MEDizzy - A 53-year-old man presents to your clinic complaining of

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A 53-year-old man presents to your clinic complaining of bilateral knee pain. He states that the pain worsens with walking and is not present at rest. He has been experiencing knee pain intermittently for many months and has had no relief from over-the-counter analgesics. He has a history of hypertension and obesity. When he was in high school and college, he played football and basketball. Which of the following represents the best initial treatment strategy for this patient?

ExplanationThis patient presents with symptoms suggestive of OA. OA is primarily a disease that is mechanically driven, and nonpharmacologic therapy should be a first-line treatment for disease that is mild or intermittent. Avoiding activities that cause pain and overload the joint, strengthening and conditioning the adjacent muscle groups, and supporting or unloading the joint with a brace or crutch are all examples of fundamental treatments aimed at reversing the pathophysiology of OA. In this patient, weight loss should be the primary goal of therapy. Each pound of weight increases loading across a weight-bearing joint three- to six-fold. This patient would benefit from a daily minimal-weight-bearing exercise regimen combined with nutritional goals aimed at slow, consistent weight loss. Avoidance of walking is impractical; a cane or supportive device to lessen the joint load can be offered. Steroids and narcotics are not indicated in this case