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: Enhancing the Effectiveness of Physical Therapy for People With Knee Osteoarthritis

Eligibility criteria:
Inclusion Criteria:

          -  40 years of age or older

          -  Meet the American College of Rheumatology (ACR) clinical criteria for a diagnosis of
             knee OA. The ACR clinical criteria for knee OA includes knee pain plus 3 of the
             following 6 criteria:

          -  age > 50 years,

          -  morning stiffness of < 30 minutes,

          -  crepitus on active movement,

          -  tenderness of the bony margins of the joint,

          -  bony enlargement of the joint noted on exam,

          -  lack of palpable warmth of the synovium. Based on this criteria, a subject who is less
             than 50 years but has knee pain and 3 of the other 5 criteria would also be classified
             as having knee OA.

        Exclusion Criteria:

          -  do not meet the ACR clinical criteria for knee OA,

          -  are scheduled for total knee arthroplasty (TKA) surgery,

          -  have undergone TJA surgery on any lower extremity joint,

          -  exhibit uncontrolled hypertension (i.e. individuals not currently taking medication
             for hypertension whose systolic blood pressure is greater than 140 mm Hg or diastolic
             blood pressure greater than 90 mm Hg at rest),

          -  have complaints of low back pain or other lower extremity joint pain that affects
             function at the time of recruitment,

          -  have a history of neurological disorders that would affect lower extremity function
             (stroke, peripheral neuropathy, parkinson's disease, multiple sclerosis, etc.),

          -  are women who are pregnant.
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