Talk:Osteoarthritis/Archive 1

Talk

This article should also mention boswellia, an herbal analgesic known in Aryuvedic medicine and widely available in health food stores as well as online. It is highly effective and, unlike NSAIDs, has no known side effects. 162.83.183.71 14:42, 29 September 2007 (UTC)

I have begun editing and adding to this article, feel free to edit and . 16, 2004.

I certainly will. Could you use Wikimarkup for headings please (==Symptoms==). Also: listing all NSAIDs is an unnecessary thing - there are hundreds of preprarations, and providing a link should be good enough.

Also please consider that news articles (Reuters Health) are usually based on studies in medical journals. If Reuters is good, they should provide the actual reference. JFW | T@lk 09:14, 17 Nov 2004 (UTC)

Congenital hip luxation - if the article does not exist then you shouldn't remove the red link but write the article! It is a major health problem, and relatively simple to diagnose. In countries with regular child-health follow-up, the Ortolani test is often performed as a screening test, with ultrasound as second line. Treatment is simple, with plaster cast immobilisation. JFW | T@lk 09:45, 17 Nov 2004 (UTC)

Thank you for your help Jdwolff, this was my first attempt at editing. Your help is appreciated. User:Gilgameshfuel 17 Nov 2004

Thanks for the work; I finally got around to writing some more about OA. In medical articles, I generally avoid addressing the reader in person. The reader may be a grandchild of a patient and not like instructions how to cope with OA :-). JFW | T@lk 12:52, 18 Nov 2004 (UTC)

Feel free to delete that section if you see best, and thanks once again. I have had severe OA for three years now. User:Gilgameshfuel 18 Nov 2004

Prevalence Incorrect

I tried double checking the article by GREEN GA that said over 80% for elderly, but couldn't access it. I do know the Farmingham studies, which are the most cited articles on osteoarthritis prevalence, state that 10% of people over 65 have osteoarthritis (Incidence and Natural History of Knee osteoarthritis in the Elderly 1995 Arthritis and Rheumatism). They said 82.7% PARTICIPATED in the follow up study from the original in 1987, and I suspect that GREEN GA or the whoever, might have got that prevalence wrong. Simonfrid (talk) 16:34, 4 June 2008 (UTC)simonfrid

Changes

With diff not working 100% I am not sure how much was changed, but PM Poon (talk · contribs) has effectively rewritten the whole page! Most of it sounds like reasonable edits, but use of edit summaries would have been helpful.

Is anyone willing to tidy up the references? JFW | T@lk 11:41, 19 September 2005 (UTC)

maybe hip luxation should be congenital hip subluxation?

a discussion of common x-ray findings would be helpful.

Regarding treatment of OA

In the article it is mentioned a primary and secondary type of OA, but these types are not distinguised between when stating that there is no cure for OA. As far as I know, this is not correct. If OA is caused by trauma to the joint (not caused by a degenerative disease), there is options for treatment such as Autologous Chondrocyte Implantation. Whether this procedure is feasible probably depends on how far the OA has gotten, i.e. the condition of the remaining cartilage. I don't know enough about this topic to add this to the article, anyone who does? Hildre 10:19, 11 July 2006 (UTC)

---

OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic (Green 2001).

Can someone update this with global data instead of just the US.

What about steem cells? I think some people are working on this kind of surgery in different countries. Can anyone specify something else? --ZUIA2 23:08, 1 January 2007 (UTC)

A self help book, which was on NY Times best seller list, is The Arthritis Cure by Jason Theodosakis.LoopTel (talk) 16:37, 22 December 2007 (UTC)

Chronic smokers have higher risk of OA. Cessation of smoking would at least delay further deterioration of the joints.

Suggest adding this comment to treatment.LoopTel (talk) 13:23, 26 December 2007

(UTC)

The article says that glucosomine has NOT been helpful for the knee. My experience in speaking with a large number of people taking the glucosomine/chondroitin supplement have found help ONLY for their knees. I am a statistician with no statistical evidence, but wanted to tell you this.

Dietary Supplement

Walk in any drugstore or vitamin store and you will see scores of brands consisting of glucosamine, chondroitin, and MSM, either separately or in combinations, all touting as treatment of osteoarthritis. Some even claim proof of efficacy through unnamed trials. When NY Times reported on FDA sponsored clinical trials that showed no benefit, interestingly enough the reporter ended the article with a personal note: "I don't care what the trial says. All I know is that without these supplements I am a prisoner in my own house. After taking these supplements, I can climb mountains." (citation needed) One possible explanation is that these supplements can be of benefit in mild cases but not in cases studied in the trials.LoopTel (talk) 18:27, 5 December 2007 (UTC) —Preceding unsigned comment added by LoopTel (talk • contribs) 18:19, 5 December 2007 (UTC)

In a study published in 2007, glucosamine sulfate appears to help patients avoid or delay total knee replacement (TKR). The study relates to treatment of knee OA with glucosamine sulphate for at least 12 months and up to 3 years and in an average follow-up of 5 years after drug discontinuation. The placebo group had twice as many TKR compared to those formerly receiving glucosamine sulphate.LoopTel (talk) 02:22, 26 August 2008 (UTC) —Preceding unsigned comment added by LoopTel (talk • contribs) 02:16, 26 August 2008 (UTC)

I have deleted the latest addition to this -- the statement that fishoil obviates the need for prescription medication. "www.TheKneeCenter.com" is a commercial endorsement for a Dr. Cooper -- hardly up to Wiki-standards for adequate support.Celia Kozlowski (talk) 12:03, 2 April 2009 (UTC)

In a Fox News Channel talk show "Ask Dr. Manny" aired 12 February 2009, available for download from FoxNews.com, Dr. Mark Liponis told his listeners to take the following, divided into several doses daily, to relieve joint pain. Glucosamine 1500 mg, chondroitin 1200 mg, curcumin 1800 mg, fish oil EPA DHA 3000 mg, and vitamin D3 1000 IU.LoopTel (talk) 17:52, 27 July 2009 (UTC)

Healing

Here are c. 10 summarized healing reports from osteoarthritis (through healing on the spiritual path): http://www.bruno-groening.org/english/heilungen/defaultheilungen.htm (go to chapter 10)

Kind regards, Dave

-- 83.173.234.146 20:53, 22 November 2006 (UTC)

Heritability

I would like to see references to articles about the heritability of Osteoarthritis.

-- Herman 2 january 2007 (UTC)

“RFQMR” item in Other Approaches section

Unreferenced statements such as, "found quite effective," "revolutionary," and, "the treatment is painless, safe and scientifically proven," without providing references to peer-reviewed or at least reputable sources show an obvious bias. Given the website of this company is provided, I would guess it stems from a commercial interest, or even a misplaced attempt at sharing what was a personally successful treatment; I have not investigated the writer to find out.

As I am not an editor I decided to note it as non-neutral and post this comment, instead of cleaning it up myself; at the moment I stick to grammar fixes.

—Podboy —The preceding unsigned comment was added by 199.212.21.22 (talk) 21:27, 4 April 2007 (UTC).

