Evidence-based management of osteoarthritis: practical issues relating to the data.
Osteoarthritis (OA) is a major cause of pain and disability in the elderly. The perspective of OA as a dynamic process triggered by diverse insults is increasingly accepted. Objectives of management are patient education, relief of pain, optimization of function and modification of the OA process. Management should be individualized and should take into account factors relating to the person as well as the OA joint. There is a reasonable evidence base for several key elements of management. Recent review of the research evidence shows a skewed distribution in favour of drugs, particularly NSAIDs, and important gaps in clinically relevant knowledge. The restricted generalizability of the research data could be improved by improvements in study design and methods of reporting. Current published guidelines on management of OA are critically reviewed and compared.
Doherty
M
M
Academic Rheumatology, Clinical Science Buildings, City Hospital, Nottingham, NG5 1PB, UK.
Dougados
M
M
D000203:Activities of Daily Living; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000188:drug therapy; D010353:Patient Education as Topic
D000894:Anti-Inflammatory Agents, Non-Steroidal