Physicians

Samuel S. Blick, M.D. Board Certified in Orthopaedic Surgery Specializing in Knee and Shoulder Surgery, Sports Medicine

Task Force Recommendations for Evidence Based Management of Knee Osteoarthritis

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

2- 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

3- Non-pharmacological treatment of knee OA should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction

4- Tylenol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic

5- Topical applications (NSAID, capsaicin) have clinical efficacy and are safe

6- 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

7- 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

8- Glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid have symptomatic effects and may modify structure

9- Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion

10- 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