Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: EMPART - Exercise and Manual Physiotherapy Arthritis Research Trial

Eligibility criteria:
Inclusion Criteria:

          -  Clinical criteria for the diagnosis of hip osteoarthritis (American College
             Rheumatology) (Altman et al, 1991):

               -  Subjective complaint of hip pain with either hip internal rotation < 15 degrees
                  and hip flexion <115 degrees or >15 degrees hip internal rotation and pain on hip
                  internal rotation

               -  morning stiffness less than or equal to 60 minutes, age > 50 years.

          -  Age 40-80 years except in 2 above (age >50 years).

          -  Radiological evidence of osteoarthritis (2 of the following 3 criteria):

               -  osteophytes

               -  joint space narrowing

               -  ESR<20mm/hr (American College of Rheumatology Criteria for the Classification and
                  Reporting of Osteoarthritis of the Hip)

          -  Referred for physiotherapy

        Exclusion Criteria:

          -  Previous hip arthroplasty, history of congenital/adolescent hip disease

          -  Clinical signs of lumbar spine disease

          -  Physiotherapy in previous 6 months

          -  Pregnancy

          -  Hip fracture

          -  Contraindications to exercise therapy

          -  Contraindications to manual therapy

          -  On waiting list for joint replacement within the next 18 weeks

          -  Rheumatic diseases e.g. Rheumatoid Arthritis, Ankylosing Spondylitis, etc

          -  Hip cortisone injection in previous 30 days
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 40 Years old.
Subject must be at most 80 Years

Eligibility (NLI label): Contradiction