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Knee arthritis

Key points about knee arthritis

Osteoarthritis is the most is the most common type of knee arthritis. It causes pain and stiffness in the joint.
Osteoarthritis causes the breakdown of cartilage in a joint. When cartilage is damaged, the joint can no longer function well and eventually the bone ends rub together. This causes pain and stiffness
Rheumatoid arthritis occurs when your immune system mistakenly targets your own body. It especially affects the lining of the joints between your bones and causes symptoms such as swelling, pain and stiffness.
Psoriatic arthritis occurs in people who have the skin disease psoriasis.

Elderly woman leaving house using her walker

Knee arthritis becomes more common as people age. You are also more likely to get osteoarthritis it if you:

are female
are overweight
have a family history of arthritis
have had previous knee injuries

Pain that increases when you are active, but gets a little better with rest.
Swelling and warmth in the joint.
Stiffness in the knee, especially in the morning or when you have been sitting for a while.
Limited movement – making daily activities such as getting into a car or crouching down difficult.
A creaking, crackly sound when the knee moves.

Your doctor will talk to you about your symptoms and will do a physical examination of your knee.

Before your appointment, take note of what things make your knee better or worse and when you notice the pain. Also, try to find out if anyone else in your family has experienced arthritis.

To assist with the diagnosis, you doctor may order additional testing, including:

X-rays, which can show bone and cartilage damage as well as the presence of bone spurs
blood tests, which can detect rheumatoid arthritis.

There is no cure for knee arthritis, but there are many ways you can relieve your symptoms and help prevent these from getting worse. Of the following strategies for managing knee arthritis, exercise and weight loss (if overweight) are seen as particularly important.

What?	Why?
Exercise – staying active	Taking part in an exercise programme which includes a mix of stretching, strengthening and cardiovascular exercises can reduce pain, improve movements and delay the need for surgery. Regular exercise keeps your muscles strong and your joints flexible. It is also important for balance.
Healthy weight	For those who are overweight, weight loss reduces stress on the joints. Loosing even a small amount of weight, if needed, can greatly reduce knee pain.
Self-management support	Your doctor or other healthcare professional can help you develop a self-management plan. This will provide you with practical advice on how to increase your skills and confidence in managing your symptoms. Read more about self-management support.
Physiotherapy and occupational therapy	If you are having trouble with daily activities, physiotherapy or occupational therapy can help. Physiotherapists can show you ways to strengthen your muscles and improve flexibility. Occupational therapists teach you things such as how to pace your activities through the day. Spreading physically hard jobs (such as housework, mowing the lawn) throughout the day, rather than trying to do them all at once.
Pain relief medications	Pain relief medications, or painkillers, are often recommended by your doctor or pharmacist to reduce pain and stiffness. However, they do not treat arthritis itself. All medications should be used at appropriate doses and for the shortest duration possible. The types of pain relief medications include: Paracetamol Combined pain relief medications – paracetamol together with a codeine-like drug. Nonsteroidal anti-inflammatory drugs (NSAIDs) These are painkillers that also reduce inflammation. Common examples are ibuprofen and naproxen (Naprosyn). These can be taken in tablet form or as creams or gel which you rub into your joints (topical treatments) Creams and gels containing capsaicin (Zostrix) which are applied to the skin of the painful area. Steroid injections into the joint – this is usually reserved for extremely painful arthritis. Discuss the benefits and potential side effects of steroids and other medications with your doctor or specialist Read more about pain relief medications.
Other treatments and tips	Tape or a brace for your knee: There are lots of devices, including joint braces, splints and tapes. Wear shoes with thick soft soles that act as shock absorbers for your knees. Avoid high heels. Use a walking stick to reduce the weight and stress on a painful knee. A physiotherapist can advise on the correct length of the stick and how to use it properly. Apply a hot or cold pack to reduce pain and inflammation Practice relaxation techniques to help your body relax when you are not being active to help relieve pain.
Surgery	Most people do not need surgery for knee arthritis; symptoms can be managed by a combination of the measures listed above. Joint surgery may be recommended for some people if the joint wears out over time.

