State-of-the-Art management of knee osteoarthritis

Abstract

Osteoarthritis (OA) is the most common type of arthritis found in the United States' population and is also the most common disease of joints in adults throughout the world with the knee being the most frequently affected of all joints. As the United States' population ages along with the increasing trends in obesity prevalence in other parts of the world, it is expected that the burden of OA on the population, healthcare system, and overall economy will continue to increase in the future without making major improvements in managing knee OA. Numerous therapies aim to reduce symptoms of knee OA and continued research has helped to further understand the complex pathophysiology of its disease mechanism attempting to uncover new potential targets for the treatment of OA. This review article seeks to evaluate the current practices for managing knee OA and discusses emerging therapies on the horizon. These practices include non-pharmacological treatments such as providing patient education and self-management strategies, advising weight loss, strengthening programs, and addressing biomechanical issues with bracing or foot orthoses. Oral analgesics and anti-inflammatories are pharmacologicals that are commonly used and the literature overall supports that some of these medications can be helpful for managing knee OA in the short-term but are less effective for long-term management. Additionally, more prolonged use significantly increases the risk of serious associated side effects that are not too uncommon. Disease-modifying osteoarthritis drugs are being researched as a treatment modality to potentially halt or slow disease progression but data at this time is limited and continued studies are being conducted to further investigate their effectiveness. Intra-articular injectables are also implemented to manage knee OA ranging from corticosteroids to hyaluronans to more recently platelet-rich plasma and even stem cells while several other injection therapies are presently being studied. The goal of developing new treatment strategies for knee OA is to prolong the need for total knee arthroplasty which should be utilized only if other strategies have failed. High tibial osteotomy and unicompartmental knee arthroplasty are potential alternatives if only a single compartment is involved with more data supporting unicompartmental knee arthroplasty as a good treatment option in this scenario. Arthroscopy has been commonly used for many years to treat knee OA to address degenerative articular cartilage and menisci, however, several high-quality studies have shown that it is not a very effective treatment for the majority of cases and should generally not be considered when managing knee OA. Improving the management of knee OA requires a multi-faceted treatment approach along with continuing to broaden our understanding of this complex disease so that therapeutic advancements can continue to be developed with the goal of preventing further disease progression and even potentially reversing the degenerative process.

How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey

“…6 Current evidence from randomized controlled trials (RCTs) has suggested that the most effective individual PT treatment modalities for knee osteoarthritis are cardiovascular or strengthening exercise and education (e.g., instructions on physical exercises and weight loss). [7][8][9][10] However, in clinical practice, physical therapists most often use a combination of two or more interventions when treating people with knee osteoarthritis. 11 For example, the use of exercise may be preceded by the use of physical agents such as ultrasound, diathermy, and electro analgesia, for example interferential current or transcutaneous electrical nerve stimulation.…”

Influence of IL13 on Periostin Secretion by Synoviocytes in Osteoarthritis

“…The main symptom of OA is pain, which is also the leading factor for patients making lifestyle changes and seeking medical intervention (3). The objectives of OA management, according to OA Research Society International, are to reduce pain and inflammation, slow-down cartilage degradation, improve function, and reduce disability (4). Therefore, an important aspect is the discovery of an early-stage mediator of OA and the elucidation of an intracellular signal transduction system.…”

Influence of Periostin on Synoviocytes in Knee Osteoarthritis

“…According to the OA Research Society International, the objectives of OA management are to reduce pain and inflammation, slow cartilage degradation, improve function and reduce disability (5). Therefore, important issues in OA treatment is discovering OA's early stage mediator and elucidating the underlying intracellular signal transduction pathway.…”