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Osteoarthritis is a leading cause of disability in older adults in the United States.1-3 Approximately 33% of American adults report some kind of arthritis or chronic joint symptoms.3 The incidence increases with age and is higher in women than in men.3
More than 5 million adults report having osteoarthritis in a knee joint, with pain, swelling, and stiffness, and >75% of these people are women.4"7 In 1999, osteoarthritis of the knee accounted for nearly 4 million physician office visits, > 150,000 hospital outpatient visits, and >400,000 hospital inpatient stays.4 Approximately half of the inpatient stays were for primary total knee replacement surgery.4
Osteoarthritis of the knee has a tremendous impact on a person's ability to function and to perform everyday activities. Between 25% and 50% of people with osteoarthritis of the knee experience - at best - significant difficulty with walking, carrying items, or stooping, while 20% either cannot perform or have difficulty performing chores around the house.4 This disease takes a severe emotional toll on its victims, as well. People with osteoarthritis of the knee report higher degrees of emotional distress than those without it, and many consider themselves as having poor or fair health.4 Patients with osteoarthritis lose more work than their healthy colleagues and spend more time confined to bed.4
Patients can now be treated with an array of nonpharmacologic, pharmacologic, and surgical interventions. The following report summarizes a case presented at a sports medicine clinic Ln New York, illustrating the importance of individualizing treatment based on the age of the patient, the level of symptoms, risk factors and comorbidities, and impact on quality of life.
CASE PRESENTATION
Mrs Jones (not her real name), 55 years old, came to a musculoskeletal specialist seeking advice for a 3-year history of progressively worsening pain in both knees. Her knees were stiff for about 20 minutes when she arose in the morning and for a few minutes after getting up from a chair during the day. She had difficulty walking >30 minutes because of pain, and her symptoms were exacerbated by kneeling, squatting, or descending stairs. Although sitting, resting, and reclining reiieved her pain, she became stiff if she stayed in one position for too long. Her symptoms were worse on humid or cold...