It is estimated that arthritis affects 1 in 5 US adults. Although there are more than 100 types of arthritis, osteoarthritis (OA) is the most common form. In the United States, OA is the third most common cause of disability. It is responsible for $65 billion in direct medical expenses and $136 billion in total costs annually. Adverse effects of medications, comorbid conditions, and decreased levels of physical activity associated with OA result in a 55% increase in all-cause mortality.¹

As a family physician, I treat patients with OA in my office every day. Often it is just one of the items on the list when a patient presents for follow-up of their blood pressure or a health maintenance visit. However, I think more about the patients for whom arthritis and its treatment have profoundly affected their lives in both positive and negative ways.

I think about the grandmother who came to the office because her day each week with her 2-year-old grandson was becoming too difficult. She was struggling to get down on the floor to play with toy trucks and play with him in the yard. It made my day when she returned after 6 weeks of physical therapy and taking topical diclofenac and acetaminophen with a smile from ear to ear because she was able to keep up with him again on those days.

I also think of my patient who developed a knee hardware infection that did not resolve with multiple surgeries or long-term antibiotics. This eventually necessitated fusion of the knee, meaning that he will never again do many of the things that we take for granted, including driving a car or sitting in the front seat of a vehicle. I think of my 52-year-old patient who had his hip replaced. A few weeks later, he returned to work on an assembly line and was once again able to care for his horses.

In the 20 years since my training, much has changed in the ways that we treat arthritis. Arthroplasty has progressed from a procedure that meant days in the hospital and often weeks of inpatient or skilled nursing rehabilitation to a same-day surgery, even for many frail, older patients with multiple comorbidities who live alone. We have new injection therapies to manage OA. Biologic, disease-modifying antirheumatic drugs have profoundly improved quality of life for patients living with rheumatoid arthritis. If you have struggled to keep up with all these changes, you are not alone. Family physicians rank initial diagnosis and management of OA and joint pain in the top one-third of educational needs.

In this edition, Section One discusses diagnosis and management of knee and hip OA, then Section Two addresses perioperative care for arthroplasty of these joints. Section Three explores septic arthritis and clinically similar conditions. Section Four reviews diagnosis and treatment of rheumatoid arthritis, including newer treatment options.

For those of us who are fortunate enough not to have the daily personal experience of the effects of arthritis on quality of life, this monograph is an excellent reminder of the experiences of so many of our patients. The information provided here will ensure that you can provide care based on the best current evidence for the patients with arthritis who you treat in your office every day.

Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Medicine Physician
Erie Shores Family Health Team, Leamington, Ontario, Canada