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: Self-administered Acupressure for Knee Osteoarthritis: A Pilot Randomized Controlled Trial

Eligibility criteria:
Inclusion Criteria:

          -  ethnic Chinese;

          -  aged 50 -70 years

          -  fulfills any 3 of the following criteria proposed by Altman et al., (1986): ( I.
             morning stiffness</= 30 min; ii. crepitus on active joint motion; iii. bone
             tenderness; iv. bone enlargement; or v. no palpable joint warmth);

          -  having knee pain for at least 3 months;

          -  ability to provide informed consent;

          -  ability to comprehend Chinese; and

          -  Knee pain ≥3/10 and </= 7 on a Likert pain scale from 1-10

        Exclusion Criteria:

          -  medical diagnoses or conditions that preclude individuals from active participation
             (bleeding disorders, alcohol or drug abuse);

          -  presence of skin lesions or infections at the treatment sites;

          -  currently participating in other interventional research studies for knee OA;

          -  cognitive impairment preventing informed consent or understanding of instructions

          -  body mass index over 25, the obese criteria for Asians (Anuurad et al., 2003);

          -  knee pain related to other conditions (cancer, fracture, rheumatoid arthritis,
             rheumatism) as screened according to the red flags for further investigation or
             referral in the NICE 2014 Guidelines for Osteoarthritis of the knee;

          -  had previous foot injury or trauma;

          -  using of steroid for knee pain;

          -  pregnancy or contemplating pregnancy;

          -  ever received acupressure for knee OA over the past 6 months.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 50 Years old.
Subject must be at most 70 Years

Eligibility (NLI label): Entailment