From the Guidelines
Patient education for knee osteoarthritis should prioritize self-management strategies and lifestyle modifications, focusing on weight management, exercise, and pain management, as recommended by the 2020 American College of Rheumatology guideline 1. Knee osteoarthritis is a chronic condition involving cartilage breakdown in the knee joint, but many approaches can help manage symptoms and slow progression.
- Weight management is crucial, as each pound lost reduces knee pressure by four pounds.
- Regular low-impact exercise like swimming, cycling, or walking for 30 minutes most days strengthens muscles supporting the joint while avoiding activities that cause pain.
- Physical therapy can provide personalized exercises to improve strength and flexibility.
- For pain management, acetaminophen (up to 3000mg daily) can be tried first, followed by NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) if needed, always taken with food to minimize stomach irritation.
- Topical NSAIDs like diclofenac gel applied to the knee 2-4 times daily may provide relief with fewer side effects.
- Heat and cold therapy can reduce pain and inflammation, with heat best for stiffness and cold for acute pain.
- Assistive devices such as knee braces, walking canes, or shoe inserts may improve mobility and reduce pain.
- Patients should be encouraged to pace activities throughout the day and use proper body mechanics when lifting or carrying objects to minimize joint stress. The 2020 American College of Rheumatology guideline 1 provides strong recommendations for exercise, weight loss, and self-efficacy and self-management programs, which should be prioritized in patient education. In contrast to older guidelines, such as the 2003 EULAR recommendations 1, the 2020 American College of Rheumatology guideline provides more comprehensive and up-to-date recommendations for the management of knee osteoarthritis.
From the Research
Knee Osteoarthrosis Patient Education
- Patient education is a crucial aspect of managing knee osteoarthritis (OA), and it should include information on non-surgical treatment options, lifestyle changes, and self-management techniques 2.
- The first-line treatment approach for knee OA includes patient education, physical exercise, and weight loss (for overweight or obese individuals) 2.
- However, less than 40% of patients with knee OA receive this kind of intervention, highlighting the need for healthcare professionals to understand the current recommended treatment strategies and provide effective rehabilitation 2.
Non-Surgical Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in reducing pain and improving function in patients with knee OA, and they can be used in conjunction with other forms of treatment 3.
- Weight loss is a safe and effective way to improve knee pain, function, and stiffness, but it can be challenging for obese patients with knee OA due to limited mobility and lack of adherence to a low-calorie diet 3.
- Intra-articular injections have had mixed results, with findings from recent studies indicating long-term outcomes to be equivocal 3.
- Physical therapy leads to significant improvements in pain and function, but decreased compliance can be due to high copayments, pain with activities, lack of transportation, and high time commitments 3.
- Bracing for knee OA is a non-invasive, non-pharmacologic option that can significantly reduce pain and improve function with minimal adverse effects 3.
Lifestyle Changes and Self-Management
- Lifestyle changes, such as weight loss and exercise therapy, are essential for managing knee OA, and patients should be educated on the importance of these changes 4.
- Self-management techniques, such as pain management and stress reduction, can also be beneficial for patients with knee OA, and healthcare professionals should provide guidance on these techniques 2.
- Patient education should also include information on the safe use of medications, such as NSAIDs and acetaminophen, and the potential risks and benefits associated with these medications 5, 6.