Section 15 / Chapter X Osteoarthritis

Treatment Type	Useful for What or Whom?	Measure	Comments
Nonpharmacologic	All patients	Exercise	Range of motion and strengthening of muscles around affected joints
		Weight loss	Particularly valuable in patients with involvement of weight-bearing joints
		Dietary measures	Adequate intake of calcium, vitamin C, and vitamin D
Pharmacologic	Most or all patients	Simple analgesics	Acetaminophen, tramadol, narcotics in selected cases
		NSAIDs	Nonselective NSAIDs for patients at low risk for GI complications; otherwise, consider addition of misoprostol, a proton pump inhibitor, or an H2 antagonist or use of a cyclooxygenase-2-specific NSAID (coxib)
Ancillary medical and surgical	Selected joints or patients	Splints	Specific for each joint
		Canes or other orthotics	Patellar taping, wedged shoe insoles for knee OA in selected patients
		Corticosteroid injections	Knees, fingers; other joints in selected cases
		Hyaluronic acid injections	Knees in some patients
		Arthroscopic surgery	For patients with mechanical symptoms or findings
		Osteotomy	Knees in selected patients
		Total joint replacement	—

NSAIDs—nonsteroidal anti-inflammatory drugs   OA—osteoarthritis