These recommendations are presented in abbreviated form. Readers should refer to the text of the EULAR Guideline document1 for a detailed discussion of each of the following topics.
Knee OA is associated with symptoms of pain and functional disability. Physical disability arising from pain and loss of functional capacity reduces quality of life and increases the risk of further morbidity and mortality. Current treatments aim at alleviating these symptoms by several different methods:
The objectives of management are to:
| Table 6 Final set of 10 recommendations based on both evidence and expert opinion | |
| 1 | The optimal management of knee OA requires a combination of non-pharmacological and pharmacological treatment modalities |
| 2 | The treatment of knee OA should be tailored according to: (a) Knee risk factors (obesity, adverse mechanical factors, physical activity) (b) General risk factors (age, comorbidity, polypharmacy) (c) Level of pain intensity and disability (d) Sign of inflammation—for example, effusion (e) Location and degree of structural damage |
| 3 | Non-pharmacological treatment of knee OA should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction |
| 4 | Paracetamol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic |
| 5 | Topical applications (NSAID, capsaicin) have clinical efficacy and are safe |
| 6 | NSAIDs should be considered in patients unresponsive to paracetamol. In patients with an increased gastrointestinal risk, non-selective NSAIDs and effective gastroprotective agents, or selective COX 2 inhibitors should be used |
| 7 | Opioid analgesics, with or without paracetamol, are useful alternatives in patients in whom NSAIDs, including COX 2 selective inhibitors, are contraindicated, ineffective, and/or poorly tolerated |
| 8 | SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid) have symptomatic effects and may modify structure |
| 9 | Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion |
| 10 | Joint replacement has to be considered in patients with radiographic evidence of knee OA who have refractory pain and disability |
Reference:
1. Jordan K M, Arden N K, Doherty M, Bannwarth B, et al.: EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62;1145-1155. doi:10.1136/ard.2003.011742.