Knee Pain Is the Malady—Not Osteoarthritis
Authors: Nortin M. Hadler
Journal: Annals of Internal Medicine (1992)

Editorials1 April 1992Knee Pain Is the Malady—Not OsteoarthritisNortin M. Hadler, MDNortin M. Hadler, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-7-598 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOsteoarthritis is a well-defined pathoanatomic entity readily demonstrable by modern imaging techniques. For a century, the pathology that is this disease has been ingrained in the mind of every medical student: inexorable progression from subtle biochemical alterations in articular cartilage through cartilage loss and reactive bone formation to the end-stage of eburnated bone and exuberant osteophytosis. We all shudder at the image of the patient suffering with end-stage osteoarthritis, bedeviled by a deformed, unstable, incapacitating, and painful knee. What physician can listen to the complaint of knee pain without conjuring up the image of such an outcome? What physician can...References1. KovarAllegranteMacKenziePetersonGutinCharlson PJCMBM. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992;116:529-34. LinkGoogle Scholar2. FelsonZhangAnthonyNaimarkAnderson DYJAJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women: the Framingham study. Ann Intern Med. 1992;116:535-9. LinkGoogle Scholar3. Hadler N. Osteoarthritis as a public health problem. Clin Rheum Dis. 1985;11:175-85. CrossrefMedlineGoogle Scholar4. National Health and Nutrition Examination Survey (U.S.). Basic Data on arthritis—knee, hip, and sacroiliac joints in adults 25-74 years, United States, 1971-1975. Hyattsville, Maryland: National Center for Health Statistics; 1979. Publication Number (PHS)79-1661. Vital and Health Statistics Series 11, No. 213, 1979. Google Scholar5. DavisEttingerNeuhousMallon MWJK. Knee osteoarthritis and physical functioning: evidence from the NHANES I epidemiologic follow-up study. J Rheum. 1991;18:591-8. MedlineGoogle Scholar6. MassardoWattCushnaghanDieppe LIJP. Osteoarthritis of the knee joint: an eight year prospective study. Ann Rheum Dis. 1989;48:893-7. CrossrefMedlineGoogle Scholar7. SalaffiCavalieriNolliGerraccioli FFMG. Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheum. 1991;18:1581-6. MedlineGoogle Scholar8. McAlindonDieppe TP. The medical management of osteoarthritis of the knee: an inflammatory issue? Br J Rheum. 1990;29:471-3. CrossrefMedlineGoogle Scholar9. Hadler N. There's the forest. The object lesson of NSAID "gastropathy." J Rheum. 1990;17:280-2. MedlineGoogle Scholar10. BradleyBrandtKatzKalasinskiRyan JKBLS. Comparison of an anti-inflammatory dose of Ibuprofen, and analgesic dose of Ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991;325:87-91. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. 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