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Archive for July, 2010

In my younger days, I used to go on long, extended runs through the rural streets of my hometown. At the time, it never occurred to me to wear appropriate footwear or pay attention to my gait; running was simply a means of exercise and personal enjoyment. And while I love to reminisce about those worry-free days of my youth, I’m afraid I’m paying for it later in life.

My joints have begun to deteriorate quickly in recent years, a phenomenon which was surely expedited by the carefree nature of my youth. Now when I exercise I make sure to wear the proper shoes and utilize a treadmill or track, but the pain in my joints simply won’t go away. I’ve decided to heed the advice of some of my friends and take a joint health supplement in an effort to reverse the trend.  I don’t have time for knee pain in my life.



This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Footwear Is Important

Footwear Is Important

Recommendation IX

Every patient with hip and knee osteoarthritis should receive advice about appropriate footwear.

There is a lot of information available about footwear and how it relates to hip and knee osteoarthritis.  Lateral wedged insoles are recommended in 12 out of 13 existing guidelines for the management of knee OA.  Three observational studies conclude that lateral wedged insoles can provide symptomatic pain relief.  However three randomized controlled studies do not support the use of lateral wedged insoles.

There haven’t been any controlled trials that supports the use of sports shoes or footwear with shock absorbing soles for treating knee osteoarthritis.

The expert opinion of the research team directs that every patient with hip and knee osteoarthritis should get advice on appropriate footwear.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 77%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Recommendation VIII

Knee braces can reduce pain, improve stability, and diminish the risk of falling in patients with knee osteoarthritis.

There is clear evidence that physical function, stiffness, and pain are significantly improved in patients with knee osteoarthritis when they use an appropriate knee brace.

Valgus knee braces, or off-loading knee braces, or bio-mechanical knee braces are recommended in 8 out of 9 existing guidelines for the management of knee osteoarthritis.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 76%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Walking with a Cane

Walking Aids Help Patients with Osteoarthritis

Recommendation VII

Patients with hip and knee osteoarthritis can reduce pain by using a walking aid.

It is recommended that patients should be given instructions on how to use an assistive walking device in their contralateral hand.  So if their right knee hurts, they should be taught how to use a cane in their left hand.  Studies on how the knee moves supports using canes, and walking sticks in  patients with knee OA to improve their biomechanics.

Randomized Clinical Trials do not exist in regards to walking devices and knee OA.  However there was complete expert consensus that walking aids help reduce pain in patients with hip and knee OA.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 90%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


OARSI – Recommendation VI: Lose Weight

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July 18, 2010

This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Weight Loss Helps OA

Weight Loss Helps OA

Recommendation VI

Patients with hip and knee osteoarthritis should be encouraged to lose weight and maintain their weight at a lower level.

Patients who are overweight should be encouraged to lose the extra pounds.  100% of the research team was in agreement on this recommendation.  Weight loss is also a core recommendation in 13 out of 14 existing guidelines for osteoarthritis treatment.  Four randomized controlled trials with data on 454 patients suffering from knee ostearthritis also support this recommendation.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 96%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Exercise Helps treat OA

Exercise Helps treat OA

Recommendation V

Regular aerobic, muscle strengthening, and range-of-motion exercises help patients with hip and knee osteoarthritis.

In 21 out of 21 published guidelines on osteoarthritis treatment options it is recommended that patients with knee osteoarthritis should participate in a regular exercise program.  Aerobic walking and home-based quadriceps muscle strengthening are core recommendations.  Patients with hip OA should be encouraged to exercise in the water.

The research team gave this treatment option a Strength of Recommendation score of 96%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Physical Therapy Helps Knee OA

Physical Therapy Helps Knee OA

Recommendation IV

Physical Therapy may help patients with symptomatic hip and knee osteoarthritis.

Physical therapists will evaluate patients and instruct them on appropriate exercises to increase function and decrease pain in patients with hip and knee osteoarthritis.

This recommendation is based mostly on expert opinion.  Referrals for physical therapy were recommended by 100% of the research team.  However three randomized clinical trials also supported referrals to physical therapy as an effective osteoarthritis treatment option.

The research team gave this treatment option a Strength of Recommendation score of 89%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Phone Calls Help OA

Phone Calls Help OA

Recommendation III

Patients with hip and knee osteoarthritis can improve their clinical status if they receive regular phone calls aimed at promoting self-care about their condition.

Monthly telephone contact from “lay personnel” where self-care is discussed and promoted with patients suffering from hip and knee osteoarthritis could be associated with improved function and a decrease in pain.  Three trials were examined where phone contact was part of a treatment program for knee osteoarthritis.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 66%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

OARSI - OA Education

OARSI - OA Education

Recommendation II

All patients with hip and knee osteoarthritis should be educated about their condition.

The focus of education for patients with knee osteoarthritis should be self-help and patient-driven treatments rather than relying on medical professionals.  The importance of lifestyle choices such as weight loss, diet, and exercise need to be stressed.  Also an emphasis on reducing the amount of drugs a patient takes is important.

This recommendation is based on expert opinion, common sense, and economic consideration.  The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 97%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


 

Osteoarthritis Research Society International

Osteoarthritis Research Society International

Recommendation I

Knee Osteoarthritis is best managed with a combination of non-pharmacological and pharmacological treatments.

There was 100% agreement among the physicians comprising the research team that a combination of pharmacological and non-pharmacological osteoarthritis treatments options provided optimal management for knee and hip osteoarthritis.

For example: weight loss, exercise, and NSAIDs.

This recommendation is based mostly on expert opinion and lacks evidence from randomized controlled trials.  The research team gave this treatment option a Strength of Recommendation score of 96%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.