Knee osteoarthritis related pain: a narrative review of diagnosis and treatment
Dr. Deepika Kaushal (BPT)
Kayakalp, VMRT, Holta, Palampur, Himachal Pradesh
Introduction: Osteoarthritis is a common progressive joint disease, mainly seen in 40+ age group, involving not only the joint lining but also cartilage, ligaments and bone. For the last 10-15 years, majority of published review articles were not specific to osteoarthritis of knee and strength of evidence and clinical guidelines were not appropriately summarized. To appraise the literature by summarizing the findings of current evidence and clinical guidelines on the diagnosis and treatment of knee osteoarthritis pain.
Causative factors: – Symptoms: –
- Age 40 + onwards
- Gender for osteoarthritis is more common and more severe in women.
- Premature menopause
- Joint injury
- Overweight (obesity)
- Joint abnormalities
- Genetic factor
- Joint pain
- Decreased function
- Cracking or grinding noise with joint movement.
Symptoms usually start gradually in a prolonged history of discomfort associated with exacerbation. Symptoms are often variable in severity and change slowly. Some patients may indicate that pain and functional disability increased over time and have symptoms that may progress from occurring during weight bearing activities towards symptoms at rest especially at night. Others, however may have their pain improved over the years (eg: if more activities such as walking are being performed
after retirement from sedentary work.)
Result: For knee osteoarthritis, the highest diagnostic accuracy can be achieved by presence of pain and five more clinical criteria (age older than 40+, swelling, bony enlargement, bony tenderness, stiffness, crepitus) plus osteophytes. Some inconsistencies in recommendations and findings were found between the clinical guidelines and systemic reviews.
Generally, from the physiotherapy point of view physiotherapy treatments included wax bath, interferential therapy or TENS (Transcutaneous electrical nerve stimulation), ultrasonic massage and physical therapy techniques, such as therapeutic exercises and joint manual therapy etc., can helpreduce pain and improve function. Patient education programs and weight reduction for overweight patients are important to be considered.
Avoid cross leg sitting, squatting, Vajra asana, frequent sitting and standing, stair climbing up/down, use railing while climbing the stairs, use assistive device while walking or cane and usecomfortable shoes.
Conclusion: Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systemic reviews. However, it is likely that a non-pharmacological treatment is more effective in treating patients with knee osteoarthritis.
Keywords: arthritis, guidelines, human, physiotherapy, review.