Osteoarthritis

This is a chronic degenerative process, usually affecting the weight-bearing joints in obese people, and the hands in any older person. It may also be associated with previous trauma to an individual joint.

Management

• Weight loss helps but is difficult to achieve.
• Try to avoid non-steroidals as much as possible, not because they don’t work (they do)¹ but because the incremental benefit over paracetamol is relatively small, and the decrement in terms of side effects in the elderly, is great.
• Paracetamol needs to be ‘sold’ that it be taken pre-emptively rather than when the pain is severe. For instance if walking back from the shops is known to cause symptoms, take 1g of paracetamol before leaving for the shops… Patients are generally not very impressed with its efficacy for long-term pain relief, and this very modest benefit is borne out by a systematic review² which found a 26 point reduction in a 100 point pain score at between 3 weeks and 3 months follow-up relative to 23 points for placebo (3% difference, when patients felt that a 9% difference in score would be clinically important.)
• Exercising goes in and out of fashion, but is worth a try if the patient is motivated. Focus on non-weight bearing exercises.

1. Bannuru RR, Schmid CH, Kent DM, et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015 Jan 6;162(1):46-54. doi: 10.7326/M14-1231. PMID: 25560713. ↩

2. Leopoldino AO, Machado GC, Ferreira PH, et al. Paracetamol versus placebo for knee and hip osteoarthritis. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013273. DOI:10.1002/14651858.CD013273. ↩