Final set of 10 recommendations based on both evidence and expert opinion
| Adapted with permission from Jordan et al.1 |
| OA, Osteoarthritis; NSAID, non-steroidal anti-inflammatory drug; COX, cyclo-oxygenase; ASU, avocado soybean unsaponifiable. |
| • The optimal management of knee OA requires a combination of non-pharmacological and pharmacological treatment modalities |
| • The treatment of knee OA should be tailored according to: |
| – Knee risk factors (obesity, adverse mechanical factors, physical activity) |
| – General risk factors (age, comorbidity, polypharmacy) |
| – Level of pain intensity and disability |
| – Sign of inflammation—for example, effusion |
| – Location and degree of structure damage |
| • Non-pharmacological treatment of knee OA should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction |
| • Paracetamol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic |
| • Topical applications (NSAIDs, capsaicin) have clinical efficacy and are safe |
| • 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 |
| • 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 |
| • SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid) have symptomatic effects and may modify structure |
| • Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion |
| • Joint replacement has to be considered in patients with radiographic evidence of knee OA who have refractory pain and disability |