Osteoarthritis is a chronic disease that has exacerbations and remissions. Pain is the symptom that patients want addressed. It is important to remember, however, that simple alleviation of pain does not alter the underlying problem. Attention must be directed toward using physical therapy and other physical measures in conjunction with pharmacologic intervention for symptom relief. Use of simple analgesic agents is the safest initial approach, perhaps in conjunction with topical treatment with a compound such as capsaicin (Zostrix). If pain relief is inadequate, use of nonsteroidal anti-inflammatory agents should be considered, with careful monitoring of gastrointestinal symptoms and renal status, particularly in the elderly. For flares of disease, intra-articular injection of a corticosteroid may give short-term relief. Relief of pain and restoration of function can be accomplished in some patients with early disease, particularly if an integrated approach to treatment is used. Advanced disease can be made more tolerable but may eventually require surgical intervention, which generally provides excellent results.
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