Preface | Osteoarthritis: Diagnosis and Medical/Surgical Management

Authors: Moskowitz, Roland W.; Altman, Roy D.; Hochberg, Marc C.; Buckwalter, Joseph A.; GoldberG, Victor M.

Title: Osteoarthritis: Diagnosis and Medical/Surgical Management, 4th Edition

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Preface

This fourth edition of Osteoarthritis comes some 22 years after its first appearance in 1984. At that time, interest in osteoarthritis (OA) was only beginning its ascendancy in both the scientific and lay universe. This interval between the third and fourth editions, 6 years, is significantly less than that between each of the first three editions (8 and 9 years respectively). This shortened interval clearly defines the rapid pace of our understanding of OA as a disease and cartilage as a target, not only with respect to basic and clinical aspects, but also to its impact on society. OA is an entity of high priority emphasis by the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS); the Arthritis Foundation (AF); the Centers for Disease Control and Prevention (CDC); the Osteoarthritis Research Society International (OARSI); and participants in the World Health Organization (WHO) Bone and Joint Decade interplays.

Publication of subspecialty books has become less attractive to publishing companies, given the easy accessibility today of updates on any and all diseases on the web throughout the world.

We are pleased that our publisher Lippincott Williams & Wilkins (LWW), an internationally recognized publishing house of the highest integrity, was enthusiastically supportive of our moving ahead with the fourth edition. LWW has a strong history in the field of rheumatic diseases, publishing Arthritis and Allied Conditions: A Textbook of Rheumatology which addresses the entire broad rheumatologic field. Support of this publication on OA broadens their outreach in the musculoskeletal disease field, especially for a disease in which it is anticipated that 40 million or more people in the United States will be afflicted, by the year 2020.

The text is designed to be of use to multiple medical disciplines including, rheumatologists, basic investigators in the field of OA and cartilage, orthopedists, physiatrists, and primary care physicians whose practices include significant numbers of patients with OA.

The textbook provides a comprehensive overview; it is not meant to be encyclopedic but, rather, to provide a comprehensive overview of the disease and its ramifications, of benefit to a diverse population of readers. As will be noted for those who have copies of the previous text, there are a number of new authors with a significantly increased international representation. This broader authorship reflects increased communication amongst physicians and investigators throughout the world, who share a common interest in the diffusion of OA knowledge.

The editorship of the text has also undergone changes. Dr. David Howell, a founding editor of the text, has elected to discontinue participation following his retirement; he is one of three individuals to whom this edition is dedicated. His advice, creativity, and sagacity will be missed. Dr. Roy Altman has assumed the role of senior co-editor with Dr. Moskowitz, with plans to assume increasing responsibility in future editions. Dr. Marc Hochberg, Professor of Medicine at the University of Maryland and Chief of the Rheumatic Disease Unit at that institution, is an internationally recognized expert in clinical and investigative rheumatology; we welcome the strengths his participation brings to this text.

The text is divided into major subsections: Basic Considerations; General Aspects of Diagnosis; General Aspects of Management; and Surgical Considerations. New chapters include a discussion of ultrasound and alternative imaging for OA; a chapter on the ever-increasing interest in complementary and alternative medicine; and a discussion of new frontiers in surgical orthopedics related to Osteoarthritis. Recognition of the multiplicity of factors related to the etiopathogenesis of OA seen in the multiauthorship of this chapter by individuals with expertise in cartilage biochemistry, inflammatory pathways, and joint biomechanics. The chapter on biochemistry and molecular and cellular biology of articular cartilage has been expanded, recognizing the major gains we have seen in our understanding of these processes. In addition to detailed discussion of radiologic presentations in OA, MRI, a modality taking its place of increased importance in OA investigations, has been expanded and includes not only traditional MRI technology, but interesting new approaches such as dGEMRIC (delayed gadolinium-enhanced MRI). The chapter on noninvasive markers similarly has been expanded to note our increased knowledge in this area. Recognizing that we still need additional answers before such biomarkers can be used in disease diagnosis, measurement of disease progression, and responses to therapy, the advent of new biomarkers and a better understanding now available auger well that biomarker relevance to OA will have increasing value. The chapter on pharmacologic treatment of OA has been materially revised, recognizing not only the gains we have made in pharmacologic approaches for symptomatic relief, but also addressing controversies in overall safety of both selective and nonselective NSAIDs. The sections on orthopedics have been revised so as to present an approach concentrating not only on surgical techniques but, rather, on a general understanding of surgical indications, outcomes, and expectations so as to be of value to clinicians no matter what their subspecialty discipline.

Despite all the advances that have been made, and these have been significant, much needs yet to be learned if we are to achieve our goals to provide optimal symptomatic relief with the highest efficacy and least toxicity; to relieve pain, improve function, and prevent disability; and, hopefully, to one day be able to effectively retard, reverse, and prevent the osteoarthritic process itself. Efforts at disease modification are hampered not only by lack of positive comparators for use in trials of new agents but, also, uncertainty as to the best outcomes to define disease-modification responses. Exciting initiatives such as the osteoarthritis initiative (OAI) funded by the NIAMS, a multi-year study to better understand the osteoarthritic process including risk factors for incident OA and for disease progression, and the relationships of biochemical and imaging markers in assessment of the disease process, will significantly advance our clinical understanding of OA. Plans by the AF and CDC to increase awareness of arthritis amongst the general population, and to advise self-help programs whereby risk factors can be modified and disease onset/progression minimized will significantly impact awareness of the disease and, subsequently, disease prevention. Organizations such as OARSI, comprised of the leading international investigators and clinicians with an interest in this disease entity, will help to further foster advances in this field. The authors of this text (and, we suspect, everyone interested in this disease) hope that by the time of the fifth edition, many of these questions will have been answered and therapeutic targets achieved!

Roland W. Moskowitz MD

Roy D. Altman MD

Marc C. Hochberg MD

Joseph A. Buckwalter MD

Victor M. Goldberg MD