There is an article in the Indian Journal of Aerospace Medicine which is peer-reviewed, which substantiates some of the above statements. --kv

"OA is the most common form of arthritis"

Is this true? I have read that gout is the most common form of arthritis. 205.158.168.99 03:37, 5 June 2007 (UTC)Steve P.

Yes it is. Check the Farmingham study Simonfrid (talk) 16:35, 4 June 2008 (UTC)simonfrid

Effect of Weather

I looked around but couldn't really find anything that suggested that humidity actually has an effect on arthritis. The closest is the idea that changes in barometric pressure might, but it seems like your body would come into equilibrium eventually wherever you were. If we can't find citations in support of it, then I think we ought to get rid of it, because it is likely unsupported by anything but anecdotes. --The Hanged Man 15:02, 4 July 2007 (UTC)

Maybe one could rephrase the text to s.th. like "doctors report increased numbers of patients complaining of pain caused by OA in cold and humid conditions". Since packed waiting rooms would not qualify as "evidence" for a wiki article "anecdotes" might be all there will be for quite a while. Most researchers have their hands full finding treatment options. An interesting, but possibly unrelated fact is that researchers in Cardiff have found that cold feet reduce blood flow in the nose. If the same happened in the capilary system around the cartilage of OA joints that might be a link. (Maybe the guys in Cardiff will look into it somewhen.) Unconscious/involuntary muscle contractions (like e.g. shivering) might be another cause. (No one seems to have studied that yet either) —Preceding unsigned comment added by 71.236.23.251 (talk) 16:51, 17 February 2008 (UTC)

Arthritis in young people.

Ok, I am only 19 and i suffer from chronic knee pain, muscle contractions and cracking noises. This has been so ever since an incident in Karate practice a few years ago when a roundhouse sent my knee the wrong way. Does this mean i have this sort of arthritis? PayneXKiller 20:35, 28 September 2007 (UTC)

Quite possibly, yes. I'm 47 and recently developed osteoarthritis after a bad fall. Medical people tell me I'm unfortunate to have it at my age. You may, like me, have what is known as patellar maltracking. If you haven't already, see a doctor for confirmation. You may need physiotherapy and a visit to a podiatrist. Eligius (talk) 07:22, 10 June 2010 (UTC)

Arthrosis or osteoarthritis

Are these terms exactly the same? This is as far as I got: -itis indicates inflammation and arthr- means joint if I got it right, and if osteo related to osseous it's bone. Osteoarthritis would then be bone-joint-inflammation. But what is an "-osis"? Is one term old and the other modern or is one a layman's term and the other the proper medical one?? thks. —Preceding unsigned comment added by 66.56.30.124 (talk) 04:53, 5 February 2008 (UTC)

John Hopkins Plug

Wikipedia shouldn't be used for advertizing. —Preceding unsigned comment added by 146.9.22.121 (talk) 14:00, 12 March 2008 (UTC)

Hello I would like to assist on this lemma but............

Hello I would like to assis on this lemma but my English is not good enough. Would it be helpfull if I post in this discussion some recent PUBMED studies on the possibele causes of osteoarthritis and that somebody else makes the changes in the lemma. Regards, Willy Witsel, Netherlands —Preceding unsigned comment added by 217.120.103.16 (talk) 11:22, 13 March 2008 (UTC)

The link that you added specifically discusses possible nutritional approaches to osteoarthritis - from an orthomolecular perspective. It would be much more helpful if we could have a single reliable source that addresses this, and in the form of a narrative. To the best of my knowledge, only glucosamine and chondroitin sulfate have reliable evidence behind them. JFW | T@lk 12:51, 14 March 2008 (UTC)

I agree on gluco and chondro. These articles I use in The Netherlands to show not only pain relieve

• Glucosamine Cochrane Review 2006

but also therapeutic aspects

• Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study

• Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial

Would these documents be accpetable for this osteo article?? Regards Willy --217.120.103.16 (talk) 13:22, 14 March 2008 (UTC)

That sounds reasonable, although your last link doesn't work - it gives gibberish. JFW | T@lk 21:49, 15 March 2008 (UTC)

OA and DDD

If DDD and OA is the same, I can upload more images into Commons for the cervical vertebrae. I could also use some help in trying to place images into spine articles on Wikipedia. Please see my discussion page if you have time. MsTopeka (talk) 13:41, 24 July 2008 (UTC)

Synovial fluid

Not entirely sure, but I don't think there is any actual decrease in Synovial fluid in this condition. Cheers!

--220.253.43.190 (talk) 07:41, 19 October 2008 (UTC)

Calcitonin

Given that natural supplements which don't have established efficiency are included should investigational drugs not be included as well. Calcitonin is on phase III trial, and other trials have already suggested efficiency. Besides, Calcitonin is already used for other conditions and noting prevent physicians to use it off-label.

Chiropractic

I don't want to open a worldwar on chiropractic here, but IF it is going to be included as something that is useful for OA, this should be justified with the highest level of evidence -- placebo-controlled, double-blind clinical trials -- not blurbs from the American Chiropractic Association. What else are they going to say but that chiropractic works for OA -- and best to come in frequently for expensive manipulations? I have a brother-in-law who thinks it helps and a father who thought it helped exactly once and was a total waste of money thereafter. Show me the medical literature and I'll go along with keeping this section in. For now I'm going to pare it down and make it so it doesn't sound like such a commercial advertisement.Celia Kozlowski (talk) 12:11, 26 March 2009 (UTC)

Agreed; the only study that I've ever read said that chiropractic therapy worked for nerve and joint pain, slightly less than a sugar pill did...Fuzbaby (talk) 04:31, 21 June 2009 (UTC)

I wish people would just stick to talking about things that they truly have knowledge about. Simply claiming an absence of citation or study does not negate the validity or truth of the statement. Second if you're basing your entire position on one study that you claim to have read, your basis for that position is sorely lacking. After all I could claim just about anything I wanted to claim if I based those claims on a single study. BTW where's the citation on that study? Also, your implication that chiropractic treatment is "expensive" or a "total waste of money" is completely contradicted by actual long term government research demonstrating that chiropractic treatment is not only effective but also cost effective when compared to medical treatment for similar complaints. Furthermore, when was the last time you disputed a medical claim based on a lack of supporting studies or "proof?" If you've actually read any medical studies you'll find that most of them are not of the "highest level of evidence -- placebo-controlled, double-blind clinical trials" In fact, many of them have obvious confounding factors and conflicts of interest. Simply knowing the terminology does not mean that you understand what you're talking about. Then consider, since we're talking about OA, why it is that most of the general public thinks OA is caused by aging. If you're honest you'll realize that it is because most physicians have been telling their patients for generations that arthritis is caused by aging. "You're just getting old, accept it" Chiropractors have been telling their patients for generations that age although a factor (through time) is not the determinant of this disease; it's actually the biomechanics of the joints. Wikipedia got it right under the "Causes" section. However, if you want to understand why chiropractors claim that chiropractic treatment can help some cases of OA particularly spinal OA, consider something called Wolff's Law. It's in just about every first year students' physiology text book. Then look up the basis for this law called the Piezoelectric Effect. I'll let you connect the dots but please do at least a semblance of research yourself before you criticize someone else's comments. Also, consider that studies that seem to "prove" some scientific "fact" are often disputed or found faulty shortly thereafter. It may be more appropriate for you criticize the pharmacological or medical approach for lack of efficacy, higher risk for detrimental side effects and eventual push for ineffective and overly utilized surgery. Chiropractic treatment can not only prevent/delay OA in many cases it can actually reverse OA by restoring the normal biomechanics of the joints. This claim is based on Wolff's Law. However, it's not a quick fix. In most cases it takes years for the degenerative changes to develop. It makes sense that it will take in some cases years for the body to remodel those bones. What doesn't make sense is to claim that some pills will make it all better in a matter of hours. Why, because they are magical? Where's the study on that? DrChun (talk) 06:10, 20 August 2010 (UTC)

Hyaluronan added then removed.

