Symptoms:

Gradual onset knee pain, worse with activity and relieved by rest

Morning stiffness (usually <30 minutes)

Crepitus (grating sensation with movement)

Swelling and occasional warmth

Reduced range of motion

Joint deformity (e.g., varus or valgus alignment)

Differential Diagnosis:

Condition:                         Key Features :

Rheumatoid arthritis Symmetrical joint involvement, prolonged morning stiffness, systemic symptoms (fatigue, weight loss), seropositivity (RF, anti-CCP)

Gout/Pseudogout Sudden onset, very painful, monoarthritis; presence of urate or calcium pyrophosphate crystals in joint fluid

Meniscal tear History of trauma or twisting injury; clicking, locking, or giving way of knee

Ligament injury Instability, history of acute trauma, positive ligament stress tests (ACL, MCL, etc.)

Bursitis Localised swelling and tenderness over bursa (e.g., prepatellar)

Referred pain From hip, spine, or vascular disease.

Treatment Options:

Non-Pharmacological

Weight loss (crucial in overweight patients)

Physiotherapy & Exercise – strengthen quadriceps, improve flexibility

Activity modification – reduce high-impact activities

Bracing or orthotics – realign and unload knee compartments

Pharmacological

Topical NSAIDs – e.g., diclofenac gel (first-line)

Oral NSAIDs – e.g., ibuprofen, naproxen (consider GI and CV risks)

Paracetamol – less effective but still used

Intra-articular corticosteroid injections – short-term relief

Hyaluronic acid injections – variable evidence.

Other

Joint aspiration – if effusion causes pain

Supplements – glucosamine/chondroitin (very limited benefit)

When to Consider Knee Replacement (Arthroplasty)?

Indications:

Severe pain and disability not relieved by conservative measures

Significant impact on quality of life and daily functioning

Radiographic evidence of joint destruction

Failed response to pharmacologic and non-pharmacologic therapy.

Contraindications:

Active infection

Severe comorbidities that preclude surgery

Poor bone quality or insufficient rehab potential.

References:

National Institute for Health and Care Excellence (NICE) guidelines NG226 – Osteoarthritis in over 16s

American College of Rheumatology (ACR) guidelines

Arthritis Research UK

Dr Geranmayeh