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Osteoarthritis: Where are we for pain and therapy in 2013?
1MBBS (Hons), FRACP, MMedSc, MD, FAFPHM, Head, Musculoskeletal Unit, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania.
Background:
Osteoarthritis is the leading musculoskeletal cause of disability in western society. General practitioners are central in the management of patients with osteoarthritis.
Objective:
To review the literature on factors associated with pain in osteoarthritis and discuss the implications of these findings for management.
Discussion:
It is well known that there is a modest correlation between X-ray changes and pain, mainly because an X-ray is a poor measure of what is happening in the joint. For example, in the knee, there is consistent evidence that bone marrow lesions, synovitis/effusions and cartilage defects are associated with knee pain and cartilage loss. In addition, muscle strength and obesity are predictors of pain, even in structurally normal knees. Lastly, central factors and genetic factors have been implicated in the pain experience. Thus, osteoarthritis is an umbrella term for a number of pathways that lead to very similar pain and structural outcomes, which is leading to lesion-specific therapies, indicating the importance of trying to pinpoint causes of pain in the individual.