Hyaluronan considered by one alternative specialist as important was added, however I do not see it here anymore...

--Caesar J.B. Squitti: Son of Maryann Rosso and Arthur Natale Squitti (talk) 16:05, 25 May 2009 (UTC)

It's still there under Osteoarthritis#Injectable, it's just been improved. Was improved by Doc James in two edits, one replacing a few sources with a better review and the other adding a 2009 review. I added the original stuff replaced; would have preferred to keep the information on the proposed mechanism ("lubrication"), the comparison to hylan, and the experimental research into a nutritive solution. II | (t - c) 18:00, 25 May 2009 (UTC)

Inflammation in OA

I am not a medical doctor, but I have been writing about arthritis for a while. All I have to go on is what is actually published in the scientific literature. Although Brandt has his slant on things -- namely that OA is caused by mechanical damage (with various sources) and the body's attempt to fix it (with diminishing success and worsening consequences as we get older and the damage is ongoing)-- his article seems to be a largely reasonable recent review and I can see no reason why he would be misleading us about inflammation in OA. It is on this basis that I have put back the modest mentions of inflammation. Although Brandt finds the definition uselessly over-broad, here is what he quotes as the definition of OA put out in 1995 by "a workshop of experts in OA sponsored by the American Academy of Orthopaedic Surgeons; the National Institute of Arthritis, Musculoskeletal, and Skin Diseases; the National Institute on Aging; the Arthritis Foundation; and the Orthopaedic Research and Education Foundation":

Osteoarthritis is a group of overlapping distinct diseases which may have different etiologies, but with similar biologic, morphologic, and clinical outcomes. The disease processes not only affect the articular cartilage, but involve the entire joint, including the subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles. Ultimately, the articular cartilage degenerates with fibrillation, fissures, ulceration, and full thickness loss of the joint surface. OA diseases are a result of both mechanical and biologic events that destabilize the normal coupling of degradation and synthesis of articular cartilage of chondrocytes and extracellular matrix, and subchondral bone. Although they may be initiated by multiple factors, including genetic, developmental, metabolic, and traumatic, OA changes involve all of the tissues of the diarthrodial joint. Ultimately, OA dis- eases are manifested bymorphologic, biochemical, molecular, and biomechani- cal changes of both cells and matrix which lead to a softening, fibrillation, ulceration, loss of articular cartilage, sclerosis and eburnation of subchondral bone, osteophytes, and subchondral cysts. When clinically evident, OA diseases are characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, and variable degrees of inflammation without systemic effects.

citation: Kuettner K, GoldbergVM. Introduction. In: Kuettner K, GoldbergVM, editors.

Osteoarthritic disorders. Rosemont (IL): American Academy of Orthopaedic Surgeons; 1995. p. xxi–v., as quoted and cited in the Brandt article.

Here are the quotes about inflammation from the Brandt article: "The inflammatory changes in OA are secondary and are caused by particulate and soluble breakdown products of cartilage and bone." Also, "The remodeling of connective tissues requires removal of damaged matrix to allow for its replacement. Inflammation and alterations of cell metabolism are an essential part of this healing process."

And here is his long section about inflammation of the joint (synovitis):

" Synovitis

The synovial membrane from patients who have advanced OA commonly exhibits hyperplasia of the lining cell layer and focal infiltration of lymphocytes and monocytes. In advanced OA the intensity of the synovitis may resemble that in rheumatoid arthritis. Synovitis in OA may be due to phagocytosis of wear particles of cartilage and bone from the abraded joint surface26,69,70, release from the cartilage of soluble matrix macromolecules71 (eg, proteoglycans, collagen, fibronectin fragments), or the presence of crystals of calcium pyrophosphate dihydrate or calcium hydroxyapatite.72 In some cases, immune complexes containing antigens derived from the cartilage matrix may be sequestered in collagenous tissue of the joint, such as meniscus, leading to chronic low-grade inflammation.73

Earlier in the course of OA, however, the synovium—even from symptomatic patients who have full-thickness ulceration of their articular cartilage—may be histologically normal, suggesting that the early pain in those cases is not attributable to synovitis.74 Conversely, in patients who have knee OA who have no joint pain, the severity of articular cartilage damage and of synovitis may be as great as in those who have knee pain.

Synovitis is an important cause of pain in patients who have OA, however. In cross- sectional MRI analyses of subjects who had knee OA, synovial thickening was much more common in those who had pain than in those who were asymptomatic and, among those who had knee pain, was associated with more severe pain.75 Furthermore, in a 30- month longitudinal study of patients who had symptomatic knee OA,76 changes in synovitis, as graded by MRI, correlated only modestly with changes in knee pain. The relatively weak correlation suggests that synovitis was not the only, or even the major, cause of the joint pain. Furthermore, pain was not correlated with the loss of articular cartilage in either the tibiofemoral or patellofemoral compartment and changes in synovial effusion were not correlated with changes in pain. In contrast, in a sample of symptomatic subjects from the Osteoarthritis Initiative (OAI), Lo and colleagues77 found that maximal joint effusion scores on MRI were highly associated with knee pain even after adjustment for bone marrow lesion (BML) scores, suggesting that effusion (a manifestation of underlying synovitis) was independently associated with knee pain. Brandtetal 14"

With this justification and sourcing, I am putting the mentions of local inflammation back in the article and would request that if they are removed again, it should be with appropriate references stating that OA never entails localized inflammation.Celia Kozlowski (talk) 12:59, 29 September 2009 (UTC)

Synovitis and inflamation describe somewhat different processes in this context. OA itself is a non-inflamatory condition. Periodic injuries, including microtrauma and repetative stress often cause synovitis in an osteoarthritic joint. This is more likely to occur than in a non OA joint due to the altered and degenerated mechanical properties of the joint. Studies with imaging and histologic studies have shown in people who are asymptomatic and have OA by imaging there is no inflamation clinically or histologically. Therefore, I would support adding language about episodes of synovitis associated with OA as more precise than saying OA is an inflamatory condition. I'll give it a couple of days for people to weigh in and edit accordingly.DoctorDW (talk) 23:02, 29 September 2009 (UTC)

acupuncture effectiveness

I updated the section on acupuncture treament for osteoarthritis since there was more new research available. —Preceding unsigned comment added by 99.255.196.199 (talk) 03:03, 3 October 2009 (UTC)

