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Chronic knee pain

BMJ 2007; 335 doi: (Published 09 August 2007) Cite this as: BMJ 2007;335:303
  1. Christian David Mallen, Arthritis Research Campaign primary care fellow and GP,
  2. George Peat, senior lecturer in clinical epidemiology and physiotherapist,
  3. Mark Porcheret, GP research fellow and GP
  1. Primary Care Musculoskeletal Research Centre, Keele University, Keele ST5 5BG
  1. Correspondence to: C D Mallen c.d.mallen{at}

    A 57 year old self employed painter and decorator presents with a six month history of pain and stiffness in his left knee. The onset was insidious, and the pain has worsened over the past few weeks.

    What issues you should cover

    • Chronic knee pain affects one in four people aged ≥55 years. Usually symptoms are mild to moderate. Osteoarthritis—presenting as activity related pain and limitation of movement, crepitus, and intermittent swelling in the absence of constitutional symptoms—is the commonest working diagnosis. Routine blood tests are not needed in these patients. Up to 70% of people with chronic knee pain will have radiographic evidence of osteoarthritis, but radiography results are only weakly related to symptoms. Plain radiography is not recommended for routine confirmation of the clinical diagnosis of osteoarthritis.

    • Exclude “red flags” signs and symptoms that indicate immediate referral (significant trauma, evidence of severe local inflammation, sepsis). Do an initial investigation before specialist referral if …

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