From the Guidelines
The patient should be started on acetaminophen 1000mg three times daily for pain relief, combined with an NSAID such as ibuprofen 600mg three times daily with food, and referred for physical therapy to begin gentle range-of-motion exercises and low-impact activities, as recommended by the American College of Rheumatology 2012 guidelines 1. The X-ray findings indicate severe osteoarthritis of the left knee, particularly in the medial compartment, with osteophytes in all three compartments but no acute fracture or significant fluid collection.
- The treatment should be tailored according to the patient's individual needs, taking into account factors such as age, comorbidity, and the presence of inflammation, as suggested by the EULAR recommendations 2003 1 and 2000 1.
- Non-pharmacological treatment of knee OA should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction, as recommended by the EULAR recommendations 2003 1 and 2000 1.
- For persistent pain, consider a corticosteroid injection into the knee joint, as recommended by the EULAR recommendations 2003 1 and 2000 1.
- Long-term management will likely require orthopedic follow-up to discuss possible surgical interventions if conservative measures fail, as recommended by the AAOS clinical practice guideline 2016 1 and 1. The patient's treatment plan should prioritize reducing inflammation, strengthening supporting muscles, and decreasing mechanical stress on the damaged cartilage, with the goal of improving morbidity, mortality, and quality of life.
From the Research
Treatment Options for Osteoarthritis
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common treatment option for osteoarthritis, as they can help reduce pain and inflammation 2, 3, 4, 5.
- Acetaminophen may be considered as a first-line treatment, but its effectiveness is limited compared to NSAIDs 2, 6.
- Intra-articular corticosteroid injections can provide short-term pain relief 4, 5.
- Duloxetine has demonstrated efficacy in reducing osteoarthritis pain 5.
- Opiates should be avoided due to their potential risks and side effects 5.
Considerations for Treatment
- The choice of treatment should be based on the individual patient's profile, including their medical history, comorbidities, and potential risks associated with different treatments 3, 4, 5.
- NSAIDs can increase the risk of gastrointestinal complications and cardiovascular events, but some NSAIDs, such as naproxen, may have a lower risk profile compared to others 2, 4.
- Regular monitoring of renal function, serum electrolytes, and gastrointestinal health is recommended when using NSAIDs 3.