Osteoarthritis

Disease State Overview

Osteoarthritis (OA) is the most common form of arthritis and is characterized by cartilage degradation, bone remodeling, osteophyte formation, and synovial inflammation. Osteoarthritis primarily affects the knees, hips, and hands and is associated with pain, stiffness, swelling, and loss of normal joint functioning. This degeneration causes pain, stiffness, and tenderness of the affected joints. Risk factors of OA include joint injury, occupation, overweight/obese, gender, age, genetics, and race.  

Risk of Condition 

​​Osteoarthritis is a degenerative disease that gets worse over time and is a top cause of disability in older adults. Osteoarthritis can result in chronic pain of the joints and stiffness that becomes so severe it affects daily activities.  

Medication 

Role of Medication 

The 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip and Knee provides recommendations for pharmacologic therapies to alleviate osteoarthritis symptoms. Guidelines recommended a multimodal approach based on shared decision making. Choice of therapy should be based on multiple factors including location of the joint affected by osteoarthritis, medication side effect profile, insurance coverage, patient preference, patient’s age, comorbid conditions, and concurrent medications.  

Osteoarthritis Treatment Recommendations  

Topical

• Topical capsaicin
  • Key Points: 
    • OTC, requires administration 3-4x daily, may cause burning, stinging or local skin reactions. 
  • Affected Joints:
    • Knee
• Topical NSAIDs 
  • Key Points:
    • OTC or RX options available, preferred over oral NSAIDs when possible due to lower SE profile. 
  • Affected Joints:
    • Hand
    • Knee

Oral

• Oral NSAIDs 
  • Key Points:
    • OTC or Rx options, lowest dose and shortest duration possible is recommended to minimize potential side effects including gastrointestinal, cardiovascular, and renal side effects 
  • Affected Joints:
    • Hand
    • Knee
    • Hip
• Tramadol
  • Key Points:
    • Can be considered in patients with contraindications to NSAIDs or other therapies, preferred over non-tramadol opioids, addiction and overdose risk should be considered
  • Affected Joints:
    • Hand
    • Knee
    • Hip
• Acetaminophen 
  • Key Points:
    • OTC, may be appropriate for short term, episodic use as long-term use has shown no benefit, daily doses > 3g are not recommended due to hepatotoxicity risk  
  • Affected Joints:
    • Hand
    • Knee
    • Hip
• Duloxetine
  • Key Points:
    • Rx options available, effective when used alone or in combination with NDAIDs 
  • Affected Joints:
    • Hand
    • Knee
    • Hip
• Chondroitin Sulfate
  • Key Points:
    • OTC option, often found in combination with glucosamine which is strongly recommended against
  • Affected Joints:
    • Hand

Injectable

• Intraarticular corticosteroid injection 
  • Key Points:
    • Recommended no more often than every 3 months
  • Affected Joints:
    • Hand
    • Knee
    • Hip 

Current guidelines strongly recommended against the use of bisphosphonates, glucosamine, hydroxychloroquine, biologics, and methotrexate.  

Monitoring 

Regular monitoring and follow-up with a health care provider is important to assess the patient’s response to their treatment plan.  

Lifestyle Education 

Lifestyle changes can play an important role in osteoarthritis management. Discussion points may include: 

• Encourage participation in a regular, ongoing exercise program based on patient preference and access.  
• In patients with knee or HIP OA, weight loss is strongly recommended. Encourage the patient to lose weight if they are overweight or obese as this can reduce strain and pain on the joint and help slow progression of the disease. 

Additional Points  

Despite osteoarthritis being the most common form of arthritis, it is still an under-recognized chronic condition. Through collaboration between the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation (AF) in 2010, the first National Public Health Agenda for Osteoarthritis was developed. In 2020, this agenda was updated to ensure availability of evidence-based interventions, focusing on prevention and management strategies, and pursuing needed research to better understand the condition. A link to this document can be found in the resources section below.  

Resources 

1. 1. A National Public Health Agenda for Osteoarthritis: 2020 Update. Center for Disease Control (CDC). https://www.cdc.gov/arthritis/docs/oaagenda2020.pdf.
2. Osteoarthritis guideline. American College of Rheumatology. https://rheumatology.org/osteoarthritis-guideline.