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. RESULTS/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.