From the Guidelines
Evidence-based supportive management strategies for preventing deterioration in knee osteoarthritis include weight management, regular exercise, physical therapy, appropriate pain management, and assistive devices. Weight loss of even 5-10% can significantly reduce joint stress and pain, as each pound lost removes four pounds of pressure from the knees 1. Exercise programs should focus on low-impact activities like swimming, cycling, or walking for 30 minutes most days of the week, combined with strength training to support the joint. Physical therapy can improve joint function through targeted exercises and manual therapy techniques.
Some key points to consider in the management of knee osteoarthritis include:
- Weight management: Weight loss can significantly reduce joint stress and pain 1
- Regular exercise: Low-impact activities and strength training can support the joint and improve function 1
- Physical therapy: Targeted exercises and manual therapy techniques can improve joint function 1
- Pain management: Options include acetaminophen, NSAIDs, and topical NSAIDs such as diclofenac gel 1
- Assistive devices: Knee braces, walking aids, and appropriate footwear can reduce joint stress during daily activities 1
Pain management options include acetaminophen (up to 3000mg daily in divided doses), NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily), and topical NSAIDs such as diclofenic gel (apply to affected area 4 times daily) 1. Knee braces, walking aids, and appropriate footwear can reduce joint stress during daily activities. Intra-articular corticosteroid injections may provide temporary relief for flare-ups but should be limited to 3-4 injections yearly 1. These interventions work by reducing mechanical stress on the joint, strengthening supporting muscles, managing inflammation, and maintaining cartilage health, ultimately slowing disease progression and preserving function.
It's worth noting that the most recent and highest quality study 1 provides strong evidence for the use of topical nonsteroidal anti-inflammatory drugs for patients with pain associated with osteoarthritis of the knee, and suggests offering physical therapy as part of a comprehensive management plan for patients with osteoarthritis of the hip or knee.
From the Research
Supportive Management Strategies for Preventing Deterioration in Knee Osteoarthritis
The following evidence-based supportive management strategies can help prevent deterioration in knee osteoarthritis:
- Exercise therapy: Regular physical activity has been suggested to have both preventive and therapeutic benefits for individuals with osteoarthritis (OA) 2. A systematic review and meta-analysis found that land-based exercise programs significantly improved pain, physical function, and stiffness in knee osteoarthritis patients compared to controls 3.
- Lifestyle changes: Promoting activity in primary care and employing non-pharmacological methods, such as lifestyle changes, can help manage knee osteoarthritis 4.
- Motivational techniques: Motivational techniques can help promote compliance with exercise and lifestyle interventions for knee osteoarthritis 4.
- Weight management: Weight management interventions, combined with exercise therapy and osteoarthritis education, can help improve outcomes for individuals with knee osteoarthritis 5.
- Osteoarthritis education: Educating individuals with knee osteoarthritis about their condition and providing them with the skills and knowledge to manage it can help improve outcomes 5.
Key Individual Characteristics Associated with Outcomes
The following individual characteristics have been associated with outcomes following combined first-line interventions for knee osteoarthritis:
- Age: Older age has been associated with reduced odds of a positive response to combined first-line interventions for knee osteoarthritis 5.
- Sex: Being female has been associated with 2-3 times the odds of a positive response to combined first-line interventions for knee osteoarthritis 5.
- BMI: The evidence for an association between BMI and outcomes following combined first-line interventions for knee osteoarthritis is limited and inconclusive 5.
- Comorbidity: The evidence for an association between comorbidity and outcomes following combined first-line interventions for knee osteoarthritis is limited and inconclusive 5.
- Depression: The evidence for an association between depression and outcomes following combined first-line interventions for knee osteoarthritis is limited and inconclusive 5.
Comparison of Interventions
The following interventions have been compared for their effectiveness in managing knee osteoarthritis pain:
- Exercise therapy: Exercise therapy has been found to have a larger effect on knee osteoarthritis pain compared to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids 6.
- NSAIDs: NSAIDs have been found to have a similar effect on knee osteoarthritis pain compared to opioids 6.
- Opioids: Opioids have been found to have a similar effect on knee osteoarthritis pain compared to NSAIDs 6.