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Three steps to changing the narrative about knee osteoarthritis care: a call to action
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    Comment on "Three steps to changing the narrative about knee osteoarthritis: a call to action."
    • John Quintner, Consultant Physician in Rheumatology and Pain Medicine (retired) Arthritis and Osteoporosis, Western Australia

    Whilst its principal message is clear, I wish to draw attention to three problems arising from the editorial authored by Caneiro et al.:

    1. They say, “… pain is described as an altered state of a person’s knee health influenced by biopsychosocial factors, of which many can be modified.”

    How is “knee health” different from “whole person health”?

    Just how many biopsychosocial factors can be modified?

    2. Contemporary evidence is said to support the proposition that “knee health” is “influenced by the interaction of different biopsychosocial factors” that have the property of “modulating inflammatory processes and tissue sensitivity”.

    Is there any evidence that such an interaction actually takes place?

    And furthermore, what are the postulated mechanisms for such interaction?

    3. Their Infographic (“What should you know about knee osteoarthritis?”) contains the statement “rest and avoidance makes pain worse.” Presumably they are referring to avoidance of graded exercise. But even so, how do the authors justify their conclusion that avoidance of exercise or rest "per se" can “make pain worse”?

    Conflict of Interest:
    None declared.