Knee osteoarthritis affects roughly 528 million adults worldwide, making it the most common form of arthritis. It involves the entire joint—cartilage, bone, ligaments, tendons and surrounding muscles—not just “wear and tear.” Doctors see a steady stream of patients seeking relief from pain and functional loss.
Symptoms and Diagnosis
Early signs typically include pain when climbing stairs or standing after sitting. Over months, discomfort may become constant, punctuated by flare-ups that intensify the ache. Limitations in daily activities often prompt a medical visit.
Primary-care physicians can diagnose knee osteoarthritis based on history and physical exam, though they may refer patients to rheumatology, sports medicine or orthopedics for further evaluation. Imaging such as X-rays or MRI can confirm joint changes but are not required for diagnosis.
Some patients mistake rheumatoid arthritis for osteoarthritis. The key distinction is that rheumatoid arthritis is driven by an immune response, whereas osteoarthritis stems from mechanical degeneration. This difference guides treatment choices, especially the use of immune-targeting drugs.
Radiographs sometimes reveal “bone-on-bone” appearance, indicating cartilage loss. However, imaging severity does not always match symptom severity; some individuals with advanced radiographic changes report minimal pain.
Treatment Options
Management is multimodal, beginning with patient education and setting realistic goals. Physical activity remains central; the general recommendation of 150 minutes of moderate-intensity exercise per week applies, though many with knee osteoarthritis find this target challenging.
Walking is a low-impact starter activity. Patients are encouraged to progress gradually, using step-tracking apps or wearable devices to monitor improvements. Referral to physical therapy is common, where therapists prescribe strength, aerobic, flexibility and balance exercises.
Biomechanical aids such as braces, taping or canes can modify joint loading. Weight reduction is also advised for overweight individuals, as excess mass increases stress on the knee.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are first-line pharmacologic options. When oral NSAIDs are contraindicated, topical agents like diclofenac gel provide localized relief with minimal systemic absorption.
Topical alternatives include lidocaine patches, capsaicin cream and, in select cases, duloxetine, an antidepressant used for chronic pain. Steroid injections, commonly called cortisone shots, are offered if other measures fall short, though they carry small risks of infection and may accelerate cartilage wear if overused.
While surgery remains an option for severe, refractory cases, many patients explore less invasive interventions first. Radiofrequency ablation, performed by pain specialists, uses heat to disrupt pain-transmitting nerves in the knee, offering relief when medication and physical therapy have failed.
Guidelines caution against several popular supplements and procedures that lack robust evidence. Hyaluronic acid injections, glucosamine, chondroitin, platelet-rich plasma and stem-cell therapies have not demonstrated consistent benefits over placebo.
In practice, clinicians must balance these options against individual health profiles and patient preferences.
Arthroscopic Meniscectomy, Mind-Body Options, and Dr. Liew’s Credentials
Patients must decide if they want surgery and whether they can obtain the physical-therapy support required afterward. Some MRIs reveal meniscus tears that often appear alongside other knee-OA findings. A large New England Journal of Medicine trial showed arthroscopic partial meniscectomy did not outperform physical therapy in long-term outcomes. Therefore, surgically treating the meniscus adds no extra benefit for these patients.
Arthroscopic partial meniscectomy is not advised for individuals with knee osteoarthritis. Patients frequently inquire about non-surgical options beyond medication and exercise. Mind-body modalities such as yoga, tai chi for balance, massage, acupuncture, and cognitive-behavioral therapy can complement existing treatments.
UCLA Health provides additional resources on knee osteoarthritis. Dr. Jean Liew earned her MD from the University of Texas Medical Branch. She then finished a rheumatology fellowship and earned an MS in epidemiology at the University of Washington. Currently she serves as an assistant professor of medicine in the Section of Rheumatology at Boston University’s Chobanian Avedisian School of Medicine. Her clinical research focuses on knee osteoarthritis and axial spondyloarthritis.
Treatment Approaches
For patients who are overweight or obese, weight loss is recommended to reduce the mechanical load on the knee joint. Recent trials suggest that medications like semaglutide may aid weight loss and modestly improve pain, though long-term benefits versus safety of these medications is not known.
Leave a Reply