Osteoarthritis (OA) affects 7% of the global population and is the leading cause of chronic pain and disability in older adults (Wen & Xiao, 2022). Although thought of as a disease of the knees and/or hips, other commonly affected joints include the hands, facet joints in the spine, and temporomandibular joint (Englund, 2023). OA is slowly progressing. It was previously considered to be a disease of "wear and tear," but recent research has found it to be a more complex disease involving inflammation and biomechanics. OA is characterized by the degradation and loss of articular cartilage that cushions the joint during movement. Once damaged, the articular cartilage is unable to repair itself (Wen & Xiao, 2022). This change causes other tissues of the joint, such as the bone, synovium, ligaments, meniscus (in the knee), labrum (in the hip), periarticular fat, and muscles to be affected, resulting in pain, reduced functionality, and disability. Biomechanical joint responses (such as cartilage defects, bone shape changes, and misalignment) cause more pathological and inflammatory responses in tissues, resulting in a vicious cycle (Englund, 2023). Diagnosis of OA occurs with the presence of joint pain and x-rays showing joint space narrowing and the presence of bony spurs (osteophytes). Unfortunately, x-ray changes often appear later in the course of the disease, after substantial loss of cartilage has already occurred (Englund, 2023).

OA prevention is challenging due to multiple circumstances that make its occurrence hard to predict. These influences include 1) the existence of multiple affected joints; 2) the occurrence of asymptomatic OA (diagnosed via x-rays) in some individuals, whereas others have OA-like pain with no x-ray evidence of disease; and 3) multiple risk factors, including modifiable ones (lifestyle, body weight, and chronic joint overloading), and nonmodifiable ones (age, sex, and genetic predisposition). Despite these complexities, universal prevention techniques include prevention of 1) overweight and inactivity (especially after menopause); 2) post-injury issues (muscle weakness, overuse, and reinjury); 3) physical work overload; and 4) age-related sarcopenia and resulting muscle weakness (Runhaar & Bierma-Zeinstra, 2022).

There are a variety of treatment modalities for OA, with increasing levels of intensity if needed. All patients need education and lifestyle advice, including weight management (as necessary); exercise therapy (consider including physical/occupational therapies in the care team); mind/body programs (e.g., yoga or tai chi); and topical nonsteroidal anti-inflammatory drugs (NSAIDs). If these measures are not sufficient, the patient may need to add oral NSAIDs, COX-2 inhibitors, braces, or other devices as recommended. The next step is intra-articular injections (generally corticosteroids), and an antidepressant with pain-relieving properties may be considered. As a last resort, surgical interventions, such as joint replacement, resurfacing, or osteotomy can be used. Although opioids are often prescribed for OA pain, they may have a limited effect in pain relief. If necessary, clinicians should educate patients on the plan for their use and discontinuation (Englund, 2023). Looking to the future, OA treatments may include stem cell or platelet-rich plasma therapies, cytotherapy to repair damaged cartilage, disease-modifying OA drugs, and inhibition of signaling pathways.

Patients with OA are commonly encountered in home healthcare and clinicians should be knowledgeable about the disease process, risk factors, prevention, and treatment. This will help guide patient education and direct patients to potential treatment modalities.

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