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 regular exercise, weight loss in overweight patients, and the use of topical NSAIDs for pain management, as supported by the 2019 American College of Rheumatology/Arthritis Foundation guideline 1. The management of OA of the knee should prioritize a comprehensive approach that includes educational, physical, behavioral, psychosocial, mind-body, and pharmacologic interventions. Key components of this approach include:
- Regular exercise, such as low-impact activities like swimming, cycling, or walking, which can help strengthen muscles supporting the knee joint and improve functional ability 1
- Weight loss for overweight patients, as each pound lost can reduce knee load by four pounds, thereby decreasing stress on the joint and potentially slowing disease progression 1
- The use of topical NSAIDs, such as diclofenac gel, for localized pain relief with fewer systemic effects compared to oral NSAIDs 1
- Consideration of intra-articular corticosteroid injections for temporary relief of flare-ups, as well as other pharmacologic interventions like oral NSAIDs and acetaminophen, with careful assessment of their benefits and risks 1
- The incorporation of assistive devices, such as knee braces, walking canes, and appropriate footwear, to reduce joint stress and improve mobility 1 It is essential to tailor the management approach to the individual patient's needs, preferences, and disease severity, and to regularly reassess and adjust the treatment plan as necessary to optimize outcomes and minimize adverse effects 1.
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 management, including manual therapy, therapeutic exercise, and modalities such as thermal, electrical stimulation, and low-level laser therapy 4, 5
- Lifestyle changes, including weight loss and anti-inflammatory regimens 6
Treatment Options
Treatment options for OA of the knee include:
- Conservative management with lifestyle changes and pharmacological interventions 6
- Injections, such as corticosteroids, hyaluronans, platelet-rich plasma, and stem cells 2
- Surgical procedures, such as high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty 2, 6
- Physiotherapy interventions, including exercise, knee taping, and knee braces 5
Multimodal Approach
A multimodal approach to the management of OA of the knee is recommended, incorporating a combination of non-pharmacological and pharmacological interventions 3. This approach should be tailored to the individual patient's needs and expectations, taking into account the severity of their symptoms and the presence of any comorbidities. The goal of treatment is to reduce symptoms, improve function, and enhance quality of life 3, 2, 4, 5, 6