From the Guidelines
Osteoarthritis (OA) patients typically have normal or mildly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, which are not significantly high compared to inflammatory arthritis. The diagnosis of OA is primarily based on clinical evaluation and imaging, rather than laboratory findings. Routine blood work, including complete blood count, ESR, and CRP, are usually normal in OA patients, helping to distinguish it from inflammatory arthritis 1.
Laboratory Findings
Some key laboratory findings in OA include:
- Normal or mildly elevated ESR and CRP levels
- Synovial fluid analysis showing clear, viscous fluid with fewer than 2,000 white blood cells per cubic millimeter
- No significant abnormalities in complete blood count
Management Options
Management of OA begins with non-pharmacological approaches, including:
- Weight loss
- Physical therapy
- Exercise programs focusing on strengthening and low-impact aerobic activities First-line pharmacological treatment includes:
- Acetaminophen (up to 3000 mg daily in divided doses)
- Topical NSAIDs like diclofenic gel 1% applied four times daily to affected joints For moderate to severe pain, oral NSAIDs such as ibuprofen (400-800 mg three times daily) or naproxen (250-500 mg twice daily) may be used, with gastroprotection using proton pump inhibitors in high-risk patients 1. Intra-articular corticosteroid injections can provide short-term relief for flare-ups, limited to 3-4 injections yearly.
Additional Treatment Options
For patients with inadequate response to conservative measures, viscosupplementation with hyaluronic acid injections or surgical interventions, including arthroscopy or joint replacement, may be considered based on disease severity and functional impairment 1. It's essential to tailor the treatment approach according to individual patient factors, such as knee risk factors, general risk factors, level of pain intensity and disability, and signs of inflammation 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Laboratory Findings in Osteoarthritis (OA)
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are commonly used to assess inflammation in various conditions, including OA.
- However, studies have shown that ESR and CRP levels are poorly correlated with clinical measures of disease activity in OA 2.
- A systematic review and meta-analysis found that serum CRP levels were modestly but statistically significantly higher in OA patients compared to controls, with a mean difference of 1.19 mg/L 3.
- CRP levels were also found to be associated with pain and decreased physical function in OA patients, but not with radiographic OA 3.
Management Options for Osteoarthritis (OA)
- The pharmaceutical management of OA is a constantly evolving field, with various treatment options available, including oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, duloxetine, intra-articular corticosteroids, and hyaluronic acid 4.
- Acetaminophen, tramadol, and capsaicin are also used to treat OA, although their efficacy and safety are more controversial 4, 5.
- The choice of treatment depends on various factors, including the severity of symptoms, comorbidities, and patient preferences 4, 5.
Inflammation in Osteoarthritis (OA)
- While OA is traditionally considered a non-inflammatory condition, there is emerging evidence that inflammation plays a role in its development and progression 3.
- Low-grade systemic inflammation may contribute to symptoms such as pain and decreased physical function in OA patients 3.
- However, the relationship between inflammation and OA is complex, and further research is needed to fully understand its role in the condition 3, 6.