Reverted edit by WLU because that source was previously rejected on the Acupuncture main page for being outdated. The 4 newer reviews that support acupuncture effectiveness in OA should suffice.99.255.196.199 (talk) 12:45, 8 October 2009 (UTC)

Please direct me to the talk page section that states that a 2007 review is outdated. The field is in flux and there is controversy over whether it works. We should be representing this controversy, not deciding which aspects we want to cover. I consider it rather absurd to state that the 2007 review is "outdated" when your revert used not one, but two 2007 reviews. Unless I'm missing something, you're claiming that the negative 2007 review is outdated, while the positive 2007 review is not. That seems unlikely. The negative review is also in the prestigious Annals of Internal Medicine, a high-impact journal. I'm not sure about the Hebrew-language Harefuah, Family Community Health or Physical Therapy, but that a prominent, recent review has conflicting results should be noted. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:41, 8 October 2009 (UTC)

Quality counts as well, as does the state of the field. There's still controversy, and rather than summing it for the readers (i.e. "three sources say it's good, one says its bad, therefore it's actually good"), leave the reviews as is. Which is the better set of reviews? Are they comparable? Are the measures similar, the results similar, are the p-values similar, were the standards for the inclusion of reviews similar, were the quality of the trials similar? Can we say this, or would this be original research? WLU (t) (c) Wikipedia's rules:^simple/_complex 01:05, 9 October 2009 (UTC)

Other points

1. is acupuncture the primary treatment modality for osteoarthritis? That's hard to tell.
2. what are the impact factors for the journals? How prestigious are they? Annals is 17.5, and as the article states, it's exceeded only by JAMA, Lancet and NEJM.
3. How many times are they cited? Manheimer is 40. White is 48, which is also good, but one of those citations is Manheimer, which means White was published earlier in the year. Selfe is 7. Lev-Ari has never been cited apparently.
4. How much do the results converge? I've found a couple of the articles as full text, and other reviews ([1], 36 citations; [2], 15 citations) that agree that it's good for short-term pain, another that states it's not good for long term results ([3], 14 citations).
5. What are the overall recommendations? There's a set of expert consensus guidelines that mention acupuncture. We should get that study.
6. What are the overall conclusions in the area? Is it "more study"? [4]? Is it that acupuncture is clearly a first-line treatment that should be picked first, or that it is of limited use? Is portraying it simply as a count of pro- versus anti- studies simplistic? What does Cochrane say? (Ernst would suggest "nothing good" [5]) A review is coming but not out yet.

There is obviously plenty to discuss here - what it works for, what it doesn't, what still needs to be researched and what's pretty much dead. A simple "works or doesn't" not only glosses over the tremendous amount of information present and granularity, it's simply incorrect. Acupuncture doesn't "work" or "not". Acupuncture is "effective for these things in these circumstances, but not in these". What is needed is less battle over a blanket statement and more reading and summarizing of results. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:23, 9 October 2009 (UTC)

Sure go on the Acupuncture talk page and look at the Evidence of effectiveness section where 2/0 commented. "There is actually a very good reason not to use a particular 2004 study. The osteoarthritis section is already cited to a meta-analysis and a systematic review, both of which are more recent. These papers better represent the current state of knowledge about the issue. ***If there are more recent reviews of similar quality, we should use those instead.***" He specifically noted that if I found more recent reviews of similar quality, they should be used instead. This was not objected to by anyone. Sure you can remove the 2 other 2007 reviews and just include the 2008 ones. No big deal for me. I just think we should keep our criteria for inclusion consistent here since I'm getting conflicting feedback about what's acceptable as a source. I also don't mind leaving your study in since you're right- controversy should be noted.

"Quality counts as well, as does the state of the field. There's still controversy, and rather than summing it for the readers (i.e. "three sources say it's good, one says its bad, therefore it's actually good"), leave the reviews as is. Which is the better set of reviews? Are they comparable? Are the measures similar, the results similar, are the p-values similar, were the standards for the inclusion of reviews similar, were the quality of the trials similar? Can we say this, or would this be original research?"

My change did not comment on quality. It simply noted the number of reviews that support and reject acupuncture on this issue. That's completely objective. You're right- we cannot interpret quality- at least I think that's what you're pointing out. The readers can make up their mind. Noting the number of reviews does NOT sum anything for readers. You added that "therefore it's actually good" yourself. Noting the number of reviews has been done on the acupuncture page too. The sources are there for readers to look at on their own. They are completely accessible.

As to your half a dozen questions about OA and acupuncture: you are free to research on those matters. The fact is that those reviews supporting/rejecting acupuncture have now all been included (except the one you took out). They are objectively noted. The statement does not make any judgments. If you really want, maybe we can add that "Ongoing research is needed to provide more information on long-term effects and attain more conclusive, high-quality evidence".99.255.196.199 (talk) 04:44, 9 October 2009 (UTC)

I added it in. Does that statement satisfy your request to note that there is still controversy?99.255.196.199 (talk) 04:56, 9 October 2009 (UTC)

I have decided to look into that OARSI info after all since I've already invested so much into debating over acupuncture. Although I highly disagree with you in many areas, at least you respond after reverting unlike other editors controlling the acupuncture page.99.255.196.199 (talk) 04:58, 9 October 2009 (UTC)

Here is the link: http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf

From a quick skim to find consensus statements on treatment: "Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, [...]and acupuncture."

The recommendation statement for acupuncture: "Acupuncture may be of symptomatic benefit in patients with knee OA."

"In addition there was a consensus for treatment recommendations, with caveats, based on four non-phamacological modalities (weight loss, shoe insoles, knee braces, TENs), four pharmacological (oral and topical NSAIDs, topical capsaicin and IA injections of corticosteroids and hyaluronate) and one surgical modality (arthroscopic debridement) which are recommended in 75% of existing guidelines; for acupuncture, thermal modalities and glucosamine sulphate recommended in 50%, and for hondroitin sulphate recommended in 25%."99.255.196.199 (talk) 05:10, 9 October 2009 (UTC)

I'm fine with the most recent changes. I'd also like to see the OARSI recommendation noted in the main acupuncutre article. —Preceding unsigned comment added by 99.255.196.199 (talk) 16:14, 9 October 2009 (UTC)

Looking through the reviews and your summaries, I changed a few things as well as corrected spelling mistakes. I will state what I changed in descending order of the list in the article:

1. Noted that both pain and function were improved.

3. Noted that results were not clinically relevant (previous wording was "equivalent" ). Article also noted that the results were statistically significant which does not point to equivalence, but I left that out the stat. sig. part because it's not relevant in this article at least. Also corrected a typo.

4. Typo.

5. This change I made in a separate edit. I removed the part about there being more evidence exercise and weight reduction effectiveness, because I felt that was irrelevant for a section on acupuncture. There is a section on exercise where this review could be noted. It's already noted the evidence for acupuncture effectiveness in the review was moderate.

