Clinical Management in Early OA

Abstract

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

Dose-related effects of radial extracorporeal shock wave therapy for knee osteoarthritis: A randomized controlled trial

“…Knee osteoarthritis (KOA) is the most common degenerative joint lesion; it has a high prevalence and a negative impact on the quality of life of affected individuals ( 1 ). It has been reported in a case–control study carried out in North Staffordshire that 9.6% of men and 18% of women have symptomatic KOA at the age of 60 years and over ( 2 ).…”

Increasing burden of osteoarthritis in Brazil from 2000 to 2017-- results from the Global Burden of Disease Study (GBD), 2017

“…Women have twice the risk of developing bilateral knee OA than men and have 2.6 times greater chance of developing hand OA. 24 This difference is credited to anatomic factors, such as having a thinner articular cartilage layer, a three-degree-higher anatomic axial knee angle (Q angle), and a narrower distal femur than men. 24 Menopause is another possible cause, many studies showing that articular cartilage is sensitive to estrogen deprivation.…”

“…24 This difference is credited to anatomic factors, such as having a thinner articular cartilage layer, a three-degree-higher anatomic axial knee angle (Q angle), and a narrower distal femur than men. 24 Menopause is another possible cause, many studies showing that articular cartilage is sensitive to estrogen deprivation. It has also been demonstrated that for each additional childbirth, women have a 2% increment in the risk for hip arthroplasty (95% CI 1-4) and of 8% (95% CI 6-10) for knee arthroplasty.…”

Cost-Effectiveness of Treating Early to Moderate Stage Knee Osteoarthritis with Intra-articular Hyaluronic Acid Compared to Conservative Interventions

“…This cost-effectiveness finding supports the use of IA-HA in patients with early and moderate knee OA, as the benefits of IA-HA are apparent within the patient population with mild to moderate knee OA. pharmacological management of knee OA often includes education and self-management, weight loss and strengthening, and biomechanical interventions such as knee braces [11][12][13]. Anti-inflammatories are recommended for patients with symptomatic OA of the knee to address pain; however, prolonged use of NSAIDS increases risk of gastrointestinal (GI), cardiovascular, and renal complications [14,15].…”