OA= Often Asymmetrical; A Synopsis of AFP's "Osteoarthritis: Diagnosis and Treatment" by Keith Sinusas

This is a review of the January 1, 2012 American Family Physician, volume 85 number 1.


OA is a common disorder, but there are other joint disorders that look similar. OA worsens with activity, especially after rest. Morning stiffness usually lasts LESS THAN 30 minutes ( RA is usually longer). Any joint can be involved, but it usually occurs asymmetrically. Heberden and bouchard nodes can be seen. Lab work and imaging isn't that helpful in the diagnosis of OA.
So there is a "stepped care approach" to treatment which is clearly described on table 5 of this article. Basically it's says this: first start with diet and exercise ( water exercises are apparently not at good as land based programs). You can also start the patient off with some acetaminophen or try an NSAID. The next step is to try ibuprofen or naproxen and a different NSAID. If that doesn't work try glucosamine and chondroitin for 3 months. If the patient is still in pain you can move on to opioids. At this point if the patient has severe OA it may be time to consider corticosteroid injections, hyaluronic acid injections and lastly, a joint replacement. Capsaicin cream and SAM-e have also shown some benefit.