7. Noted that it's *short-term* acupuncture that does not result in long-term benefits as per review wording. Previous wording could imply that eventually acupuncture slowly stops working for pain management over the long run. This new wording makes it more clear that acupuncture does not treat the underlying cause.99.229.146.30 (talk) 05:13, 10 October 2009 (UTC)

On May 14, 18 kbytes taken out of article

On May 14, Doc James made about 40 edits and reduced the page size from about 45k to about about 27k. Boldness is good and I think there is some good editing that happened here, but I've also got a few concerns. I think a fair bit of important information has been removed, including the clinical significant of standard treatments, side-effects of treatments, some comparative effectiveness, and some less notable but still relevant items. Comparison between Revision as of 14:20, 14 May 2010 to Revision as of 21:03, 14 May 2010. I'll admit that some of the material I added so I have an interest in it.

• For one, the OARSI consensus document mentioned questioned the clinical significance of the standard treatment, acetaminophen. This significant commentary was removed, leaving, with no commentary, an implication that the standard treatment is highly effective.
• In this edit, Doc removed all the interesting, more experimental "alternative" remedies, including a 2004 review on bromelain hosted on PubMedCentral.
• The edits apparently removed Kokebie's review which was used for diagnosis, leaving some text simply unsupported.
• In the alternative medicine treatments section, the new version has: "There is no evidence supporting benefits for most alternative treatments including: vitamin A, C, and E, ginger, turmeric, omega-3 fatty acids, and chondroitin sulfate and these are thus not recommended". This is not supported the two citations: one is a positive review of SAM-e, the other a negative meta-analysis of chondroitin (which nevertheless notes that other recent reviews did not come to the same conclusion).

Anyway, I hope to get a response although I'm not sure when I can spend some time on this. II | (t - c) 09:31, 16 May 2010 (UTC)

Yes I have removed a great deal of primary research and replace it with review articles. I replaced a 2006 Cochrane review with an update version from 2010. I am attempting to make the article WP:MEDMOS compliant. Have changed the language to a more general tone. One does not need to state that the reference being added is a review as all references should be reviews. Etc. Doc James (talk · contribs · email) 20:16, 16 May 2010 (UTC)

BTW I am sorry about the mess up in the references. Must have hit the wrong button well editing here is the correct on Rosenbaum CC, O'Mathúna DP, Chavez M, Shields K (2010). "Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis". Altern Ther Health Med. 16 (2): 32–40. PMID 20232616.{{cite journal}}: CS1 maint: multiple names: authors list (link) Doc James (talk · contribs · email) 20:24, 16 May 2010 (UTC)

I have a number of problems with the Bromelain reference. It was a review of both controlled and uncontrolled studies. The two placebo controlled trials in the 10 trails examined has non significant results. The people who published the paper work for the manufacturer. I am happy to discuss things further.Doc James (talk · contribs · email) 20:33, 16 May 2010 (UTC)

The Kokebie's review was broken [6] and this paper is neither on pubmed nor google scholar. I would be happy to review it and replace it if you can find a copy. I agree that I probably should have tagged it for a bit.Doc James (talk · contribs · email) 20:36, 16 May 2010 (UTC)

I attempted a restructuring of this discussion so that we don't have to go too deep in our indentation too fast. If it bothers you please switch back. I apologize for the response delay but I'm still working on this and I'll respond in several points as you did. For a few points:

• As a general point, I have to take issue with some your revisions which reduce detail and clarity. I drafted a sentence which said: "There is a "striking" difference between the results reported from trials involving glucosamine sulfate as compared to glucosamine hydrochloride, with glucosamine sulfate reporting an effect size of 0.44 compared to a 0.06 effect size from glucosamine hydrochloride; Osteoarthritis Research Society International recommends discontinuing glucosamine if no effect is observed after six months". You changed this to say: "A difference has been found between trials involving glucosamine sulfate and glucosamine hydrochloride, with glucosamine sulfate showing a benefit and glucosamine hydrochloride not. It is thus recommends to discontinue glucosamine if no effect is observed after six months". I can appreciate the shortening and tightening of the text, but there's no reason for the "thus", since these two concepts are not related, and the "it" in this case is now undefined. I don't see why we should remove references to effect size, since without discussing it the reader is left basically in the dark about how to compare different treatments. Incidentally, be careful that when you mean to say "while" you don't say "well".
• I didn't add the bromelain reference and I think you have a fair point, but if something has had 10 trials, it certainly deserves to be mentioned. We also need to make clear when there is no evidence as opposed to lack of evidence. Your text did not distinguish that the chondroitin conclusion is largely negative. Incidentally, I think we could likely replace that altmed review with a more accessible one.
• You did update the Cochrane review for acetaminophen, but the "questionable significance" point was made by OARSI, and I somehow doubt that there was a trial which showed that the drug was highly effective based on the some change between 2006 and 2010. The drug was already well-studied in 2006. At the same time you retain the statement that acunpuncture is of questionable significance.
• Kokebie was cited to the publication Journal of Musculoskeletal Medicine with an article title, so ordinarily it should be easy to find. I see this is not one of those cases, but the problem is that in this case you left at least one entire paragraph completely uncited, leaving it open for future deletion. Better to hold off until you've done the research to either delete as unlikely or replace the citation.
• Doing a GAN for the article sounds interesting. I don't have much experience with that and I imagine the standards aren't that high. II | (t - c) 12:58, 22 May 2010 (UTC)

Feel free to make these changes. I am away this weekend and will comment next week. We should not however remove good reviews just because they are hard to access.Doc James (talk · contribs · email) 14:30, 22 May 2010 (UTC)

The issue I have with bromelain is WP:DUE. This sort of information may belong on a page pertaining to alterantive medicine used in osteoarthritis but I do not think is of great enough significance for this page. If we mentioned everything than the good evidence gets and mainstream POV gets lost in the clutter.Doc James (talk · contribs · email) 14:47, 22 May 2010 (UTC)

Diet

There are a number of books that report that diet, apart from weight loss, can affect osteoarthritis. This deserves a mention and discussion of the data either supporting or refuting or lacking for these positions.

Diet

There are a number of books that report that diet, apart from weight loss, can affect osteoarthritis. This deserves a mention and discussion of the data either supporting or refuting or lacking for these positions. —Preceding unsigned comment added by 96.252.61.70 (talk) 00:42, 23 January 2011 (UTC)

Thermotherapy

I am a little bit surprised of not finding any reference to thermotherapy in this article. I am a patient of osteoarthritis that affects my hands, shoulder and spinal bones. I do not take any drug. When my hands hurt, I apply hot water to them, and pain subsides pretty much. I used to develop pain in my shoulder after simple actions consisting in few repetitions of arm movement involving the shoulder. A physician recommended me to apply cold water after a regular hot water shower. Very simple, though mildly unpleasant in winter, but very effective. I have greatly reduced shoulder pain. According to the physician that recommended the treatment, the effect of cold water shock is to increase blood flow toward joints. Blood carries the "chemicals" that repair the connective tissue.

