| Abstract [eng] |
Rokas Venclovas. TREATMENT ALGORITHMS FOR KNEE OSTEOARTHRITIS. Research aim. To compare non-surgical treatment algorithms for knee osteoarthritis (OA) in leading countries around the world. Objectives. 1. To compare non-pharmacological treatments for knee OA across the treatment algorithms of leading countries and classify each into one of four categories: recommended, conditionally recommended, conditionally not recommended, or not recommended. 2. To compare pharmacological treatments for knee OA across the same countries and classify them using the same four categories. 3. To develop practical treatment recommendations for knee OA. Methods. Five databases were used (PubMed, Science Direct, Clinical Key, Google Scholar, Cochrane Library). The search strategy included the keywords: (“osteoarthritis” OR “osteoarthrosis” OR “OA”) AND (“guidelines” OR “guidance” OR “algorithm” OR “recommendations”). The databases returned 2,651 scientific publications. After applying inclusion and exclusion criteria, 11 articles were selected. In total, 20 non-pharmacological and 22 pharmacological treatment methods were identified. Each article and treatment method was classified into one of the four categories based on the authors' recommendations. Results. Across different countries’ treatment algorithms for knee OA, the following non-pharmacological interventions were consistently recommended: physical exercise, Tai Chi, yoga, weight management, the use of 6 a walking aid (e.g., cane), and patient education/treatment planning programs. The following were not recommended: medial/lateral wedge insoles, manual therapy, and transcutaneous electrical nerve stimulation (TENS). Opinions varied regarding knee bracing (tibiofemoral/patellofemoral), kinesiology taping, acupuncture, thermal therapy, and massage therapy. Among pharmacological treatments, the following were recommended: non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, and intra-articular glucocorticoid injections. The following were not recommended: platelet-rich plasma (PRP), stem cell injections, bisphosphonates, and vitamin D. Opinions varied on acetaminophen, tramadol and other opioids, glucosamine, chondroitin sulfate, and intra-articular hyaluronic acid injections. Conclusions and Recommendations. The foundation of different treatment recommendations lies in a combination of non-pharmacological and pharmacological approaches. Following the algorithms of leading countries, treatment should begin with patient education and awareness of available therapies, and the creation of a treatment plan. Priority should be given to non-pharmacological treatments such as physical exercise (muscle strengthening, balance exercises), as well as Tai Chi and yoga. Weight control is also critically important. The use of slow-acting drugs for OA, like chondroitin sulfate and glucosamine, should be evaluated critically and individually per patient. If results are unsatisfactory, treatment should begin with topical NSAIDs. Due to varying recommendations on long-term acetaminophen use, NSAIDs (in the absence of contraindications) are advised as the first-line oral symptomatic treatment. In cases of acute inflammatory episodes in the affected joint, intra-articular glucocorticoid injections are recommended. Due to mixed evidence, intra-articular hyaluronic acid injections should be considered cautiously in the long-term. Treatment algorithms advise against PRP and stem cell injections into the knee joint. |
