What is the diagnosis and treatment for Osteoarthritis (OA)?

From the Guidelines

The most effective management approach for osteoarthritis (OA) involves a combination of exercise, weight loss, and pharmacologic therapies, with strong recommendations for exercise, weight loss in overweight or obese patients, and the use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) for knee OA, as supported by the 2020 American College of Rheumatology guideline 1. The illness script for OA typically includes risk factors such as advanced age, obesity, previous joint injury, and genetic predisposition. Patients commonly present with joint pain that worsens with activity and improves with rest, morning stiffness lasting less than 30 minutes, reduced range of motion, and joint crepitus. Key management strategies include:

• Exercise, which is strongly recommended for all patients with OA, as it improves function and reduces pain 1
• Weight loss, which is strongly recommended for patients with knee and/or hip OA who are overweight or obese, as it reduces mechanical stress on the joints and improves symptoms 1
• Pharmacologic therapies, such as topical NSAIDs, oral NSAIDs, and intraarticular glucocorticoid injections, which are strongly recommended for knee OA, as they provide effective pain relief and reduce inflammation 1 Radiographic findings include joint space narrowing, osteophyte formation, subchondral sclerosis, and subchondral cysts. The pathophysiology of OA involves mechanical stress leading to cartilage matrix degradation, release of inflammatory mediators, and abnormal bone remodeling, creating a cycle of progressive joint degeneration. Advanced cases unresponsive to conservative management may require surgical interventions such as joint replacement.

From the FDA Drug Label

In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease The therapeutic action of naproxen in patients with osteoarthritis (OA) includes:

• Reduction in joint pain or tenderness
• Increase in range of motion in knee joints
• Increased mobility
• Improvement in capacity to perform activities of daily living impaired by the disease 2 2

From the Research

Illness Script for Osteoarthritis (OA)

• Osteoarthritis (OA) is a chronic, disabling, and common disease that requires core treatments such as education, advice, or information about the etiology, progression, prognosis, and treatment options 3.
• Nonpharmacological and nonsurgical interventions are recommended as the core treatments for OA, including weight loss (if overweight) and exercise, which should be considered regardless of age, structural disease severity, functional status, pain levels, or the presence of comorbidities 3.
• Walking aids/devices are recommended for both hip and knee OA, while orthoses are recommended for patients with carpometacarpal (CMC) joint OA 3.
• Trained healthcare providers with the skills to provide the core treatments are essential, and proactive management from the first consultation for OA symptoms is necessary 3.

Pharmacological Interventions for OA

• Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line therapy for OA, but selection is challenged by patient age, comorbidities, and polypharmacy, as well as the drug's benefit/risk balance 4.
• Acetaminophen has been found to be effective in alleviating pain in patients with OA and merits a trial as initial therapy in patients with mild to moderate pain, based on cost-effectiveness and safety profile 5.
• The safety of oral non-selective non-steroidal anti-inflammatory drugs in OA is a concern, with gastrointestinal, cardiovascular, and renal adverse events associated with their use 6.
• The efficacy and safety of oral NSAIDs and analgesics in the management of OA have been evaluated in real-life setting trials and surveys, with recommendations for the use of ibuprofen, naproxen, and low-dose celecoxib in patients with elevated risk 7.