Knee Osteoarthritis

Knee Osteoarthritis

Core Management for all Patients with knee osteoarthritis

  • Structured Exercise Program
  • Weight Reduction
    • Even 5–10% weight loss significantly reduces pain.
    • Refer to health coach or Obesity clinic if needed.
  • Lifestyle & Aids
    • Use cane on opposite side, knee brace or sleeve for extra support.
    • Avoid prolonged sitting, deep squatting, stairs, and heavy loads.
  • Stepwise Pain Management

First-line (Mild pain): Topical NSAIDs 

Diclofenac 1% gel: 2–4 g applied QID directly to knee (max 16 g/day/joint).

If Moderate/Severe or persistent Pain: Short-Term Oral NSAIDs

Diclofenac 50 mg BID or TID (preferred first-line oral NSAID for knee OA when topical therapy is insufficient, due to strong efficacy evidence).

Naproxen 250–500 mg BID (effective alternative with a relatively safer cardiovascular profile for longer-term use).

Meloxicam 7.5–15 mg once daily (when simplified once-daily dosing is desired or when GI tolerability is a concern, has similar overall efficacy to other NSAIDs).

Before prescribing NSAIDs:

  • Always assess renal function, GI risk, cardiovascular risk.
  • If ≥65 y or GI risk → co-prescribe PPI (omeprazole 20 mg daily).
  • Avoid long-term use; use lowest effective dose for shortest duration.

NOTE: Paracetamol is no longer first-line for osteoarthritis due to limited analgesic efficacy, even at full regular dosing. It may be considered as adjunctive therapy or for patients who cannot tolerate NSAIDs, but its benefit remains modest and inferior to NSAIDs

Indications for Referral to Orthopedic clinic:

Persistent moderate-severe symptoms despite 6 months of PHC management

Confirmed advanced knee osteoarthritis (Level 3-4)

Symptoms affecting quality of life and/or sleep.

Significant impact on daily activity and functional capacity.

Patient is medically fit and accepting surgical treatment.

 

Author: Dr. Fahad Saad Almutairi, 

Reviewer: Dr. Bader Thuwaini Alanazi