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A systematic search of the medical literature was performed on August 20, 2007, using the terms osteoarthritis and arthritis. The search, limited to human subjects and English language journals, included the PubMed and Cochrane Collection databases.

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Osteoarthritis (OA) is the most common of the rheumatic diseases, with a prevalence of approximately 200 per 100,000 person-years, and is responsible for enormous disability and loss of productivity.1–3 The prevalence and severity of OA is higher in older age groups than in younger groups, affecting an estimated 46 million Americans.4

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The most common risk factors for the development of OA, which is typically a multifactorial disease, include obesity, previous occupation, participation in certain sports, history of joint trauma, and a genetic predisposition to OA. Patients with osteoarthritis are less likely to have osteoporosis, probably because heavy individuals have higher bone density because of weight-bearing, but increased risk of OA as a result of excessive joint loading.3

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The typical patient presenting with OA is older than 50 years of age and has had the presenting symptoms for months to years, often having treated them with nonprescription medications or dietary supplements. Pain in the affected joint is a nearly universal complaint, and hands, knees, or hips are the most commonly affected joints. Pain is most common with motion, unless the disease is advanced, in which case pain can be present at rest. Joint stiffness resolves with motion and recurs with rest.

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Late-stage disease is associated with joint deformity (Fig. 35-1). Joint space narrowing and/or osteophytes may be evident in X-ray films (Fig. 35-2). Abnormal alignment of joints and joint effusion can occur in late disease (Fig. 35-3).

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Figure 35-1.
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Typical appearance of the bony changes associated with Heberden’s and Bouchard’s nodes.

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Figure 35-2.
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Plain X-ray films of the knee demonstrating joint space narrowing.

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Figure 35-3.
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Physical findings of joint enlargement and genu varum of the knees.

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The diagnosis of OA is made through history, physical examination, characteristic radiographic findings, and laboratory testing.2,5 The major diagnostic goals are: (1) to discriminate between primary and secondary OA and (2) to clarify the joints involved, severity of joint involvement, and response to prior therapies, providing a basis for a treatment plan.

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Physical examination reveals a patient in mild, moderate, or severe pain. Crepitus—a crackling or grating sound heard with joint movement that is caused by irregularity of joint surface—may be present. Limited range of motion may be accompanied by joint instability.

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The American College of Rheumatology has published traditional diagnostic criteria and also “decision ...

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