Meeting the therapeutic challenge of the patient with osteoarthritis.

OBJECTIVE: To discuss the diagnosis of osteoarthritis and the efficacy of available pharmacologic and nonpharmacologic treatment options. DATA SOURCES: Published reports on the diagnosis and treatment of osteoarthritis were identified through a MEDLINE search of English-language journal articles using a focused title search for the keywords acetaminophen, nonsteroidal anti-inflammatory, COX-2 nonsteroidal, opioids, capsaicin, tramadol, glucosamine, hyaluronic acid, and osteoarthritis and by reviewing the bibliographies of selected reviews. The American College of Rheumatology (ACR) guidelines, as updated in September 2000, for the treatment of osteoarthritis of the hip and knee were analyzed with appropriate references to clinical and scientific studies, review articles, and other published guidelines. DATA SYNTHESIS: Each patient's medical history and level of pain should decide the most appropriate treatment. Nonpharmacologic therapies should always be included in the treatment regimen. If further pain management is required, the most appropriate pharmacologic treatments are acetaminophen or nonsteroidal anti-inflammatory drugs for mild-to-moderate pain, tramadol or opioid combinations for moderate-to-moderately severe pain, and opioids for severe pain. Adjunctive treatments, intraarticular injections, and surgery are also viable options for some patients.
CONCLUSION: If used properly, the ACR guidelines for the treatment of osteoarthritis are important tools in the care of the patient with this disease.