From the Guidelines
The best conservative treatment for mild right knee osteoarthritis is a combination of weight management, exercise, and supportive measures, with a strong recommendation for participating in a regular, ongoing exercise program and weight loss if overweight or obese, as stated in the 2019 American College of Rheumatology guideline 1.
Key Recommendations
- Participate in cardiovascular (aerobic) and/or resistance land-based exercise, aquatic exercise, or tai chi programs to strengthen muscles around the knee and improve joint stability 1.
- Lose weight if overweight or obese, as even a 5-10% weight loss can significantly reduce knee pain 1.
- Consider using medially directed patellar taping, medially wedged insoles for lateral compartment OA, or laterally wedged subtalar strapped insoles for medial compartment OA, as conditionally recommended by the American College of Rheumatology 1.
Exercise and Weight Management
- Start with low-impact exercises like swimming, cycling, or walking for 30 minutes most days of the week to strengthen muscles around the knee and improve joint stability.
- Supervised exercise programs or self-management programs can enhance the effectiveness of exercise and weight loss efforts 1.
Supportive Measures
- Use walking aids, such as canes, as needed to reduce joint load and improve mobility 1.
- Apply ice for 15-20 minutes after activity to reduce inflammation and relieve pain.
- Consider physical therapy focusing on quadriceps and hamstring strengthening to improve knee function.
Medications
- While not the primary focus of conservative treatment, topical NSAIDs such as diclofenac gel 1% can provide localized relief with fewer systemic side effects, as conditionally recommended by the American College of Rheumatology 1.
- Oral NSAIDs, such as ibuprofen or naproxen, may be considered for patients who do not respond to topical NSAIDs or have more severe pain, but their use should be carefully weighed against potential gastrointestinal risks 1.
From the FDA Drug Label
Rheumatoid arthritis and osteoarthritis, including flare-ups of chronic disease: Suggested Dosage: 1200 mg to 3200 mg daily (400 mg, 600 mg or 800 mg tid or qid). Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain.
The best conservative treatment for right knee mild osteoarthritis is ibuprofen 400 mg every 4 to 6 hours as necessary for relief of pain or 1200 mg to 3200 mg daily.
- Key considerations:
- Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
- Do not exceed 3200 mg total daily dose.
- If gastrointestinal complaints occur, administer ibuprofen with meals or milk. 2
From the Research
Conservative Treatment Options for Right Knee Mild Osteoarthritis
The best conservative treatment for right knee mild osteoarthritis involves a combination of non-pharmacological and pharmacological approaches.
- Non-pharmacological therapies include:
- Patient education
- Lifestyle modification
- Weight reduction
- Regular exercise
- Physiotherapy
- The use of orthopaedic appliances (canes, insoles, braces) 3
- Physical therapy, which leads to significant improvements in pain and function 4
- Bracing, which can significantly reduce pain and improve function with minimal adverse effects 4
- Pharmacological treatment includes:
- Non-opioid or opioid analgetics
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Coxibes
- Intra-articular glucocorticoids
- Glucosamin, chondroitin sulphate, and hyaluronic acid, which are safe and provide symptomatic relief 3
- NSAIDs, which are most effective when used continuously and may be used in conjunction with other forms of treatment for knee OA 4
Treatment Goals
The overall management goal of conservative treatment for right knee mild osteoarthritis is to improve the patient's quality of life by reducing pain and other symptoms, maintaining and/or improving joint mobility, and limiting functional disability 5, 6, 7.
Key Considerations
When selecting a conservative treatment option, it is essential to consider the individual patient's needs, medical history, and potential risks and benefits associated with each treatment modality 4, 7. A combination of knee braces along with other non-operative modalities should be one mainstay of treatment in conjunction with other treatment modalities to reduce pain, improve function, stiffness, and mobility in knee OA 4.