[Hard]

Вопрос о возможности использования глюкозаминов и хондроитинсульфатов рассматривался при разработке данных клинических рекомендаций, однако, не было найдено оснований для их включения в список лечебных мероприятий (см. раздел "Лечение" пункт 12).


DISEASE/CONDITION(S)

Osteoarthritis of the knee


GUIDELINE CATEGORY

Diagnosis
Evaluation
Management
Treatment


CLINICAL SPECIALTY

Family Practice
Internal Medicine
Orthopedic Surgery
Physical Medicine and Rehabilitation
Rheumatology


INTENDED USERS

Physicians


GUIDELINE OBJECTIVE(S)

To guide qualified physicians through a series of diagnostic and treatment decisions in an effort to improve the quality and efficiency of care in patients with osteoarthritis of the knee


TARGET POPULATION

• Adults (skeletally mature individuals) with confirmed osteoarthritis of the knee

Note: The guideline does not address the treatment of children or the skeletally immature.


INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis

Differential diagnosis of osteoarthritis of the knee based on patient history and physical findings

Treatment/Management

1. Analgesics (e.g., acetaminophen) or nonsteroidal anti-inflammatory medication (NSAIDs), including cyclooxygenase-II (COX-II) inhibitors
2. Activity modification
3. Ongoing monitoring of complete blood count, renal and liver function tests, and stool guaiac
4. Ongoing assessment of response to treatment, with medication change as needed
5. Radiography, including standing anteroposterior (AP) view, lateral view, tangential view of the patella-femoral joint ("sunrise" view), and standing posteroanterior (PA) view
6. Patient education (counseling about weight loss, avoidance of aggravating activities, and support groups)
7. Use of durable medical equipment (e.g., assistive devices, modified footwear, bracing)
8. Physical therapy including general conditioning, muscle strengthening, and range of motion
9. Aspiration of synovial fluid to assess for infection
10. Arthrocentesis with intraarticular steroid injection
11. Viscosupplementation
12. Glucosamine and chondroitin sulfate treatment (considered but no recommendation given)
13. Referral to musculoskeletal specialist

MAJOR OUTCOMES CONSIDERED

• Patient satisfaction with treatment and progress
• Symptomatic relief (control of pain)
• Range of motion
• Physical functioning
• Complications associated with treatment