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Knee osteoarthritis — SCE Rheumatology MCQ

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ModerateOsteoarthritis and soft tissue rheumatologyKnee osteoarthritisSCE Rheumatology

A 69-year-old man has activity-related knee pain and brief morning stiffness consistent with knee osteoarthritis. His BMI is 33 kg/m², and examination shows varus alignment without features suggesting an alternative diagnosis. He has not previously received structured non-surgical treatment. Which intervention should form the core of his initial management?

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Correct answer: B — Offer tailored therapeutic exercise with weight-management support

The correct answer is B. NICE defines tailored therapeutic exercise and, when appropriate, weight management as core osteoarthritis treatments. His BMI of 33 kg/m² makes supported weight loss particularly relevant; any weight loss is likely to help, with greater benefit generally achieved at 10% than at 5%. A topical NSAID may be added for knee pain but should support rather than replace non-pharmacological management. Intra-articular corticosteroid provides only short-term relief and is considered when other pharmacological treatments are ineffective or unsuitable, or to facilitate exercise. Bracing is not routinely offered solely because of varus alignment and generally requires ineffective or unsuitable exercise plus a likely functional benefit. Arthroplasty referral is appropriate only when substantial symptoms persist despite, or cannot be managed with, non-surgical treatment.

Reference: National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226), recommendations 1.2.2, 1.3.1, 1.3.5, 1.3.11 and 1.6.1. 2022. https://www.nice.org.uk/guidance/ng226/chapter/Recommendations