Management of moderate to severe knee osteoarthritis

OA: osteoarthritis; NSAID: nonsteroidal antiinflammatory drug; TENS: transcutaneous electrical nerve stimulation.
* Patients with moderate to severe knee OA have persistent pain, which significantly impairs functionality, activity participation, and quality of life.
¶ If the patient has OA limited to the knees and hands, a trial of topical NSAIDs is reasonable before advancing to oral NSAIDs (if not otherwise contraindicated).
Δ Assess the need for a proton pump inhibitor if increased risk for gastrointestinal side effects.
◊ Intraarticular glucocorticoid injections are not routinely recommended because the pain relief is mild to moderate and is short-lived. Refer to UpToDate content on management of knee OA.
§ Refer to UpToDate content on management of knee OA for adjunctive measures.