Managing osteoarthritis of the knee: Holistic approach is important

doi:10.1136/bmj.330.7492.673

BMJ 2005;330:673 (19 March), doi:10.1136/bmj.330.7492.673

Letter

Managing osteoarthritis of the knee

Holistic approach is important

The first 150 words of the full text of this article appear below.

EDITOR—The editorial by MacAuley on managing osteoarthritisof the knee provides a welcome emphasis on the EULAR recommended,holistic, multidisciplinary approach to the condition.¹

Excessive prescribing of non-steroidal anti-inflammatory drugsin primary care reflects the dependence of health professionalson "medicines based evidence" rather than evidence based medicineand the chronic underinvestment in other approaches to osteoarthritisof the knee.² No reference was made to evidence of benefit ofweight loss programmes linked to exercise; this is important,since increasing levels of obesity and incident knee osteoarthritisare strongly associated.³ Even relatively small amounts of weightloss can reduce pain and improve activity levels. At the pointat which knee replacement is appropriate, severely disabledpatients with a high body mass index may be denied surgery.

MacAuley comments that physiotherapy may delay decline. Communityphysiotherapists could have a central role in the treatmentof knee osteoarthritis, using motivating . . . [Full text of this article]

Caroline A Mitchell, general practitioner

Woodhouse Medical Centre, Sheffield S13 7LY C.Mitchell@sheffield.ac.uk

Ade Adebajo, consultant rheumatologist

Barnsley District General Hospital, Barnsley S75 2ED