Knee Osteoarthritis

Joint Center

Recommendations for Evidence Based Management of Knee Osteoarthritis

The optimal management of knee OA requires a combination of non-pharmacological and pharmacological treatment modalities.
The treatment of knee OA 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 OA 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