What is important in treating osteoarthritis? Whom should we treat and how should we treat them?

Most of the treatments used today for OA have a relatively weak evidence base to support their use, and their effect size is small. Many key questions about OA management remain unanswered, in part because of the strong bias toward research on single pharmaceutical agents rather than nonpharmacologic interventions and a comprehensive package of care involving pharmacologic and nonpharmacologic measures. Good management of OA involves the coordination of several different types of interventions provided by health care professionals; however, while a great deal of research is available on the use of individual treatments, there is a lack of information on how health services for patients who have OA should be organized. The problem is compounded by the fact that many people who have OA use complementary therapy as well as, or instead of, allopathic treatments despite the fact that most of the evidence suggests that many such interventions are no better than placebo [123], which might be because of the relatively small effects of most conventional nonsurgical treatment for OA and to the need for a more holistic, individualized approach to treatment than most conventional health professionals usually provide. For many people who have OA, the fear of side effects is a major barrier to the use of pharmacologic interventions [11]. The authors believe that future research in OA therapeutics should concentrate more on behavioral and physical interventions than on drugs, should examine packages of care involving combinations of treatment modalities, and should include a consideration of patient preferences. The authors also believe that the academic community striving to provide help for people who have OA should bear in mind the concept that there is "too much medicine" [37].