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  • Treatment goals for osteoarthritis should be identified prior to beginning treatment and individualized to the patient, with the goal of achieving an acceptable balance between minimizing pain and side effects as well as maximizing functionality along with quality of life.

  • Optimal treatment of osteoarthritis includes both pharmacologic and nonpharmacologic therapies. Adherence to both should be assessed at each MTM encounter.

  • Given the significant adverse effects of long-term NSAID treatment, reassessment of cardiovascular risk and GI bleeding risk should be conducted during each MTM encounter to ensure safety of continued treatment and the potential need for additional medications to reduce risk (eg, proton-pump inhibitors for GI bleeding risk).

  • Assessment of potential adverse effects from analgesic therapy should be determined during each MTM encounter. Importantly, bleeding from NSAIDs and constipation, sedation, or respiratory depression associated with opioids should be monitored frequently.


Osteoarthritis (OA) is the most common form of arthritis, characterized by damage to the joint and joint structures, commonly in weight-bearing joints such as the hips and knees (Figure 29-1). OA can also occur in non-weight-bearing joints such as the hands. OA affects approximately 27 million Americans,1 and because the prevalence of the disease increases with age, it is estimated that the number of individuals with OA will increase significantly in the near future.2 Women are more commonly affected than men, and they also tend to have more joints involved. The prevalence of OA is similar in both African Americans and Caucasians, although Caucasians are more likely to experience severe disease.

Figure 29-1.

Characteristics of Osteoarthritis in the diarthrodial Joint

Source: Buys LM, Elliott ME. Osteoarthritis. In: DiPiro JT, Talbert RL, Yee GC, et al. eds. Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York, NY: McGraw-Hill; 2014: Chap 71. Available at Accessed April 29, 2014.

The development of OA is the multifactorial result of biomechanical weaknesses and risk factors in a susceptible individual. Increasing age is the most significant risk factor for OA. Other risk factors include a history of trauma, obesity, involvement in certain sports, occupations with repetitive or strenuous movements, female sex, and genetic factors.3

Osteoarthritis can be broadly categorized as primary or secondary (Table 29-1). Primary OA does not have an identifiable cause and can be further classified as localized, generalized, or erosive OA. Secondary OA can be attributed to an identifiable cause, such as trauma, inflammatory conditions, congenital disorders, endocrine disorders, metabolic disorders, or other conditions that contribute to or increase the risk of developing OA.3

Table 29-1.Classification of Osteoarthritis3

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