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INTRODUCTION
Osteoarthritis (OA) or degenerative joint disease is the most common form of arthritis. The disease is associated with progressive loss of the hyaline cartilage of the joints.1 In 1987, the Framingham OA Study showed that radiographic OA of the knee was estimated to affect 27% of adults younger than 70 years and 44% of adults ages 80 and older.1 More recently, an analysis of available epidemiologic data estimated that nearly 27 million US adults had clinical OA in 2005, an increase from 21 million in 1995.2,3 The impact of OA-related morbidity and disability on public health is considerable, and effective management is needed to improve OA pain and inflammation.

Current guidelines for hip and knee OA management call for both nonpharmacologic and pharmacologic interventions to achieve optimal outcomes.4,5 These consensus guidelines are based on both expert opinion and observations from clinical trials.4 Recommended nonpharmacologic modalities have included exercise, weight reduction, and patient education. Although these therapeutic interventions are often advocated, both the physician and patient seldom achieve these goals. Numerous studies have documented the impact of exercise and weight loss in patients with lower extremity OA. For example, a 10% loss of body weight has been consistently shown to yield a 50% improvement in function, and weight loss of at least 20% can reduce pain by 20% to 40% with advanced knee OA. Pharmacologic modalities aimed at pain control include acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, capsaicin, intraarticular (IA) corticosteroids, IA hyaluronate, nutraceuticals, or weak opioids and narcotic analgesics.5

Oral analgesics, including acetaminophen and NSAIDs, are commonly prescribed to manage OA, but can be associated with important risks, especially considering the possibility of comorbidities and underlying health issues in many patients presenting with OA. Pharmacologic options for OA often require consideration of cardiac gastric, renal, and hematologic issues to maintain patient safety. With a changing understanding of OA pathophysiology, including the role of inflammation, obesity, and nociceptive pain, management strategies have substantially evolved. This activity will concentrate on the pharmacologic management of OA with oral agents, and evaluations of the relative efficacy and potential safety risks associated with these systemic therapies.




SECTION 1: NONPHARMACOLOGIC MANAGEMENT OF OA

A 57-year-old, overweight female presents with chronic knee pain that has not responded to self-medication with over-the-counter analgesics and rest. She is diagnosed with mild OA of the knee. Which of the following is the MOST critical primary measure for early OA management in this patient?









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