Management of knee osteoarthritis in primary care

Abstract

Osteoarthritis (OA) of the knee is one of the most common chronic inflammatory joint diseases, and its prevalence increases with age. It is degeneration of the joint secondary to a multitude of causes such as infection, trauma and systemic inflammatory conditions such as gout. Patients often experience pain, joint stiffness, swelling and restriction in mobility. Symptoms may not correlate with radiological changes. Some patients may have significant pain without many arthritic changes on radiography, and vice versa.Knee OA often leads to gradual adaptation to symptoms and can result in functional and psychological problems such as weakness, poor balance, inability to fulfil work or recreational needs, and poor sleep and mood.

Generalised knee swelling in adults

“…Jun-Nian Beatrice Tan 1 , MBChB, Yu Xian Aline Sim 2 , MBBS, Choon How How 3 , MMed, FCFP, Sir Young James Loh 4 , FRCSEd, FRCSEd Elvis, a 62-year-old man, visited your clinic for his diabetes mellitus and gout follow-up. You wondered how his right knee pain was and whether it might have been affecting his delivery work, which involved carrying heavy goods in and out of a truck.…”

“…Patients tend to have no systemic symptoms and may report symptoms of intermittent acute synovitis. (3,4) Post-surgery patients such as those who had a total knee replacement or other metal implants placed in the knee may also present with knee swelling. It is important to determine whether the swelling is a postoperative swelling, which can be present for a few months after surgery.…”

“…However, such signs might not be obvious in the early stages of the disease. (4) In the rare cases of a malignancy, a palpable mass might be present. It can also present as a pathological fracture.…”

“…In a knee with early degeneration, the radiographs might be normal, with no significant arthritic changes such as osteophytes. (4) Magnetic resonance imaging might be indicated in selected patients, such as those with a suspected degenerated meniscus that is persistently symptomatic, to discuss further treatment. (1) A skyline view radiograph is needed for a patient with anterior knee pain or patellofemoral osteoarthritis.…”

“…Orthopaedic Surgery, Changi General Hospital, 2 Family Medicine, SingHealth Polyclinics, 3 Care and Health Integration, 4 Orthopaedic Surgery, Changi General Hospital, Singapore Correspondence: Dr Jun-Nian Beatrice Tan, Medical Officer, Orthopaedic Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889. beatrice.tan@mohh.com.sg…”