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This chapter addresses the following Geriatric Fellowship Curriculum Milestone: #14

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LEARNING OBJECTIVES

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Learning Objectives

  • To be aware of potential causes and risk factors for developing osteoarthritis (OA).

  • To learn how to diagnose OA based on patient clinical presentation, imaging tests, and other diagnostic tools.

  • To be familiar with nonpharmacologic, pharmacologic, and surgical treatments available for patients with OA.

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Key Clinical Points

  1. OA is a prevalent and disabling disease, especially among older adults.

  2. Joint pain and self-limited morning stiffness are characteristic symptoms of the disease.

  3. OA may be diagnosed based on patient-reported symptoms and physical examination findings (eg, Heberden nodes). Radiographic imaging can help confirm the diagnosis.

  4. Various nonpharmacologic and pharmacologic therapies can be used to treat patients with OA.

  5. Joint replacement surgery and other surgical options may be considered when conservative therapies fail.

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INTRODUCTION

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Osteoarthritis (OA) is a highly prevalent and disabling disease. Nearly 27 million US adults have clinical OA, the most common form of arthritis. This number is also expected to rise with longer life expectancies and the worsening obesity epidemic. Lifetime risk of symptomatic knee OA is 1 in 2 overall. OA is also the third leading cause of years lived with a disability in the United States and is the most common cause of mobility limitation. Finally, the economic burden associated with OA is highly significant due to direct medical costs and indirect costs (eg, lost wages, home care).

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EPIDEMIOLOGY, CAUSES, AND PREDISPOSING FACTORS

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Age, Sex, and Race

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Age is the strongest risk factor for developing OA. The prevalence of the disease increases with increasing age. Among adults over 60, approximately 80% have radiographic evidence of hand OA while 37% have evidence of knee OA. Symptomatic OA is less prevalent, with 7% of all adults having symptomatic hand OA and 12% of those aged 60 years or more with symptomatic knee OA. Among adults aged 45 years or more, 27% have radiographic and 9% have symptomatic hip OA.

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Women are more likely than men to be affected by hand and knee OA. This higher prevalence of OA is most prominent among perimenopausal women. Such epidemiologic observations suggest that sex hormones are possible factors in the development of OA. The prevalence of OA may also vary by race and ethnicity. OA of the knee is more common in African-Americans than in non-Hispanic whites or Mexican-Americans. OA of the hip is more common in people of European descent compared to those of Asian or African descent. Compared to older whites in the United States, older Chinese subjects have higher prevalence of knee OA but lower prevalence of hip and hand OA.

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Obesity

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Obesity is the strongest modifiable factor for the development of OA. It is estimated that the odds of developing radiographic and symptomatic knee OA is ...

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