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Feature Article

Osteoarthritis: moving beyond ageing

JULIAN D. SEGAN, ANITA E. WLUKA, FLAVIA M. CICUTTINI
OPEN ACCESS

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Abstract

Osteoarthritis is a heterogeneous group of diseases characterised by pain and loss of function, and is a leading cause of disability worldwide. Although risk factors vary across joints, common factors include obesity and advancing age. A largely clinical diagnosis, management for symptomatic disease is centred on nonpharmacological and nonsurgical measures.

Key Points

  • Osteoarthritis (OA) is the most common form of arthritis, and a leading cause of disability worldwide.
  • OA is a heterogeneous disease with risk factors varying across different joints affected, although there are some shared risk factors (e.g. age, obesity).
  • A clinical diagnosis can be made in the absence of red-flag features (e.g. prolonged early-morning stiffness).
  • Nonpharmacological therapies are the mainstay of OA management and include exercise and weight loss; comprehensive assessment and regular review are also important features of therapy.
  • Pharmacotherapy is ideally limited to the treatment of acute flares of pain; opiates are rarely indicated given an unfavourable risk-benefit profile.
  • Joint replacement is reserved for advanced symptomatic disease; arthroscopy rarely provides clinical benefit.

Osteoarthritis (OA) is the most common form of arthritis, affecting 2.1 million people in Australia (9% of the population).1 OA is a significant cause of progressive pain and disability for the individual, leading to significant societal costs related to healthcare spending and disability.1 The burden of disease is expected to rise in our ageing population, with the increased prevalence of major risk factors for OA including obesity. GPs are usually the first point of contact and the main co-ordinating healthcare practitioner for patients with OA.

Common presentation

OA is a complex condition. Although it can affect any joint, it most commonly affects the hands, knees, hips, neck and feet. OA also commonly affects the back, although pathological and imaging changes, which are more common with advancing age, do not correlate well with clinical features.2 

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The most common presenting symptoms in patients with OA are pain and limitation of function. Joint pain can vary over time, but is often increased with or after activity. Morning stiffness may be present but generally lasts less than 30 minutes, an important feature differentiating OA from inflammatory arthritis. Bone swelling may be present over affected joints.

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Dr Segan is a Medical Registrar at the Alfred Hospital, Melbourne. Associate Professor Wluka is a Consultant Rheumatologist at the Alfred Hospital, Melbourne; and Senior Research Fellow in the Musculoskeletal Unit of the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne. Professor Cicuttini is the Director of the Rheumatology Unit at the Alfred Hospital, Melbourne; and the Director of the Musculoskeletal Unit of the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic.