Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Nonsurgical Therapies for Knee OA Pain: From Medications to Bracing to Exercise, What Works & What Doesn’t

Susan Bernstein  |  Issue: January 2019  |  November 28, 2018

David Felson, MD, MPHCHICAGO—Many nonsurgical therapies are available for knee osteoarthritis pain, but they vary greatly in effectiveness.

“How should I proceed and figure out what to do with our patients?” asked David T. Felson, MD, MPH, professor of medicine at Boston University School of Medicine, during OA Management Without Surgery in 2018, a session at the 2018 ACR/ARHP Annual Meeting. He also shared tips on how to interpret the effect size of clinical trial meta-analyses to see how available therapies work and compare to each other.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Pain is not patients’ only concern. Between 14% and 26% of patients with knee OA experience periodic knee buckling, and limit activity as a result, he said.1 “I had one patient who couldn’t go down to a basement and had to have her daughter come over to do her laundry,” he said. Her knees buckled when she walked downstairs, “and she was very scared she was going to fall.”

Patients with frequent, bothersome knee buckling should be referred to physical therapy (PT). “I don’t just refer patients to physical therapy. I instruct the physical therapist about exactly what I want.” To address muscle weakness that is the likely cause of the buckling, he prescribes functional closed-chain quadriceps strengthening and balance training. (Note: Chains are links of body parts, such as foot, ankle, knee and hip during walking. In a closed chain, the end of the chain farthest from the body is fixed, such as a squat where your feet are fixed and the rest of the leg chain moves.)

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

‘I don’t just refer patients to physical therapy. I instruct the physical therapist about exactly what I want.’ —David T. Felson, MD, MPH

Effect Sizes
To accurately interpret clinical trial data on medications for knee pain and other therapies, look at meta-analyses’ effect sizes, and watch for red flags that suggest publication bias, said Dr. Felson. Be skeptical of study results that seem too positive, trials that are not randomized and controlled, very small studies or markedly inconsistent results across studies. Trials with null results may never be published, and trials done in developing countries are overwhelmingly and suspiciously positive, he added.

Effect size in a trial is the average improvement in pain on the treatment minus the average improvement in pain while on placebo, divided by the standard deviation, he said. Dr. Felson offered a simple guide to gauge effect sizes of OA treatments: 0.2 to 0.5 is a small treatment effect, 0.5 to 0.8 is a moderate treatment effect, and 0.8 or greater is a large treatment effect. Total knee replacement surgery trials may have effect sizes of closer to 1.5, he said. Due to a strong placebo response in OA trials, look for effect sizes that show the treatment works better than placebo.

Page: 1 2 3 4 | Single Page
Share: 

Filed under:American College of RheumatologyConditionsMeeting ReportsOsteoarthritis and Bone Disorders Tagged with:2018 ACR/ARHP Annual Meeting

Related Articles

    Basics of Biologic Joint Reconstruction

    April 6, 2012

    For young patients especially, this can delay knee replacement and provide better outcomes.

    A Passion for Multidisciplinary Collaboration

    February 3, 2012

    Through teamwork, David T. Felson, MD, MPH, has advanced understanding and treatment of rheumatic diseases

    Exercise Therapy Recommended to Manage Knee Osteoarthritis

    July 12, 2016

    The benefits of exercise therapy for individuals with knee osteoarthritis (OA) are well known. The ACR strongly recommends both aquatic exercise and land-based aerobic and resistance exercise for managing knee OA.1 A recent Cochrane systematic review and meta-analysis concluded that high-quality evidence supports the use of exercise to reduce pain and improve physical function and…

    Post-Traumatic Osteoarthritis: Managing OA That Develops After Joint Injuries & Reconstructive Surgery

    November 28, 2018

    CHICAGO—Joint trauma is one of many potential drivers of osteoarthritis disease activity and structural progression. In Post-Traumatic OA: Pathogenesis, Clinical Evolution and Management, a session at the 2018 ACR/ARHP Annual Meeting, experts discussed the effects of sports and other injuries on even young patients’ joints. Post-traumatic osteoarthritis (OA) may account for 12% of hip, knee…

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences