From the Guidelines
The best management of osteoarthritis (OA) of the knee involves a multimodal approach combining non-pharmacological and pharmacological interventions, with strong recommendations for exercise, weight loss, and topical NSAIDs, as supported by the 2019 American College of Rheumatology/Arthritis Foundation guideline 1.
Key Components of Management
- Weight loss is essential for overweight patients, with a goal of 5-10% body weight reduction to significantly decrease joint load and pain.
- Regular low-impact exercise, particularly swimming, cycling, and walking, helps maintain joint mobility and strengthen supporting muscles.
- Physical therapy focusing on quadriceps strengthening and range-of-motion exercises is beneficial.
- For pain management, topical NSAIDs like diclofenac gel (apply to affected knee four times daily) provide localized relief with fewer systemic effects.
Pharmacological Interventions
- Oral NSAIDs, such as ibuprofen or naproxen, can be used for moderate pain, but should be used at the lowest effective dose for the shortest duration due to gastrointestinal and cardiovascular risks.
- Intra-articular corticosteroid injections (typically methylprednisolone 40mg or triamcinolone 40mg) can provide temporary relief for acute flares, limited to 3-4 injections yearly.
Assistive Devices and Alternative Therapies
- Assistive devices such as knee braces, walking canes, and appropriate footwear can improve stability and reduce pain.
- Alternative therapies like tai chi and self-efficacy programs may also be beneficial, as recommended by the 2019 American College of Rheumatology/Arthritis Foundation guideline 1.
Surgical Options
- For severe OA unresponsive to conservative measures, surgical options including knee arthroplasty should be considered, as a last resort to improve quality of life and reduce morbidity.
From the Research
Management of Osteoarthritis (OA) of the Knee
The management of OA of the knee involves a multimodal approach, including non-pharmacological and pharmacological interventions. Some of the key management strategies include:
- Non-pharmacological interventions such as patient education, self-management strategies, weight loss, strengthening programs, and addressing biomechanical issues with bracing or foot orthoses 2
- Pharmacological interventions such as symptomatic slow-acting drugs for OA (SYSADOAs), non-steroidal anti-inflammatory drugs (NSAIDs), and intra-articular treatments with SYSADOAs/NSAIDs 3
- Physical therapy, including manual therapy, therapeutic exercise, and modalities such as thermal, electrical stimulation, and low-level laser therapy 4
- A minimum standard of care that includes providing advice on self-management and lifestyle change, weight loss, land-based exercises, and adequate pain relief with paracetamol or NSAIDs 5
Emerging Treatment Options
There are several emerging treatment options for knee OA, including:
- Intra-articular human serum albumin
- Conventional disease-modifying anti-rheumatic drugs (DMARDs)
- Metformin
- Lipid-lowering agents (statin)
- Nerve growth factors antagonists
- Bone morphogenetic protein
- Fibroblast growth factors
- Platelet-Rich Plasma (PRP)
- Mesenchymal Stem Cells (MSC)
- Exosomes
- Interleukin-1 blockers
- Gene-based therapy
- Bisphosphonate 6
Multimodal Approach
A multimodal approach to managing knee OA is recommended, as it can provide better outcomes than single interventions. This approach should be based on a combination of non-pharmacological and pharmacological interventions, and should be tailored to the individual patient's needs and expectations 3, 2