Osteoarthritis. (Women's Health Adviser).

The fact that the American College of Rheumatology has revised its guidelines for the treatment of osteoarthritis twice in recent years is a testament to how many advances have occurred. New drugs and treatment options abound, and researchers are studying therapies that target the causes of the disease, not just alleviate symptoms.

Diagnosis. Pain will bring the patient into the exam room. The pain will be localized in a particular joint, usually the knee, hip, or hand; the most severe pain will likely occur later in the day. The fingers may appear knobby, and you may be able to feel bone spurs, or osteophytes, through the skin. Osteoarthritis (GA) patients will have less inflammation than many other arthritis patients, but some inflammation is still present. Usually the joints will be cool to the touch and without evidence of synovitis. The rheumatoid arthritis (RA) patient, on the other hand, will complain of diffuse pain, experienced mostly in the morning, and will show increased signs of. inflammation. Be aware also that GA patients may show low levels of RA factor in their blood work.

It's easy to mistake polymyalgia rheumatica (PMR) for GA and vice versa, or to miss coexisting PMR in an GA patient. PMR occurs in patients over 50 years old, usually of northern European descent. Pain will present in the neck and shoulder area or the hip. PMR maybe dangerous, because 15%-20% of PMR patients also have temporal arteritis, inflammation of an artery near the temple that can be associated with vision loss.

Obesity and a previous injury to the affected joint are also risk factors for GA.

The confirming diagnosis for OA is an x-ray showing osteophytes. If the affected joint is a knee, the x-ray should be taken while the patient is standing.

Treatment. The first step should be a nonpharmaceutical regimen that includes muscle strengthening, aerobic exercise, and, if the patient is overweight, diet. Even small amounts of weight loss, 10-15 pounds, can reduce pain. These nonpharmaceutical steps should continue throughout treatment.

The most significant recent advance in treatment has been the introduction of cyclooxygenase-2 (COX-2) inhibitors, which, contrary to popular belief, are not "super" NSAIDs but merely safex ones. They are less likely to induce gas-trointestinal bleeding in older patients but are not necessarily more ...