A 60-year-old male complains of pain in both knees coming on gradually over the past 2 years. The pain is relieved by rest and worsened by the movement. There is bony enlargement of the knees with mild inflammation. Crepitation is noted on motion of the knee joint. There are no other findings except for bony enlargement at the distal interphalangeal joint. The patient is 5 feet 9 in. tall and weighs 88 kgs. The best way to prevent disease progression is

(Braunwald, 15/e, pp 1987-1993.) The clinical picture of a noninflammatory ahritis of weight-bearing joints is suggestive of degenerative joint disease, also called osteoahritis. Crepitation over the involved joints is characteristic, as are bony enlargements of the DIP joints. In this overweight patient, weight reduction is the best method to decrease the risk of fuher degenerative changes. Aspirin or acetominophen can be used as symptomatic treatment, but do not affect the course of the disease. Calcium supplementation may be relevant to associated osteoporosis, but not to the osteoahritis. Oral prednisone would be contraindicated; intraaicular coicosteroid injections may be given two to three times peryear for symptom reduction. Knee replacement is the treatment of last reso, usually when pain occurs around the clock and symptoms are not controlled by medical regimens.