Synopsis
Identify clinically typical knee osteoarthritis, separate inflammatory, infective, mechanical and referred alternatives, build core exercise and weight treatment around the person's function, prescribe safely, and escalate appropriately to replacement assessment.
- Use NICE's clinical pattern: age at least 45, activity-related joint pain and no or no more than 30 minutes of morning stiffness; do not routinely image a typical presentation.
- Assess gait, alignment, effusion, extension and flexion, joint lines, patellofemoral tracking, quadriceps strength, ligament stability and hip and neurovascular sources.
- Therapeutic exercise and supported weight management are core treatment; discomfort can initially increase, but regular progressive strengthening and aerobic work improve pain and function.
Key red flags
A hot swollen knee with systemic illness or severe passive-movement pain requires urgent aspiration and septic-arthritis treatment sequencing.
Investigation priorities
Recognise a typical syndrome and establish functional baseline.
Management branches
The clinical pattern is typical and no urgent competing diagnosis is present.
- Agree meaningful goals and prescribe progressive knee and hip strengthening, aerobic activity and range work.
- Offer sustained weight support when relevant and address walking aids, pacing and participation barriers.
Key medicines
Topical NSAIDOffer a licensed topical NSAID preparation for the painful knee at the product's adult frequency, typically applied three or four times daily depending on formulation, for a time-limited trial with review of function and skin tolerance.
Oral NSAID plus proton-pump inhibitorIf topical treatment is ineffective or unsuitable, use one oral NSAID at the lowest effective licensed dose for the shortest period and co-prescribe gastroprotection such as omeprazole 20 mg orally once daily while the NSAID continues when appropriate.