I see that this article is a "serious" one, subjected to the use of "high-quality medical sources". I am sure these sources have to exist for Thermotherapy, only I am not trained to find them. I, therefore would appreciate if some medical wikipedist could help in this task.--Auró (talk) 13:48, 30 January 2011 (UTC)

Recent edits

This [7] recent edit removed a secondary source (systematic review and meta-analysis). The reason provided for the deletion is that "the ref does not support this..." however, the deleted text was a direct summary of the deleted sources' abstract:

• "meta-regression indicated that exercise plus manual mobilisations improved pain significantly more than exercise alone (p = 0.03)."[8].
  

WP:MEDRS outlines what constitutes a reliable source for wikipedia, and the source that was removed meets those standards for the highest level of evidence (systematic review and meta-analysis). Moreover, I cannot find a conflicting viewpoint published in the literature that contradicts the findings nor that criticizes the methodology. If a noteable controversy exists then both viewpoints could be included. However, without a noteable controversy, I fail to see why this source and its findings should not be included.Puhlaa (talk) 21:18, 29 September 2011 (UTC)

The text was "The addition of manual joint mobilizations to an exercise program for the treatment of knee osteoarthritis results in better pain relief then a supervised exercise program alone." Yet the ref says "No randomised comparisons of the three interventions were identified" And they used meta regression which is not a actually comparison. Thus one cannot conclude that any of the measures looked at results in better pain relief. It is not the source that is the issue but the interpretation of said source.Doc James (talk · contribs · email) 11:34, 30 September 2011 (UTC)

I see. If the issue is with the interpretation, then perhaps a slight modification of the deleted text would be sufficient? Would you be content with just qualifying the previous text by adding the word "might" in front of "result in better pain relief...", otherwise, would you provide a better summary?

I have included the relevant discussion from the sources' full text for convenience:Puhlaa (talk) 20:15, 30 September 2011 (UTC)

• "The effect size of exercise with additional manual mobilisation on pain was significantly higher than that of exercise therapy alone. Since our review provides only an indirect comparison between the different treatment types, it is not possible to conclude with certainty which treatment program is superior. We were unable to find any study that directly compared these intervention types. There has been one..." & "Despite the limitations of the review, it suggests that additional manual mobilisations may have significantly better effects compared to exercise alone in terms of pain relief. The manual mobilisation techniques used...."

This trial design does not allow comparison. The key here is "it is not possible to conclude with certainty which treatment program is superior." because no trials have been done comparing them.The work "might" in this context could just as easily be "might not". IMO this paper says nothing useful and is using stats (my undergrad) inappropriately.Doc James (talk · contribs · email) 20:33, 30 September 2011 (UTC)

Dr Heilman, I respect your knowledge of stats (I have only a basic knowledge; my undergrad and grad school were mol. bio.) and I am empathetic to your concerns here. No disrespect is meant, but please consider my concern:

My understanding of wikipedia policy is that an editors expert knowledge is not what determines the inclusion/exclusion of a source or its findings. I respect your knowledge of stats, but is it enough to prevent inclusion of the findings of a systematic review?

I believe that my concern is valid because of a recent disagreement over a paper recently published by Ernst[9], which used 25 case reports to make very strong conclusions Re: the safety of SMT. In my opinion, a list of case-reports is not a systematic review, nor is it evidence, it is confirmation bias. However, it was argued by multiple editors that my concerns over the methodolgy hold no weight on wikipedia, only verifiable sources matter. Ernst' manuscript passed peer-review with the label of a systematic review, thus Ernst' bold conclusions are included as the most recent and high-quality source examining the risk of spinal manipulation.

In conclusion, I am torn as to how to proceed. I trust your opinion on the value of meta regression and I do not want inaccurate or misleading information included here. However, if this source[10] is rejected based soley on your personal knowledge and experience with statistics, it will be hard not to feel that adherence to wikipedia policies (Re: sources) are only enforced 'on occassion'. Is this a valid concern? Puhlaa (talk) 22:17, 30 September 2011 (UTC)

We could say "it is not possible to conclude with certainty which treatment program is superior as there are no trials which compares them but after meta regression exercise plus manual mobilisations appears to improved pain greater than exercise alone(p =0.03)" And for those who understand what it means... Doc James (talk · contribs · email) 23:56, 30 September 2011 (UTC)

I am satisfied with the approach you have suggested, although, what if we replace 'meta regression' with 'statistical analysis'. The word 'statistics' has more meaning to the general reader than 'meta regression', and a inquisitive mind can easily identify the type of stats in the actual source. I have proposed something similar to your last proposal, but with an altered 'order'. What if we said:

"Statistical analysis has suggested that exercise plus manual therapy is more effective than exercise alone, however, it is not possible to conclude with certainty which treatment program is superior, as there are no trials which compares them directly." Puhlaa (talk) 20:24, 3 October 2011 (UTC)

2012 review

Loeser, RF (2012 Jun). "Osteoarthritis: a disease of the joint as an organ". Arthritis and rheumatism. 64 (6): 1697–707. PMID 22392533. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 21:48, 25 July 2012 (UTC)

Mis-cited section on Alternative medicine

The following two sources, [11] and [12] were used to cite the clause:

"there is no evidence supporting benefits for most alternative treatments including: vitamin A, C, and E, ginger, turmeric, omega-3 fatty acids, chondroitin sulfate and glucosamine. These treatments are thus not recommended"

But upon looking at these sources, they do not support this assertion. The Reichenbach source only deals with chondroitin, but it acknowledges that "Previous meta-analyses described moderate to large benefits of chondroitin in patients with osteoarthritis.". There is hardly a consensus on this particular issue.

The Rosenbaum source concludes that there are studies supporting some of the treatments, and that they in particular cannot recommend them yet because more research needs to be done. This is a far cry from the claim of "no evidence", it's just insufficient evidence to support these authors from recommending them. Their conclusion is "Whether any of these supplements can be effectively and safely recommended to reduce nonsteroidal antiinflammatory drug or steroid usage is unclear and requires more high-quality research".

