Osteoarthritis Hunter, David J; Bierma-Zeinstra, Sita
The Lancet (British edition),
04/2019, Letnik:
393, Številka:
10182
Journal Article
Recenzirano
Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in ...previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.
Throughout the past few weeks, the U.K. mantra regarding Covid-19 has been “we will act at the appropriate time according to the science.” Though experts have been pushing the panic button, the ...alarm, if heard, was not acted on publicly until the third week of March.
Far from ushering in an age of diagnostic and prognostic certainty, precision-medicine tools will demand a greater tolerance of uncertainty and greater facility for calculating and interpreting ...probabilities than we have been used to as physicians and patients.
A National Research Council report on “precision medicine” explains that the term “refers to the tailoring of medical treatment to the individual characteristics of each patient.” The report goes on to say, “It should be emphasized that in ‘precision medicine’ the word ‘precision’ is being used in a colloquial sense, to mean both ‘accurate’ and ‘precise.’”
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In the colloquial sense, “precision” also implies a high degree of certainty of an outcome, as in “precision-guided missile” or “at what precise time will you arrive?” So will precision medicine usher in an age of diagnostic and prognostic certainty?
In fact, the opposite . . .
Osteoarthritis (OA) is a highly prevalent, disabling disease, with a commensurate tremendous individual and socioeconomic burden. This Perspectives article focuses on the burden of OA for the ...individual, the health-care system and society, to draw attention to the magnitude of the current problem with some reference to projected figures. We have an urgent opportunity to make fundamental changes to the way we care for individuals with OA that will have an effect upon the direct and indirect costs of this disease. By focusing on the burden of this prevalent, disabling, and costly disease, we hope to highlight the opportunity for shifts in health-care policy towards prevention and chronic-disease management.
Challenges at the interface of medical statistics and AI are population inference vs. prediction, generalizability, reproducibility and interpretation of evidence, and stability and statistical ...guarantees.
A 67-year-old woman with osteoarthritis of the right knee seeks guidance regarding the possible benefit of hyaluronate injection. Injections of hyaluronate for viscosupplementation have been used in ...osteoarthritis of the knee, but their efficacy remains uncertain.
Foreword
This
Journal
feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author’s clinical recommendations.
Stage
A 67-year-old woman with right-knee osteoarthritis is referred by her primary care physician for treatment of her knee pain. The patient weighs 83 kg and is 161 cm tall, and her body-mass index (the weight in kilograms divided by the square of the height in meters) is 32. She has had pain intermittently for 9 years, which has been relieved with infrequent use of naproxen. She has recently become more sedentary and is finding it increasingly difficult to play golf. A recent radiograph of her right knee reveals moderate joint-space narrowing and osteophytes, affecting primarily the medial tibiofemoral compartment . . .
Osteoarthritis (OA) is a prevalent and disabling condition for which few safe and effective therapeutic options are available. Current approaches are largely palliative and in an effort to mitigate ...the rising tide of increasing OA prevalence and disease impact, modifying the structural progression of OA has become a focus of drug development. This Review describes disease modification and discusses some of the challenges involved in the discovery and development of disease-modifying OA drugs (DMOADs). A variety of targeted agents are in mature phases of development; specific agents that are beyond preclinical development in phase II and III trials and show promise as potential DMOADs are discussed. A research agenda with respect to disease modification in OA is also provided, and some of the future challenges we face in this field are discussed.
The United Kingdom’s National Health Service has been pushed to the brink by long-term underinvestment, dependence on nursing homes, and demands created by a sicker population, influenza, and ...Covid-19.
In this randomized trial involving 438 hospitalized patients with severe Covid-19 pneumonia, the use of the monoclonal antibody tocilizumab did not result in significantly better clinical status or ...lower mortality than placebo at 28 days.
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