Osteoarthritis: rational approach to treating the individual

Jüni, Peter; Reichenbach, Stephan; Dieppe, Paul (2006). Osteoarthritis: rational approach to treating the individual. Best practice & research - clinical rheumatology, 20(4), pp. 721-40. London: Baillière Tindall 10.1016/j.berh.2006.05.002

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Osteoarthritis (OA) is the most common form of joint disease and the leading cause of pain and physical disability in older people. Risk factors for incidence and progression of osteoarthritis vary considerably according to the type of joint. Disease assessment is difficult and the relationship between the radiographic severity of joint damage and the incidence and severity of pain is only modest. Psychosocial and socio-economic factors play an important role. This chapter will discuss four main guiding principles to the management of OA: (1) to avoid overtreating people with mild symptoms; (2) to attempt to avoid doing more harm than good ('primum non nocere'); (3) to base patient management on the severity of pain, disability and distress, and not on the severity of joint damage or radiographic change; and (4) to start with advice about simple measures that patients can take to help themselves, and only progress to interventions that require supervision or specialist knowledge if simple measures fail. Effect sizes derived from meta-analyses of large randomized trials in OA are only small to moderate for most therapeutic interventions, but they are still valuable for patients and clinically relevant for physicians. Joint replacement may be the only option with a large effect size, but is only appropriate for the relatively small number of people with OA who have advanced disease and severe symptoms. The key to successful management involves patient and health professionals working together to develop optimal treatment strategies for the individual.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology

UniBE Contributor:

Jüni, Peter and Reichenbach, Stephan

ISSN:

1521-6942

ISBN:

16979535

Publisher:

Baillière Tindall

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:46

Last Modified:

17 Mar 2015 21:45

Publisher DOI:

10.1016/j.berh.2006.05.002

PubMed ID:

16979535

Web of Science ID:

000241283000009

URI:

https://boris.unibe.ch/id/eprint/19125 (FactScience: 1503)

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