Recommendations for Evidence Based Management of Knee Osteoarthritis
- The optimal management of knee osteoarthritis requires a combination of non-pharmacological and pharmacological treatment modalities.
- The treatment of knee osteoarthritis should be tailored according to:
- Knee risk factors (obesity, adverse mechanical factors, physical activity)
- General risk factors (age, comorbidity, polypharmacy)
- Level of pain intensity and disability
- Sign of inflammation—for example, effusion
- Location and degree of structural damage
- Non-pharmacological treatment of knee osteoarthritis should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction
- Tylenol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic
- Topical applications (NSAID, capsaicin) have clinical efficacy and are safe
- NSAIDs should be considered in patients unresponsive to paracetamol. In patients with an increased gastrointestinal risk, non-selective NSAIDs and effective gastroprotective agents, or selective COX 2 inhibitors should be used
- Opioid analgesics, with or without paracetamol, are useful alternatives in patients in whom NSAIDs, including COX 2 selective inhibitors, are contraindicated, ineffective, and/or poorly tolerated
- Glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid have symptomatic effects and may modify structure
- Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion
- Joint replacement has to be considered in patients with radiographic evidence of knee OA who have refractory pain and disability
Source: Annals of Rheumatoid Disease; 2003; 62: 1145-1155