Management of osteoarthritis in older adults

Management of osteoarthritis (OA) is directed primarily towards relief of pain and functional limitation. This article discusses a range of nonpharmacologic modalities, including education, social support, weight reduction, and exercise. Drug treatment should begin with adequate doses of acetaminophen. Guidelines for appropriate use of NSAIDs also are suggested in this article. Intraarticular steroids help a proportion of patients, particularly those with OA of the knee or thumb base; the role of intraarticular therapies remains uncertain. Surgery (total joint replacement) remains an excellent treatment for patients in whom medical treatment has failed to provide adequate symptom relief. Future developments are likely to include earlier intervention using drugs with the potential to modify the course of the disease.