Alshami Ali M
Assistant Professor, Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam.
Int J Health Sci (Qassim). 2014 Jan;8(1):85-104. doi: 10.12816/0006075.
Osteoarthritis is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone. For the last ten years, majority of published review articles were not specific to osteoarthritis of the knee, and strength of evidence and clinical guidelines were not appropriately summarized.
To appraise the literature by summarizing the findings of current evidence and clinical guidelines on the diagnosis and treatment of knee osteoarthritis pain.
English journal articles that focused on knee osteoarthritis related pain were searched via PubMed (1 January 2002 - 26 August 2012) and Physiotherapy Evidence Database (PEDro) databases, using the terms 'knee', 'osteoarthritis' and 'pain'. In addition, reference lists from identified articles and related book chapters were included as comprehensive overviews.
For knee osteoarthritis, the highest diagnostic accuracy can be achieved by presence of pain and five or more clinical or laboratory criteria plus osteophytes. Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. Generally, paracetamol, oral and topical non-steroidal anti-inflammatory drugs, opioids, corticosteroid injections and physical therapy techniques, such as therapeutic exercises, joint manual therapy and transcutaneous electrical nerve stimulation, can help reduce pain and improve function. Patient education programs and weight reduction for overweight patients are important to be considered.
Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. However, it is likely that a combination of pharmacological and non-pharmacological treatments is most effective in treating patients with knee osteoarthritis.
骨关节炎是一种常见的进行性关节疾病，不仅累及关节内膜，还包括软骨、韧带和骨骼。在过去十年中，大多数已发表的综述文章并非专门针对膝关节骨关节炎，证据强度和临床指南也未得到恰当总结。
通过总结当前关于膝关节骨关节炎疼痛诊断和治疗的证据及临床指南的研究结果来评估文献。
通过PubMed（2002年1月1日至2012年8月26日）和物理治疗证据数据库（PEDro）检索聚焦于膝关节骨关节炎相关疼痛的英文期刊文章，使用关键词“膝关节”“骨关节炎”和“疼痛”。此外，将已识别文章的参考文献列表和相关书籍章节纳入作为全面综述。
对于膝关节骨关节炎，通过存在疼痛以及五个或更多临床或实验室标准加骨赘可实现最高诊断准确性。临床指南和系统评价之间在推荐意见和研究结果方面存在一些不一致。一般来说，对乙酰氨基酚、口服和外用非甾体抗炎药、阿片类药物、皮质类固醇注射以及物理治疗技术，如治疗性锻炼、关节手法治疗和经皮电刺激神经疗法，可帮助减轻疼痛并改善功能。患者教育项目以及对超重患者进行减重也很重要，需加以考虑。
临床指南和系统评价之间在推荐意见和研究结果方面存在一些不一致。然而，药物治疗和非药物治疗相结合可能对治疗膝关节骨关节炎患者最有效。
