Physician’s Weekly: online CME courses, articles on hypertension, arthritis

According to recent estimates, about 9.3 million adults have symptomatic osteoarthritis (OA) of the knee. The condition is estimated to affect 5% of all adults aged 26 and older, 17% of adults aged 45 and older, and 12.1% for adults aged 60 and older. The incidence of symptomatic OA of the knee increases with age, especially for women. Current trends suggest that the emotional and physical impact of OA will continue to increase in the future.

Patients with OA of the knee often experience joint pain, stiffness, and functional deficits. Effective treatments and prevention strategies for OA of the knee have emerged. The primary goals of treatment are to achieve pain relief and to improve or maintain functional status. Most treatments have been associated with some known risks, especially invasive procedures, and contraindications vary widely. In December 2008, the American Academy of Orthopeadic Surgeons (AAOS) released a clinical practice guideline for knee OA, updating guidelines that were last published in the 1990s. Available online at www.aaos.org, the new guideline focuses largely on treatments that are less invasive than knee replacement surgery.

Inform Patients About Options

Treatment for symptomatic OA of the knee, according to the AAOS guidelines, should be based on the premise that physicians have informed patients about the available treatments and procedures that are applicable to them. Ensuring informed decision making is essential to achieving and sustaining good outcomes. Clinician input—based on experience with conservative management and surgical skills—can increase the probability of identifying patients who’ll benefit from specific treatment options. Physicians need to collaborate with other care providers and patients to weigh the potential risks and benefits of interventions under consideration.

Encourage Weight Loss

The AAOS guidelines provide information on patient education, lifestyle modifications, and physical rehabilitation when managing symptomatic OA of the knee. Patients should be encouraged to participate in self-management educational programs and incorporate more physical activity into their lives. Overweight patients are encouraged to lose a minimum of 5% of their body weight and maintain their lower weight with diet and exercise to avoid invasive procedures and treatments. Physical rehabilitation is often beneficial as well. Patients should be directed to participate in low-impact aerobic fitness exercises. Range of motion and flexibility exercises and quadriceps strengthening should also be encouraged.

When to Use Therapies, Interventions, & Surgery

For patients with symptomatic OA of the knee, the AAOS guidelines recommend patellar taping for short-term pain relief and improvement in function. Intra-articular corticosteroids are suggested for short-term pain relief. Analgesics such as acetaminophen and NSAIDs can also be used for pain relief, but the guidelines note that people at high risk for gastrointestinal bleeding need to consider other analgesics, such as topical NSAIDs, non-selective oral NSAIDs plus a gastro-protective agent, or COX-2 inhibitors.

With regard to surgery, an important recommendation in the guidelines surrounds use of arthroscopy to manage symptomatic OA. The guidelines recommend against performing arthroscopy with debridement or lavage in patients with a primary diagnosis. However, arthroscopic partial meniscectomy or loose body removal can be a treatment option in patients who also have primary signs and symptoms of a torn meniscus and/or a loose body. The key is to be selective when deciding which patients should receive arthroplasty to manage symptomatic OA of the knee.

John C. Richmond, MD, has indicated to Physician’s Weekly that he has or has had no financial interests to report.