In addition to the nonarticular rheumatologic conditions discussed previously, a number of articular disorders warrant the attention of the pain specialist. Among these, osteoarthritis and rheumatoid arthritis are among the most common. In the United States, as many as 40 million persons are affected by arthritis and musculoskeletal conditions.
Osteoarthritis (degenerative joint disease) is the most common form of arthritis and is the most prevalent articular disease affecting elderly persons. The condition results from destruction of joint cartilage by chondrocytes and affects multiple joints, including the distal interphalangeal joints, the proximal interphalangeal joints, spine, hip, and knees, but rarely wrist, shoulder, or metacarpal-phalangeal joints. Weight-bearing joints are most apt to be affected. Osteoarthritis may arise from primary joint dysfunction, involving the synovial capsule, or it can arise from secondary processes (e.g., prior injury or joint trauma). Symptoms of osteoarthritis can be very distressing and may include pain, joint stiffness (especially after inactivity), swelling, deformity, and ultimate loss of function. Because of joint degeneration, osteoarthritis causes significant morbidity, accounting for substantial work disability in persons over age 50 years.
Treatment endeavors should include weight loss, exercise (especially of the knee joints), and analgesics. Weight loss becomes difficult for many patients, par-
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