Managing osteoarthritis: current and future directions.

Osteoarthritis (OA) was considered a disease of articular cartilage but now is thought to involve the entire joint. Research findings have helped improve the understanding of disease progression and the strategies used to alter the disease course. There is no laboratory or pathological definition of OA; the diagnosis must be made clinically. The approach to treatment should be tailored to specific patients. Topical agents often are used before oral medications. NSAIDs and cyclooxygenase-2 inhibitors remain the mainstay of therapy. Intra-articular corticosteroid injections have been shown to provide short-term relief and several hyaluronans are available for use in knee OA. Surgery may be required; modern implants provide significant pain relief and have proved to be durable and functional. [ABSTRACT FROM AUTHOR]