From the Guidelines
For the management of arthropathy of the knee, a strong recommendation is made for exercise, weight loss in patients who are overweight or obese, and the use of topical nonsteroidal antiinflammatory drugs (NSAIDs) as first-line treatments. Arthropathy of the knee refers to any disease or condition affecting the knee joint, with osteoarthritis being a common cause. Treatment typically begins with conservative measures including rest, ice, compression, and elevation (RICE protocol). According to the 2019 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1, exercise and weight loss are strongly recommended for patients with knee osteoarthritis who are overweight or obese.
Key Recommendations
- Exercise is a crucial component of knee arthropathy management, as it helps improve joint mobility and strength, reducing pain and disability.
- Weight loss is essential for patients who are overweight or obese, as it reduces the pressure on the knee joint, with each pound lost reducing knee pressure by four pounds.
- Topical NSAIDs are recommended for knee osteoarthritis, as they provide local anti-inflammatory effects with fewer systemic side effects compared to oral NSAIDs.
- Intraarticular glucocorticoid injections may be considered for temporary relief in moderate to severe cases, as they can provide significant pain reduction for 1-3 months 1.
- Physical therapy focusing on strengthening the quadriceps and hamstrings is also essential for joint stability and should be performed 2-3 times weekly for 6-8 weeks.
Additional Considerations
- The underlying cause of knee arthropathy—whether osteoarthritis, rheumatoid arthritis, gout, or trauma—determines the specific treatment approach, so proper diagnosis through physical examination, imaging, and sometimes laboratory tests is essential for effective management.
- In advanced cases where conservative treatment fails, surgical options including arthroscopy for debridement or partial/total knee replacement may be necessary.
From the Research
Arthropathy of the Knee
- Arthropathy of the knee, also known as osteoarthritis (OA), is a common cause of knee pain, affecting an estimated 654 million people worldwide 2.
- The exact causes of OA progression are not entirely understood, making it difficult to establish the best treatment strategy for each patient 3.
- Risk factors for developing OA include age, with the condition most likely to occur in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness 2.
Diagnosis and Treatment
- Diagnosis of knee OA can be made clinically, with radiographic imaging not recommended for all patients with possible knee OA 2.
- First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition 2.
- Pharmaceutical treatment options for OA include oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, and intra-articular hyaluronic acid, among others 4.
- Acetaminophen, NSAIDs, and opioids are common pharmacologic treatments for OA, with varying levels of efficacy and safety observed in patients with OA 5.
Conservative Management
- Conservative management, including exercise therapy, is recommended for most cases of knee OA, patellofemoral pain, and meniscal tears 2.
- Physical therapy interventions, such as Diathermy, Exercise therapy, Ultrasounds, Knee Brace, and Electrical stimulation, can be effective in reducing knee pain and improving quality of life for patients with knee OA 3.
- A systematic approach to examination of the knee, including inspection, palpation, evaluation of range of motion and strength, neurovascular testing, and special (provocative) tests, can help diagnose and manage knee pain 6.