We need to be very careful of introducing bias for or against any sort of supplements. Be careful about how you cite things, and make sure to maintain WP:NPOV. I'm going to try to clean this sentence up. Cazort (talk) 18:11, 23 September 2012 (UTC)

Further looking at these sources, the one meta-analysis also examined rheumatoid arthritis, which is outside the scope of this article, and some of the cited conclusions are not about OA. This is really sloppy. I'm just going to remove the whole sentence until someone cares to actually read this whole article. It's not public access so right now I can just see the abstract. Cazort (talk) 18:13, 23 September 2012 (UTC)

Sure so the first ref states "We cannot recommend use of vitamin E alone; vitamins A, C, and E in combination; ginger; turmeric; or Zyflamend (New Chapter, Brattleboro, Vermont) for the treatment of OA or RA or omega-3 fatty acids for OA." [13] because there is insufficient evidence of benefit. I have changed the word from "no" to "little" to address your concerns. The second ref states "the symptomatic benefit of chondroitin is minimal or nonexistent." [14] The ref for the glucosamine bit is a little lower down Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:37, 23 September 2012 (UTC)

By the way nearly every research paper ever written finishes with more research is needed. We do not typically repeat this as it is just a given. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:46, 23 September 2012 (UTC)

Thanks, I like the way you cleaned this section up after my edits. I still have one concern though, which is with the phrase "are thus not recommended". I think using passive voice is best avoided when there is any sort of recommendation. Not recommended by whom? By the authors of this study? By consensus of the modern medical establishment? It's not clear what this phrase means...it carries a lot of implications that I think are important to spell out. Cazort (talk) 04:07, 25 September 2012 (UTC)

It is generally accepted that evidence is required for something to be recommended. If the evidence is insufficient it is not recommended. We could state not recommended due to a lack of evidence but that is basically what we already say. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:07, 25 September 2012 (UTC)

Editing gone AMOK

I'm always thrilled when a page is given more impact through shortening and getting back to the best current sources. But it is ham-handed editing to say every bloody source in an article has to be a SECONDARY source or a review. While I appreciate the stipulation that sourcing should be to reliable journals, I would contend that if this means only reviews you will NEVER have a page that is up-to-date. Why should medicine not be as current as any other subject? Could it be that the M.D. and Chiropractor who want to remove my well-sourced additions simply don't want their patients to be better informed than they are??? Wikipedia:Identifying reliable sources (medicine) does NOT say we should only have secondary sources or reviews. It says: "Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies." And then there's the rest: "All Wikipedia articles should be based on reliable, published secondary sources. Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse. For that reason, edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely to the interpretation of the data given by the authors or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources, as defined above .... When citing primary sources, particular care must be taken to adhere to Wikipedia's undue weight policy. Secondary sources should be used to determine due weight."

With respect to my added section on DMOADs, I made it clear that this is about *research*; I began with two very reputable medical sources. When "Doc James" removed my addition to the page because it was primary sources only, I added two reputable secondary sources, leaving the very reputable primary sources as useful supporting references so that people who actually want to weigh the strength of the underlying evidence behind the secondary sources can readily access it. I really feel the edits that "Doc James" made and that "Puhlaa" threatened me with ("If you dont replace the primary sources with secondary sources, someone will revert your changes again.Puhlaa (talk) 15:52, 9 November 2012 (UTC)" are efforts to dumb-down the OA article and make it antiquated. Research progress on OA has stalled out appallingly. My section on the search for DMOADs at least points to the direction of a glimmer of hope. It's contemporary; it is grounded in reliable sources; and it at least touches on research -- something that will be crucial to making progress on OA and other diseases but something that has been edited right off this page, thanks to "Doc James" and misguided application of Wikipedia:Identifying reliable sources (medicine)Celia Kozlowski (talk) 18:55, 9 November 2012 (UTC)

With this edit [15] you have added 4 references to support the medical claims you have added to this article. Two are from non-peer-reviewed magazines ('Arthritis today' and 'Arthritis Self-Management'), one from a primary source (RCT), and a fourth that is a basic bench-lab study, not a clinical trial. The only source that comes close to being of adequate quality to make medical claims is the RCT, however, as a primary source it is considered a relatively weak source. None of these sources meet the standards of WP:MEDRS for making medical claims. As someone with a PhD, I would think that you would recognize the bias inherent in magazine articles and single-trials that make them unsuitable for supporting medical claims here. I apologize if you felt 'threatened' by my friendly note on your talk page, it was meant to be helpful, as it seemed you were not familiar with what constitutes high-quality sources on wikipedia for use in medical articles. Puhlaa (talk) 19:46, 9 November 2012 (UTC)

I have reverted your addition (as per WP:BRD due to the above stated issues with the sourcing. I would be happy to work with you to try and improve the sourcing. If adequate sources can be found, then the text you want to add can be inserted with those proper sources. I will have a look, as well, to see what I can find, but without proper sourcing your additions will not likely gain consensus. If you can gain consensus for your edits without what I think is proper sourcing, then that would also be ok according to policy. However, you are going to need one of either consensus or better sources. Puhlaa (talk) 19:58, 9 November 2012 (UTC)

Agree with Puhlaa, we are happy to help with sourcing issues. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:27, 9 November 2012 (UTC)

Here is a bit-older (2008) review of the first drug (strontium ranelate) mentioned in the suggested edits [16]. It suggests that "Even if pre-clinical data and some preliminary in vivo studies have suggested that ... strontium ranelate could be of potential interest in OA, additional well-designed studies are needed." I have not yet found a newer review on the topic. Thus, It does not seem like the scientific or medical communities are ready to start making bold claims for this drug just yet. However, it does seem that strontium ranelate could be added to the osteoporosis article, as there are a couple reviews that provide some favourable conclusions. The second drug mentioned in the suggested edits (parathyroid hormone) is in much earlier stages of research than strontium ranelate (according to the weak sources originally used), thus I am not confident that we will find any secondary sources that make claims of efficacy.Puhlaa (talk) 21:00, 9 November 2012 (UTC)

You are both focused on the rules and neither comes to grips with my basic point that if your sourcing is always to reviews, this will NEVER be a current, up-to-date picture of the state of the art. It takes several years before the reviews are written. In the meantime, people who are looking for information go where? The two arthritis magazines I cite are for patients and are reputable. That's the sort of "secondary source" people go to (if they're lucky; if they're unlucky they get sucked in by quacks pushing ineffective -sometimes even dangerous- crap typically with personal testimonials.) Without any references to areas of research Wikipedia looks like it doesn't know about the latest things. Especially if these are clearly labelled as "research" it makes it clear we are looking ahead, not offering medical advice.

And yes, thank you, my Ph.D. as well as my 20+ years as a science writer do help me to understand bias. Including the sorts one finds in doctors and chiropractors. Very large, multicenter international trials with government funding (primary research) that also get raves from the head of a multi-million pound arthritis research charity (secondary) and research published in the Science journals receive intensive scrutiny.

There's been a lot of discussion in the scientific community and among science writers about writing and editing for Wikipedia. Heretofore I've always encouraged people to contribute their expertise for the greater good. But you guys have at last convinced me Wikipedia is a waste. Read quality research, write about it clearly to inform people on subjects of vital interest, and some pontifical rule-monger hits the delete button. There are plenty of other charities that can better use one's time and talents.Celia Kozlowski (talk) 18:46, 10 November 2012 (UTC)

Yes many academics have trouble getting encyclopedia / Wikipedia writing. There are a number of reasons that we much prefer secondary sources over primary ones. First of all we are not trying to capture the cutting edge, we are not a news source, there is by the way Wikinews. We at Wikipedia are trying to cover the foundations of all of knowledge. This is actually a good example of why we should not allow primary sources.

