritis should be acetaminophen. NSAIDs were recommended for those individuals who do not get sufficient pain relief from acetaminophen. In 1998, a new form of NSAID, called COX-2 Inhibitors, was released. COX-2 medications are similar to other NSAIDs in their effect on pain and joint inflammation, but they have significantly fewer gastrointestinal side effects. Physicians now vary in whether they initiate treatment for osteoarthritis with acetaminophen, another NSAID, or a COX-2 medication.
Other treatments are also used. For example, symptomatic knee osteoarthritis may benefit from an injection of cortisone into the joint. The
Rehabilitation services, such as physical and occupational therapy, are also important in the management of osteoarthritis. Therapists may prescribe therapeutic exercise to increase joint range of motion, muscle strength, and aerobic conditioning; they make teach strategies to reduce fatigue and stress on joints; and they may recommend environmental or task modification and assistive devices to make it easier to perform daily activities. Rehabilitation services may also be used after joint surgery.
Persons with severe symptomatic osteoarthritis, marked by pain and declining function, may benefit from total joint replacement. Both total hip and knee replacement have substantially reduced pain and improved function in the vast majority of individuals who have received them.
Self-Management Strategies. The ACR guidelines for medical management of osteoarthritis recommend specific self-management strategies as well as clinical interventions. The guidelines specify self-management education, exercise and aerobic conditioning, and weight control as integral to optimal health outcomes in osteoarthritis.
Because of its demonstrated efficacy and cost-effectiveness, the premiere self-management education intervention for osteoarthritis is the Arthritis Self-Help Course (ASHC). ASHC, developed in the early 1980s by Kate Lorig and colleagues, was adopted in the United States by the Arthritis Foundation and has been disseminated nationwide. A 20 percent reduction in pain and a 43 percent reduction in physician visits was demonstrated in four-year follow-up studies of ASHC. Early research demonstrated that each individual's belief that there was "something they could do," which Lorig labeled "self-efficacy," was more strongly correlated with positive health outcomes from ASHC than were specific health behaviors. Cost-effectiveness calculations indicated an annual savings of $189 per osteoarthritis participant due to the decreased need for physician visits.
Physical activity and weight control are important self-management strategies in osteoarthritis. Physical Activity and Health: A Report of the Surgeon General (1996) specifically addressed osteoarthritis and stated that regular moderate exercise programs, either aerobic or resistance training, relieve symptoms and improve physical function and psychosocial status among people with osteoarthritis. Low-impact forms of exercise, such as walking, swimming, and stationary or on-the-road bicycling, are recommended to minimize the stress on affected joints. The Arthritis Foundation disseminates structured physical activity programs. Preliminary studies have shown positive health outcomes among participants in these programs. Obesity is a well-documented risk factor for the development of symptomatic osteoarthritis. A randomized controlled study showed that the amount of weight lost was strongly correlated with improvements in signs and symptoms of knee osteoarthritis.
Some persons with osteoarthritis choose to manage their condition by using various forms of complementary and alternative medicine (CAM) modalities, either along with, or in place of, medically prescribed therapies. Symptoms associated with chronic musculoskeletal conditions, including osteoarthritis, are among the most common reasons for using CAM. More information is needed, however, about the safety and efficacy of CAM modalities.
Author Info: JOSEPH E. SNIEZEK, TERESA J. BRADY, JAMES S. MARKS, The Gale Group Inc., Macmillan Reference USA, New York, Gale Encyclopedia of Public Health, 2002
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