Osteoarthritis: New insights - Part 2: Treatment approaches

Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemi c factors, such as genetics, diet, estrogen use, and bone density, and loca l biomechanical factors, such as muscle weakness, obesity, and joint laxity . These risk factors are particularly important in the weight-bearing joint s, and modifying them may help prevent osteoarthritis-related pain and disa bility. Major advances in management to reduce pain and disability are yiel ding a panoply of available treatments ranging from nutriceuticals to chond rocyte transplantation, new oral antiinflammatory medications, and health e ducation. This article is part 2 of a two-part summary of a National Instit utes of Health conference that brought together experts in osteoarthritis f rom diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progr ession, and disability. Part 2 focuses on treatment approaches; evidence fo r the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is pres ented. Biomechanical interventions, such as exercise and bracing, and behav ioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnolog y-oriented approaches to treatment are suggested.