Here is some of what was added "People taking "strontium ranelate typically exhibited around a third less cartilage degradation than those who took placebo. For every three years of treeatment, disease progression slowed by one year." Data also showed people taking the drug enjoyed reduced knee OA pain and improved function compared to participants receiving placebo" Now lets look at the ref http://www.ncbi.nlm.nih.gov/pubmed?term=23117245 Everything other than JSW was a secondary endpoint. One does not make recommendations on secondary endpoints with this being only for hypothesis generation. We even added "enjoyed reduced knee OA pain" yet that secondary endpoint did not reached significance p=0.06. Their primary endpoint, JSW, is not a patient oriented outcome. Other issues is that they quote benefit with 2 grams but do not mention one gram (because if you look at the full paper their is not a clinical benefit). This is strange as 1gm per day led to less degradation of the joint than 2 gms but yet resulted in no benefit. Thankfully our guideline means that I do not need to argue this every time someone uses a primary source. This is the type of stuff the authors of secondary sources take care of.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:19, 10 November 2012 (UTC)

Might not some of the contribution that was recently reverted[17] be incorporated into a Research directions section per WP:MEDMOS/WP:PRESERVE? Biosthmors (talk) 20:32, 10 November 2012 (UTC)

Would prefer to see an analysis by a proper secondary source first. I guess we could put it in a section on research but even this should really be properly referenced. One RCT does not get FDA approval. There are some concerns with this RCT as mentioned. The popular press typically overstates new finding. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:53, 11 November 2012 (UTC)

I am leaving this as a waste of time. As I said before, the people controlling this page Know Best About the Rules and won't engage on the subject of timeliness, and writing about interesting, well grounded evidence of research promise, which I have made clear is different than medical advice. Timeliness counts for every Wikipedia subject except medicine??? One CAN write about uncertainty. The idea of a research page is a good one, especially if you have a link to it from the mouldy OA page. Most importantly, I can't let Doc James' misrepresentation above stand. Quote from the primary research: "The reduction in total WOMAC score and pain subscore was numerically greater with treatment than placebo at every visit, with a significant between-group difference for pain subscore at 36 months (p=0.029 for 2 g/day)." From the Discussion: "Additionally to this structural effect, symptomatic improvement was observed, with a significant impact on WOMAC total score and pain subscore (p=0.045 and p=0.028, respectively), and a trend towards improvement in global knee pain (p=0.065) at 2 g/day, but not 1 g/day." I don't think the statement based on the secondary source or my paraphrase of it is off the mark. Here's the direct quote from the secondary source: "The researchers also observed that strontium ranelate was associated with a reduction in pain and improved mobility." And if I knew why there wasn't a link between structural effects and WOMAC effects (in this research or just about any other study of OA) I'd be solving a question that has thus far stumped the medical establishment. The more important "forest" point (as opposed to the trees which preoccupy Those Who Know Best) is that this is the first time a large multicenter, multinational double-blind placebo-controlled clinical trial has offered credible evidence of an effective DMOAD. There are a few million people who might find a ray of hope in that, as their only prospect, as conveyed in this page, is joint deterioration and/or replacement. Celia Kozlowski (talk) 22:15, 10 November 2012 (UTC)

Research

Added section on research. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:53, 11 November 2012 (UTC)

Thank you. This is a positive addition. To keep your page "clean" and distinct as "medical advice" as opposed to research, I would suggest keeping this section to one paragraph on this page, listing key areas of research in no more than a phrase or a single sentence, and then developing these areas on a separate page, Osteoarthritis Research.

On this new page, I would suggest a strong "caveat" paragraph making it clear that this page is not to be construed as medical advice and underscoring that many therapies that look promising in early-stage testing in animals never work in humans, and, in fact, barely more than half of drugs that make it to clinical trials offer any improvement over existing therapies [http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000024.pub3/abstract "New treatments compared to established treatments in randomized trialsNew treatments compared to established treatments in randomized trials The Cochrane Library, DOI:10.1002/14651858.MR000024.pub3, Published Online: 17 OCT 2012.

IMHO, the new page should include at least:

a section on DMOADs; including my offending paragraph with info on PTH and in the same breath RUNX-1 downregulator: Ann Rheum Dis. 2012 Oct 5. [Epub ahead of print] A novel disease-modifying osteoarthritis drug candidate targeting Runx1. Two "secondary" articles summarizing the challenges to DMOAD evaluation are old: Curr Drug Targets. 2010 May;11(5):528-35. Disease modifying osteoarthritis drugs: facing development challenges and choosing molecular targets. PMID: 22682469 And new: OARSI-OMERACT initiative: defining thresholds for symptomatic severity and structural changes in disease modifying osteoarthritis drug (DMOAD) clinical trials. Manno RL, Bingham CO 3rd, Paternotte S, Gossec L, Halhol H, Giacovelli G, Rovati L, Mazzuca SA, Clegg DO, Shi H, Tajana Messi E, Lanzarotti A, Dougados M. Osteoarthritis Cartilage. 2012 Feb;20(2):93-101. Epub 2011 Nov 28. PMID: 22178465

A section on imaging -- this article includes review of new approaches in imaging OA: Arthritis Res Ther. 2012 Jun 7;14(3):212. [Epub ahead of print] Early diagnosis to enable early treatment of pre-osteoarthritis., Chu CR, Williams AA, Coyle CH, Bowers ME.; I'm sure there are others

a section on tissue engineering/stem cell therapy; I know there've been some reviews/secondary sources summing up general areas of success and challenge. Obviously this needs to include a link to Tissue Engineering but engineering cartilage is sufficiently distinctive to warrant a section on the subject for this page

a section on early-stage monitoring, study, treatment/prevention of progression from injury, e.g. meniscal tear / ACL to OA again see (Arthritis Res Ther. 2012 Jun 7;14(3):212. [Epub ahead of print] Early diagnosis to enable early treatment of pre-osteoarthritis., Chu CR, Williams AA, Coyle CH, Bowers ME.PMID: 22682469 )

possibly a section on new modalities of drug delivery. I am very fond of this paper, which won its author the "Young INvestigator" award from the Society for biomaterials: "On-demand drug delivery from self-assembled nanofibrous gels: a new approach for treatment of proteolytic disease."Vemula PK, Boilard E, Syed A, Campbell NR, Muluneh M, Weitz DA, Lee DM, Karp JM. J Biomed Mater Res A. 2011 May;97(2):103-10. doi: 10.1002/jbm.a.33020. Epub 2011 Mar 14.PMID: 21404422

and a section on new-generation pain relievers (e.g. the "on clinical hold" tanezumab )with a link to the Pain Management page -- although possibly it should be the other way 'round and the people who edit that page should add a research page and we could both link to that; And I would definitely include the tanezumab example to underscore that research is NOT the same thing as "approved drug"Celia Kozlowski (talk) 00:37, 12 November 2012 (UTC)

Sure we can create Osteoarthritis research as a subpage and link it to here. Feel free to do so if you wish. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:11, 12 November 2012 (UTC)

Offer of some good images.

According to my surgeon, my MRIs beautifully show the severe (but not painful!) osteoarthritis in my right hip joint, which is why I'm getting an artificial hip next week. According to the Radiology clinic, the MRIs are my property, so I may post them on Wikipedia if I so wish. So should I post those images? Old_Wombat (talk) 09:26, 15 November 2012 (UTC)