Figure 1. Knee OA: Overview of Management
• Exercise programs
• Weight loss
• Psychosocial interventions
• Self-management programs
• Physical therapy
• Walking aids, if needed
Nonpharmacologic therapy
Acetaminophen / OTC NSAIDs
Topical NSAIDs
Oral NSAIDs, incl. COX-2 SI
Referral for Surgery
Opioids
Acupuncture
Intra-articular
steroids
/
hyaluronate
injections
Tramadol,
Duloxetine
Treatment of knee OA should be individualized through a strateg y that takes into
consideration the types of risk factors and coexisting medical conditions present to
guide management.
1
As this algorithm depicts, nonpharmacologic therapies are fundamental to the overall
approach. Subsequent progression to nonopioid analgesics, such as acetaminophen,
over-the-counter doses of NSAIDs, prescription-strength doses of NSAIDs, and
surgery will be dictated by the patient's response to each intervention. Additional
intervention by means of intra-articular hyaluronate and/or topical analgesics may be
considered for all patients at any point in their disease progression.
1
Creamer P, Hochberg MC. Osteoarthritis. Lancet. 1997;350:503–509.
