Lancet. 2019 Apr 27;393(10182):1745-1759. doi: 10.1016/S0140-6736(19)30417-9.


Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.

Publication types

  • Review

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Analgesics / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Arthroplasty, Replacement / statistics & numerical data
  • Arthroscopy / statistics & numerical data
  • Clinical Trials as Topic
  • Cost of Illness
  • Exercise Therapy
  • Female
  • Forecasting
  • Global Health
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / diagnosis
  • Osteoarthritis, Hip / etiology
  • Osteoarthritis, Hip / therapy*
  • Osteoarthritis, Knee / diagnosis
  • Osteoarthritis, Knee / etiology
  • Osteoarthritis, Knee / therapy*
  • Osteotomy / statistics & numerical data
  • Pain / etiology
  • Pain / physiopathology
  • Practice Guidelines as Topic
  • Precision Medicine / methods
  • Prevalence
  • Referral and Consultation
  • Sex Distribution


  • Analgesics
  • Anti-Inflammatory Agents