Foreword

Considered as inevitable for decades, osteoarthritis (OA) is now regarded as a "real" disease rather than an unavoidable marker of aging, like white hairs or wrinkles. This changing face of the disease is mainly due to researchers and to patients: (i) researchers, because they have demonstrated that OA is not the simple consequence of passive wear and tear of the cartilage but the result of biological events, with many degradative and inflammatory processes involving multiple tissues, cell types, chemical and physical mediators, (ii) patients, because they rejuvenate year after year. Indeed, the age corresponding to the so-called "third age" has moved back each year because of an increased life expectancy (an increase of 2 months every year). How can we now consider a 65 year-old patient as an “old” person (although this was the case even 30 years ago)?! Thus, patients' behaviour is changing, fortunately more demanding, requiring more effective treatments for their symptoms, pain and function. They now need their knees, hips, and hands for their profession, travels, daily activities, sports, etc. Based on these patients’ requests and given the exponential increase in incidence and prevalence of OA expected in the next years, societal costs will soon be abysmal. The three main risk factors for OA, aging, obesity and trauma, can only be amplified in the coming decade. The new lifestyles observed in industrialized countries lead to new leisure activities or sports that increase lower limb injuries, or instead multiply the time spent in front of screens of any kind that increases weight proportional to the sedentary time. It is therefore urgent to anticipate this situation by implementing methods of prevention possibly cheaper than potential targeted drugs to come for cure.

All national and international recommendations for the management of OA stress the importance of not neglecting the non-pharmacological treatments, not only for primary prevention, but also for secondary prevention. This book, consisting of chapters written by authors, who are international leaders in this field, highlights all the potential of non-pharmacological treatments for OA, from weight loss, to manual therapy, exercises, educational programs, crenobalneotherapy, acupuncture, insoles, footwear and dietetic supplements. The added-value of this book is undeniably the effort to keep an evidence-based approach in all the chapters although this is challenging: it is much more difficult to conduct studies methodologically perfect for these types of intervention than it is for drugs: placebo groups, blinding, randomisation are uneasy to define, as Dr. Marty’s chapter points out

I am grateful to Professor Yves Henrotin for the coordination of such a book that will be a must to serve as a source of information for health care professionals, primary care physicians, orthopaedists, rheumatologists, geriatricians, physiotherapists, and any other professionals committed to helping all these patients who have to cope with such a painful and disabling disease.