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 Effect on Knee Joint Loads of Analgesic Use Compared With Exercise in Patients With Knee Osteoarthritis - An RCT

Eligibility criteria:
Inclusion Criteria:

          -  Compliance with the ACR criteria

          -  Medial knee OA defined as "No osteoarthritis", "Doubtful narrowing of joint space
             and/or possible osteophytes", "Definite osteophytes and possible narrowing of joint
             space", "Multiple osteophytes, definite narrowing of joint space and some sclerosis
             and deformity of bone ends". This corresponds to the Kellgren and Lawrence (KL) grades
             0, 1, 2 and 3 respectively

          -  Willingness to participate in exercise and use of analgesics

          -  A maximum of 75/100 points in the KOOS Pain subscale

          -  BMI of 32 or less

        Exclusion Criteria:

          -  Medial greater than lateral joint space width

          -  Medial knee OA of KL grade 4

          -  Knee surgery or steroid injection within the past 6 months

          -  Already taking max dose NSAIDs or acetaminophen

          -  Any physician-determined condition that is a contraindication for use of
             acetaminophen, NSAIDs or to exercise

          -  Problems affecting the lower extremity overriding the problems from the knee

          -  Knee surgery planned in the next 6 months

          -  Known ACL tear within the past 6 months

          -  ACL reconstruction

          -  Diagnosis of systemic arthritis

          -  Difficulty complying with treatment schedule

          -  Inability to fill out questionnaires

          -  Inability to ambulate without an assistive device

          -  Ankle, knee or hip replacement

          -  Tibial/femoral osteotomy
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 70 Years

Eligibility (NLI label): Entailment