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Evaluation and Treatment of Knee Pain

A presenting complaint in 5% of primary care visits, knee pain is commonly the result of osteoarthritis (OA), patellofemoral pain, and meniscal tears, according to the authors of a review article. These conditions “can be diagnosed clinically, and can be associated with significant disability,” the authors write. “First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.”

“First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition,” the authors write. “First-line symptomatic management comprises nonpharmacological approaches including (1) exercise therapy; (2) weight loss (if overweight or obese); (3) prescription of walking aids or braces (if indicated, eg, during pain flares); and (4) education and self-management, alongside possible institution of pharmacological options such as nonsteroidal anti-inflammatory drugs (topical or oral) and, only if required (ie, inadequate response to all other therapies), intra-articular therapies such as steroids. The indication for surgical interventions is typically end-stage knee OA (defined as no or minimal joint space with inability to cope with pain) after conservative options have not effectively relieved symptoms.”

Source: JAMA