An evidence-based approach to managing osteoarthritis in the primary care setting

摘要: Osteoarthritis (OA) is the most common form of arthritis and patients with OA have pain that typically worsens with weight bearing activity and improves with rest, as well as morning stiffness and gelling of the involved joint after periods of inactivity. On physical examination, they often have tenderness on palpation, bony enlargement, crepitus on motion, and/or limitation of joint motion. Unlike the case with rheumatoid arthritis (RA) and other inflammatory arthritis, inflammation, if present, is usually mild and localized to the affected joint. Joint symptoms and/or back pain were amongst the top 10 commonest reasons for general practice consultation and cases attending Accident and Emergency departments classified as primary care cases. 1, 2The epidemiology of osteoarthritis of the hip and knee differs considerably between Caucasian and Chinese populations. Hoaglund et al observed the prevalence of osteoarthritis of the hip to be 1 percent or lower in Chinese and the prevalence of osteoarthritis of the knee to be 13 percent in Chinese women and 5 percent in Chinese men. 3 Such findings were confirmed in a recent study, which showed the rate of hip replacement in American Chinese to be 10 percent of the rates in American Caucasians. 4 The racial difference in the prevalence of osteoarthritis may be attributable to both genetic and lifestyle factors. Constitutional and lifestyle factors may also be important in the aetiology of osteoarthritis.