Guidelines for Osteoarthritis of the Knee

Peter L. Salgo, MD: Tell me about some guidelines that are out there. The American College of Rheumatology (ARC) has some. Are there guidelines that the primary care guys really need to know?

Andrew Spitzer, MD: I think that most of the guidelines, and in particular the ACR guidelines, are really common sense. There’s not 1 marker or 1 diagnostic test that you can make for osteoarthritis. But, the ACR guidelines suggest that for a patient with knee pain who’s over the age of 50—who has pain for less than 30 minutes on startup, no significant warmth, bony crepitus, perhaps bony enlargement, malalignment—you can make that diagnosis with 3 to 5 of those factors, without going any further at all. But at the end of the day, X-ray is confirmatory of that—with subchondral sclerosis, cyst formation, marginalized…

Peter L. Salgo, MD: X-ray? Not MRI? X-ray?

Andrew Spitzer, MD: As we’ve all said, X-ray first. Once you’ve made that diagnosis, the constellation of things that you will see on a MRI, exactly as Rich suggested, are things that don’t necessarily need treatment, out of the context of a global treatment program for osteoarthritis.

Peter L. Salgo, MD: I could text you 1 phrase for that: TMI—too much information, right?

Paul Lachiewicz, MD: Right.

Richard Iorio, MD: True.

Paul Lachiewicz, MD: Peter, one of the other guidelines that you may not be aware of is from our organization, the American Academy of Orthopaedic Surgeons. These are available online to primary care physicians, free of charge. The last guideline was in 2013. I really believe that these have some value. I did not design them, but the methodology was excellent of what types of treatments work. I was a member of the committee that reviewed them before they were published—I was a member of the Knee Society. I think they did follow the accepted guidelines for determining how you decide if something is effective or not. Now, it certainly brought in a lot of controversy. But, again, for our primary care physicians, I think this is a good way to start looking at treatment.

Transcript edited for clarity.