Here are expert recommendations for management of people with hip and knee osteoarthritis The landscape of managing hip and knee osteoarthritis (OA) is constantly evolving, with new research and guidelines informing best practices. Here’s a summary of the latest recommendations (updated January 2024):
Non-pharmacological Interventions (First-line):
Education and Self-management: Empower patients with knowledge about OA, symptom management techniques, and self-care strategies.
Exercise: Structured exercise programs, including strength training, aerobic exercise, and flexibility exercises, are highly recommended. Tailoring the program to individual needs and preferences is crucial.
Weight management: For overweight or obese individuals, sustained weight loss (even 5%) can significantly improve pain and function.
Assistive devices: Consider walking aids, appropriate footwear, and home/work adaptations to reduce pain and increase mobility.
Pharmacological Interventions (Second-line)
- Topical NSAIDs: These are preferred over oral NSAIDs for pain relief due to a lower risk of side effects.
- Oral NSAIDs: Use cautiously, with gastrointestinal and cardiovascular risk assessment and mitigation strategies. Consider COX-2 inhibitors or NSAIDs with proton pump inhibitors for individuals with specific comorbidities.
- Intra-articular corticosteroid injections: Offer short-term pain relief but not a long-term solution.
- Other medications: Glucosamine, chondroitin sulfate, and hyaluronic acid injections are not currently recommended due to limited evidence of effectiveness.
Additional Considerations:
- Tai chi: Emerging evidence suggests potential benefits for pain and function improvement, especially in knee OA.
- Manual therapy and massage: May provide some pain relief and functional improvement as a complementary therapy.
- Laser therapy: FDA-approved laser treatment may offer pain relief, but further research is needed.
- Psychological interventions: Cognitive behavioral therapy can help manage pain and improve coping skills.
- Joint replacement surgery: Considered a last resort when non-surgical interventions fail to provide adequate pain relief and functional improvement.
Note: These are general recommendations, and individualized management plans are crucial based on each patient’s specific situation, needs, and preferences. Patient-centered care is essential, involving the patient in decision-making and treatment choices. Regular follow-up and monitoring are necessary to assess progress, adjust treatment plans, and address any emerging complications.
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Resources
- EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update: https://www.bmj.com/content/380/bmj.p24
- Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation: https://www.aafp.org/pubs/afp/issues/2018/0415/p523.html
- EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update – https://ard.bmj.com/content/early/2024/01/11/ard-2023-225041
