2008+bcma+周围关节的骨关节炎的诊疗指南.pdf

Osteoarthritis in Peripheral Joints – Diagnosis and Treatment Effective Date: September 15, 2008 Scope This guideline summarizes current recommendations for assessment, diagnosis and treatment of osteoarthritis (OA) in peripheral joints for patients 19 years-of-age and older. Discussion will include patient education, rehabilitation, medications, and surgical choices as viewed within the chronic disease management context. A medication table is enclosed for reference. Diagnostic Code: 715 (Osteoarthritis) Introduction Arthritis is a leading cause of long-term disability and one of the leading economic burdens to society. From a 2005 survey, 10.8% of British Columbians aged 12-64 and 42.4% aged 65 and over self- 1 report that they have arthritis or rheumatism. OA is the most common form of arthritis. From British Columbia 2005/2006 Medical Services Plan (MSP) claims data (physician billing, hospitalizations and PharmaCare claims), approximately 306,000 people (6.03% of the population) received medical services for OA.2 OA should not be considered simple wear and tear of joints. It is a slowly progressing disorder of unknown cause, but risk factors include: obesity, muscle weakness, heavy physical activity, inactivity, 3 previous trauma, reduced proprioception, family history of primary generalized OA, and mechanical factors. Often there is a progressive loss of articular cartilage and abnormal bone formation. OA symptoms usually begin in mature adults, presenting with minimal morning stiffness or stiffness after inactivity, pain in and around the affected joints (particularly with weight-bearing exercise), and transient pain alleviated with inactivity and rest. The joints usually have bony enlargemen