The treatment and prevention of knee osteoarthritis: a tool for clinical decision-making.
BACKGROUND
Osteoarthritis (OA) is a major cause of disability, which will increase further with longer lifetime and higher average weight of the population.


OBJECTIVE
To review a hierarchy of interventions for OA in clinical practice, and compare it with the Strength of Recommendation (SOR) proposed by the Osteoarthritis Research Society International (OARSI).


METHODS
Search for relevant randomized controlled trials in databases, as well as published systematic reviews and meta-analyses.


CONCLUSIONS
Preventive measures are few and uncertain; however, basic therapy includes reduction in weight in the obese and exercises to keep in shape; this is in accordance with the OARSI guidelines (OARSI, 100% consensus) emphasizing the need for obese individuals with knee OA to lose weight (OARSI, SOR = 96%). There are indications of an effect of some nutraceuticals, though further studies are needed for validation (OARSI, SOR = 63%). Pharmacological treatment has paracetamol as primary prescription, which is a safe, albeit weak analgesic. Supplementary medications are prescribed according to level of pain and possible inflammation.
Bliddal
Henning
H
Frederiksberg Hospital, The Parker Institute, DK-2000 Copenhagen F, Denmark. hb@frh.regionh.dk
Christensen
Robin
R
D019587:Dietary Supplements; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000517:prevention & control / Q000628:therapy*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical; D015431:Weight Loss