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Nonpharmacologic therapy of osteoarthritis

Kenneth C Kalunian, MD
Section Editor
Peter Tugwell, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


The goals of management of patients with osteoarthritis (OA) are to control pain and swelling, to minimize disability, to improve the quality of life, to prevent progression of the process, and to educate the patient about his or her role in the management team. Management should be individualized to the patient’s expectations, to the levels of function and activity, to the joints involved, to the severity of the patient’s disease, to occupational and vocational needs, and to the nature of any coexisting medical problems. Subjective complaints and objective findings may guide the clinician in designing appropriate therapeutic goals. (See "Clinical manifestations and diagnosis of osteoarthritis".)

An essential component in the development of a therapeutic plan is the correct attribution of signs and symptoms at the target site. Pain and other symptoms of OA can be confused with soft tissue processes such as bursitis at periarticular sites; in addition, pain in a particular area may be referred from OA at another site or may be due to a nonarticular process.

The American College of Rheumatology (ACR) has developed classification criteria for OA of the hip [1] and knee [2] in order to assist the clinician in identifying patients with symptomatic OA of these areas. Classification criteria for other areas have not been developed, but a rheumatologist can be helpful in difficult situations.

This topic review will discuss the major nonpharmacologic modalities used in the treatment of OA, including weight loss, rest, physical therapy, and exercise. The roles of pharmacologic and surgical therapy are discussed separately. (See "Initial pharmacologic therapy of osteoarthritis" and "Treatment of osteoarthritis resistant to initial pharmacologic therapy" and "Overview of surgical therapy of knee and hip osteoarthritis".)


The generalized therapeutic approach to patients with inflammatory or noninflammatory osteoarthritis (OA) is outlined (algorithm 1). European and North American guidelines for the management of specific sites of OA have also been developed for the hand, hip, and knee [3-5].


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Literature review current through: Jan 2017. | This topic last updated: Fri Jan 20 00:00:00 GMT+00:00 2017.
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