The goals of knee osteoarthritis (OA) treatment are to improve health-related quality of life and limit the progression of joint damage. “The optimal management of knee OA requires that patients be given a combination of non-pharmacologic and pharmacologic treatments,” says Pekka Mooar, MD. “Educating patients about the nature of their condition and strategies to manage it is important when caring for these individuals.”

Informing patients about the pros and cons of the various types of therapies to alleviate pain and improve function takes time, but Dr. Mooar says it is an important part of the process. “Recent guidelines from groups like the American Academy of Orthopaedic Surgeons have provided recommen­dations for the non-pharmacologic and pharmacologic management of knee OA,” he says. “These guidelines make recommendations that are based on only well-designed studies with placebo controls. They do not support many of our traditional or surgical treatment options. For clinicians, this can make patient education even more challenging. Patients must be treated on a case-by-case basis, depending on their specific characteristics.”

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Lifestyle Interventions

One of the most important aspects of managing patients with knee OA, according to Dr. Mooar, is to provide education about the objectives of treatments and the importance of lifestyle changes. “Patients should recognize that they can take action to reduce their chances of requiring knee surgery or arthroplasty,” he says. “Lifestyle changes are among the most effective non-operative treatments, but these options are best used when patients with knee OA are identified early.”

Guidelines recommend that patients with knee OA be encouraged to undertake regular aerobic, muscle strengthening, and range of motion exercises,” says Dr. Mooar. “If knee pain is a problem, clinicians should make efforts to find alternative exercises, such as cycling or swimming. For those with knee OA who are overweight, it’s crucial that they lose weight and keep it off. Dietary counseling is an important component to weight loss for patients and should be addressed with the help of either a dietician or another trusted healthcare provider.”

Preparing for the Long Haul

For those with symptomatic knee OA, referrals to physical therapy (PT) are recommended. “PT can help with evaluating patients and instructing them on appropriate exercises to reduce pain and improve functional capacity,” Dr. Mooar says. “But referral alone will not be sufficient, and the co-pays for patients can add up quickly. To improve patients’ quality of life for the long term, interventions like PT need to be paired with other pharmaceutical and non-pharmaceutical treatments. Surgery should be viewed as a last resort. Non-operative approaches can go a long way toward delaying surgery until later in life.”

References

Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137-162. Available at: http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf.

American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. May 18, 2013. Available at: http://www.aaos.org/research/guidelines/guidelineoaknee.asp.

Coleman S, Briffa NK, Carroll G, Inderjeeth C, Cook N, McQuade J. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Res Ther. 2012;14:R21.

Tallon D, Chard J, Dieppe P. Exploring the priorities of patients with osteoarthritis of the knee. Arthritis Care Res. 2000;13:312-319.

Finset A. Clinician-patient interaction and health outcome: a potential impact on symptoms and quality of life in patients with pain? Patient Educ Couns. 2012;89:217-218

Frankel L, Sanmartin C, Conner-Spady B, et al. Osteoarthritis patients’ perceptions of “appropriateness” for total joint replacement surgery. Osteoarthritis Cartilage. 2012;20:967-973.

Tsai PF, Kuo YF, Beck C, et al. Non-verbal cues to osteoarthritic knee and/or hip pain in elders. Res Nurs Health. 2011;34:218-227. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100797/.