Review Question - QID 4565

The only recommendation that was supported in the above mentioned answer choices was the use of NSAIDs or tramadol for patients with symptomatic osteoarthritis of the knee.

The 2011 AAOS Guidelines for the treatment of symptomatic arthritis discuss both conservative and non-conservative forms of therapy, and critique the literature supporting each modality. Amongst the strong or moderately strong recommendations were weight loss, physical activity, and NSAIDs or tramadol for the treatment of pain. While tramadol is a u-opioid receptor agonist, NSAIDs block the cyclooxygenase enzyme. Numerous modalities were not supported including the use of acupuncture, hyaluronic acid or corticosteroid injections, lateral wedge insoles, and braces. Of note, they were unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus.

Zhang et al. critically appraise the quality of the guidelines and review current research evidence for the management of osteoarthritis. They find that the overall quality of existing guidelines is sub-optimal, and consensus recommendations are not always supported by the best available evidence.

Zhang et al., in part II of their study, present 25 recommendations for the treatment of osteoarthritis. They cover pharmacologic, non-pharmacologic and surgical modalities including joint replacements, arthroscopy, fusion, and osteotomy. Their strongest recommendation is that all patients with hip and knee OA should be given information access and education about the objectives of treatment and the importance of changes in lifestyle, exercise, pacing of activities, weight reduction, and other measures to unload the damaged joints.

Illustration A shows the mechanism of action of different antiinflammatory medications.

Incorrect Answers:
Answers 1, 2, 3, 5: These were not supported in the 2011 AAOS Guidelines.