The Specialist Forum Volume 13 No 11 November 2013 | Page 43

ARTHRITIS

New US guideline for the
treatment of knee osteoarthritis

A

ccording to the World Health Organization (WHO), osteoarthritis
(OA) is the fourth leading cause of years lived with dis­ bility (YLDs),
a
accounting for 3.0% of total global YLDs. OA is more common
in women than men but the prevalence increases dramatically with age.
Approximately 45% of women over the age of 65 have symptoms while
radiological evidence is present in 70% of those over the age of 65.
The WHO defines OA ‘as a condition characterised by focal areas
of loss of articular cartilage within synovial joints, associated with hypertrophy of bone (osteophytes and subchondral bone sclerosis) and
thickening of the capsule. In this sense it is the reaction of synovial
joints to injury’.
Histologically, the disease is characterised early by fragmentation of
the cartilage surface, cloning of chondrocytes, vertical clefts in the cartilage, variable crystal deposition, remodeling, and eventual violation of
the tidemark by blood vessels. Clinically, the condition is characterised
by joint pain, tenderness, limitation of movement, crepitus, occasional
effusion, and variable degrees of local inflammation.
The American Academy of Orthopaedic Surgeons (AAOS) published
their new guideline for the treatment of OA of the knee recently.

Recommendation 6
The AAOS cannot recommend using glucosamine and chondroitin for
patients with symptomatic OA of the knee.

Pharmacologic treatments
Recommendation 7a
The AAOS recommends nonsteroidal anti-inflammatory drugs (NSAIDs;
oral or topical) or tramadol for patients with symptomatic OA of the
knee.

Recommendation 7b
The AAOS is unable to recommend for or against the use of acetaminophen, opioids, or pain patches for patients with symptomatic OA
of the knee.

Conservative treatments
Recommendation 1
The AAOS recommends that patients with symptomatic osteoarthritis
of the knee participate in self-management programmes, strengthening, low-impact aerobic exercises, and neuromuscular education; and
engage in physical activity consistent with national guidelines.

Recommendation 2
The AAOS suggests weight loss for patients with symptomatic OA of
the knee and a BMI ? 25.

Recommendation 3a
The AAOS cannot recommend using acupuncture in patients with
symptomatic OA of the knee.

Recommendation 3b
The AAOS are unable to recommend for or against the use of physical
agents (including electrotherapeutic modalities) in patients with symptomatic OA of the knee.

Recommendation 3c
The AAOS is unable to recommend for or against manual therapy in
patients with symptomatic OA of the knee.

Recommendation 4
The AAOS is unable to recommend for or against the use of a valgus
directing force brace (medial compartment unloader) for patients with
symptomatic osteoarthritis of the knee.

Recommendation 5
The AAOS cannot suggest that lateral wedge insoles be used for patients with symptomatic medial compartment OA of the knee.
Rheumatology Forum | November 2013

Page 7