Osteoarthritis in the aged. Epidemiological issues and optimal management.

Osteoarthritis (OA) is the most common of the arthropathies. The prevalence increases significantly with age, with as many as 68% of women and 58% of men aged 65 years or older having radiological evidence of disease. With an aging population, OA will represent an increasingly significant healthcare burden. The current treatment of patients with OA is purely symptomatic. As yet, there is no evidence that treatment changes the course of the disease. The current optimal treatment involves a combined approach which includes modification of risk factors, particularly obesity, and nonpharmacological treatments such as physiotherapy. If drugs are required in the treatment of OA, full dose regular paracetamol (acetaminophen) should be the first line of analgesic therapy. There is little evidence that the current over-reliance on long term treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is justified. If NSAIDs are used, it is necessary to regularly review their use and to be aware of their potential toxicity, particularly in the older age group.