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: The Distraction of Knee Joint to Alleviate osteoArthritic Pain (DiKAP) Trial

Eligibility criteria:
Inclusion Criteria:

          -  ≥40 years of age;

          -  having knee pain;

          -  having at least three of the following additional symptoms: a-morning stiffness ≤ 30
             minutes, b-crepitation, c-bone margin tenderness, d-bony enlargement or e-no palpable
             warmth;

          -  willing to provide informed consent

        Exclusion Criteria:

          -  rheumatoid arthritis;

          -  serious pathological conditions (inflammatory arthritis and malignancy); total or
             partial arthroplasty of the affected knee joint, or on waiting list for joint
             replacement surgery;

          -  recent surgical procedure of the lower extremities in the previous 6 months;

          -  uncontrolled hypertension and unstable cardiovascular problems that could subject the
             participant to increased risk with exercise and physical exertion;

          -  physical incapability to safely perform exercises, walking or stationary cycling, as
             in: debilitating visual defects, neurological problems, exaggerated low back pain,
             advanced osteoporosis, and inability to walk 10 meters without an assistive device;

          -  use of prescribed analgesics, corticosteroid or analgesic injection intervention for
             knee pain within the previous 30 days;

          -  lack of clear comprehension of study procedures or inability to comply with
             instructions;

          -  stated inability to attend or complete the proposed course of intervention and
             follow-up schedule.
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.


Eligibility (NLI label): Entailment