Knee arthritis(external link) Oxford University Hospitals, NHS, UK
Knee pain(external link) Arthritis Foundation, US
Osteoarthritis of the knee(external link) WebMD, US

Information for people with knee arthritis [PDF, 871 KB] University of Otago, NZ, 2021
Knee workout(external link) NHS, UK
Nutrition and arthritis(external link) Arthritis New Zealand, 2014

Care of feet(external link) Arthritis New Zealand, 2011

Pain management(external link) Arthritis New Zealand, 2013 (Also available in the language Hindi)(external link)

Arthritis – an introduction
Ageing – what is normal and when to seek medical advice
Strains and sprains
Osteoarthritis | Pona ngoikore
Rheumatoid arthritis | Mate rumatiki

Systematic management of osteoarthritis(external link) BPAC, NZ, 2008
OARSI guidelines for the non-surgical management of knee osteoarthritis(external link) Osteoarthritis Research Society International, Osteoarthritis & Cartilage Vol. 22 (2014).
Recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee(external link) American College of Rheumatology, Arthritis Care & Research, Vol. 64 (2012)
European League Against Rheumatism (EULAR) and the American Academy of Orthopaedic Surgeons

Management of osteoarthritis

Systematic management of osteoarthritis(external link) BPAC, NZ, 2008

Image: BPAC, NZ

Guidelines

AAOS guidelines for the treatment of osteoarthritis of the knee(external link) American Academy of Orthopaedic Surgeons
OARSI guidelines for the non-surgical management of knee osteoarthritis(external link) Osteoarthritis Research Society International, Osteoarthritis & Cartilage Vol. 22 (2014).

Source	Extracts from summary of recommendations
AAOS(external link)	"Recommendation 1. We recommend that patients with symptomatic osteoarthritis of the knee participate in self-management programs, strengthening, low-impact aerobic exercises, and neuromuscular education; and engage in physical activity consistent with national guidelines. Strength of Recommendation: Strong Recommendation 2. We suggest weight loss for patients with symptomatic osteoarthritis of the knee and a BMI ≥ 25. Strength of Recommendation: Moderate Recommendation 7. We recommend nonsteroidal anti-inflammatory drugs (NSAIDs; oral or topical) or Tramadol for patients with symptomatic osteoarthritis of the knee. Recommendation 9. We cannot recommend using hyaluronic acid for patients with symptomatic osteoarthritis of the knee. Strength of Recommendation: Strong Recommendation 12. We cannot recommend performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee. Strength of Recommendation: Strong" Extract from Treatment of Osteoarthritis of the Knee, Summary of recommendations, 2nd edition(external link) See full summary of recommendations(external link).
OARSI(external link)	"The new (Osteoarthritis Research Society International) guidelines recommend a set of non-pharmacological core treatments as appropriate for all individuals (listed in order from highest benefit-to-risk score to lowest): land-based exercise, weight management, strength training, water-based exercise, and self-management and education. For weight management, the OARSI guidelines make a specific recommendation of achieving a 5% weight loss within a 20- week period to be effective at treating knee OA." Extract from Non-Surgical Treatment of Osteoarthritis of the Knee, Physician Summary March 2014. See full summary(external link)

Source

Extracts from summary of recommendations

AAOS(external link)

"Recommendation 1. We recommend that patients with symptomatic osteoarthritis of the knee participate in self-management programs, strengthening, low-impact aerobic exercises, and neuromuscular education; and engage in physical activity consistent with national guidelines. Strength of Recommendation: Strong
Recommendation 2. We suggest weight loss for patients with symptomatic osteoarthritis of the knee and a BMI ≥ 25. Strength of Recommendation: Moderate
Recommendation 7. We recommend nonsteroidal anti-inflammatory drugs (NSAIDs; oral or topical) or Tramadol for patients with symptomatic osteoarthritis of the knee.
Recommendation 9. We cannot recommend using hyaluronic acid for patients with symptomatic osteoarthritis of the knee. Strength of Recommendation: Strong
Recommendation 12. We cannot recommend performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee. Strength of Recommendation: Strong"

Extract from Treatment of Osteoarthritis of the Knee, Summary of recommendations, 2nd edition(external link) See full summary of recommendations(external link).

OARSI(external link)

"The new (Osteoarthritis Research Society International) guidelines recommend a set of non-pharmacological core treatments as appropriate for all individuals (listed in order from highest benefit-to-risk score to lowest): land-based exercise, weight management, strength training, water-based exercise, and self-management and education. For weight management, the OARSI guidelines make a specific recommendation of achieving a 5% weight loss within a 20- week period to be effective at treating knee OA."

Extract from Non-Surgical Treatment of Osteoarthritis of the Knee, Physician Summary March 2014. See full summary(external link)

Articles

Guidelines can help doctors choose the best OA treatments(external link) Consensus from American College of Rheumatology stresses exercise and weight loss, but are doctors following the guidelines? Arthritis Foundation (US), accessed August 2016.