Nonsurgical management of osteoarthritis, with an emphasis on nonpharmacologic measures

Osteoarthritis is treated primarily with nonsteroidal anti-inflammatory drugs. Concern is growing, however, among physicians and patients about the gastrointestinal side effects of these agents. Nonpharmacologic measures are underused in the treatment of osteoarthritis; isometric exercise and provision of social support may be as effective as nonsteroidal anti-inflammatory drugs in reducing pain and improving mobility in patients with knee osteoarthritis. Recent data argue persuasively for a change in our strategy for treatment of patients with osteoarthritis: the treatment program should emphasize nonpharmacologic measures, with drugs used in an adjunctive role. Only when this approach is not effective should nonsteroidal anti-inflammatory drugs be prescribed, and then, in the lowest dose needed for symptomatic relief.