Modern methods of non-drug treatment of osteoarthritis of the knee joint. Review of updated national clinical guidelines «Gonarthrosis 2024»

Objective. To present an analysis of the updated national clinical guidelines «Gonarthrosis (GA) 2024» with an emphasis on non-drug treatment methods.

Results. The following have a high level of persuasiveness of recommendations and reliability of evidence for the effectiveness of non-drug therapy for GA: modification of sports/physical loads and unloading of the affected joint, application of methods of therapeutic physical training, aerobic exercises, weight correction, methods of knee joint orthosis, physiotherapeutic effects and manual therapy. New in the recommendations was the reliability of the effectiveness of shock wave therapy and the lack of such in acupuncture in the treatment of GA.

Conclusions. Currently, the effectiveness of non-drug treatments for GA has a high evidence base combination with drug therapy. An important advantage of non-drug treatments for GA is their ability to reduce the need for analgesics, which can cause dangerous complications in patients with GA and comorbid conditions.

1. Zhugrova E. S., Belyaeva I. B., Samigullina R. R. Insights in osteoarthritis from the perspectives of evidence-based medicine and authors' own experience. Russian Medical Inquiry. 2023; 7 (3): 167–173. (In Russ.).

2. Belyayeva I. B., Mazurov V. I., Zhugrova e.s. New aspects of the management strategy for patients with osteoarthritis and high cardiovascular risk. Effective Pharmacotherapy. 2024; 20 (25); 36–42. (In Russ.).

3. Bruyere O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, Pelletier JP, Rannou F, Rizzoli R, Roth R, Uebelhart D, Cooper C, Reginster JY. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019 Apr 30.

4. Belyayeva I. B., Mazurov V. I., Itskovitch I. E., Burulev A. L. NEW Strategies for the medical rehabilitation of patients with osteoarthritis of the knee, based on the principles of immunological tolerance. Effective Pharmacotherapy. 2024; 20 (10): 18–24. (In Russ.).

5. Clinical guidelines. Association of Traumatologists and Orthopedists of Russia, Association of Rheumatologists of Russia, All-Russian public organization Association of Rehabilitation Specialists of Russia. Gonarthrosis, 2024 (approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation). (In Russ.).

6. Mazurov V. I., Belyayeva I. B., Trofimov E. A., Zhugrova E. S. Modern strategies of ostheoartritis effective therapy in comorbid patients. Effective Pharmacotherapy. 2024; 20 (10): 26–32. (In Russ.).

7. Madry H., Kon E., Condello V., Peretti G. M., Steinwachs M., Seil R., Berruto M., Engebretsen L., Filardo G., Angele P. (2016) Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 24: 1753–1762.

8. Felson D. T., Hodgson R. Identifying and treating pre-clinical and early osteoarthritis. Rheum Dis Clin N Am. 2014; 40 (4): 699–710.

9. Coleman S., Briffa N. K., Carroll G., Inderjeeth C., Cook N., McQuade J. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Res Ther 2012; 14 (1): R 21. PM: 22284848.

10. Trofimova A. S., Ulanova V. I., Belyaeva I. B. Analysis of therapeutic interventions in osteoarthritis: structure-modifying and analgesic aspects. Polyclinic. 2023; 3–2: 10–15. (In Russ.).

11. Belyaeva I. B., Mazurov V. I., Raimuev K. V. Current esceo recommendations for the treatment of knee osteoarthritis. Effective Pharmacotherapy. 2018; 4: 36–41. (In Russ.).

12. Coleman S., Briffa N. K., Carroll G., Inderjeeth C., Cook N., McQuade J. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Res Ther. 2012; 14 (1): R21. PM: 22284848.

13. Jan M. H., Lin C. H., Lin Y. F., Lin J. J., Lin D. H. Effects of weight-bearing versus non-weight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil. 2009; 90 (6): 897–904.

14. Lee R., Kean W. F. Obesity and knee osteoarthritis. Inflammopharmacology. 2012; 20 (2): 53–58. PM: 22237485.

15. Brouwer R. W., van Raaij T. M., Verhaar J. A., Coene L. N., Bierma-Zeinstra SM. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage 2006; 14 (8): 777–783. PM: 16563810.

16. Stausholm MB, Naterstad IF, Joensen J. et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open. 2019; 9(10): e031142. Published 2019 Oct 28. DOI: 10.1136/bmjopen-2019–031142

17. Atamaz F. C., Durmaz B., Baydar M. et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil. 2012; 93 (5): 748–756. PM: 22459699.

18. Ponomarenko G. N. Physiotherapy National Guide – 2009. P. 171–172. (In Russ.).

19. Guillot X. et al. Cryotherapy decreases synovial Doppler activity and pain in knee arthritis: A randomized-controlled trial. Joint Bone Spine. 2017; 84 (4): 477–483.

20. Liu Y, Wu C, Chen C et al. Impact of soft tissue around the knee on the efficacy of extracorporeal shockwave therapy in knee osteoarthritis. Medicine (Baltimore). 2022 Dec 16; 101 (50): e32334.

21. Tsokanos A. et al. The Efficacy of Manual Therapy in Patients with Knee Osteoarthritis: A Systematic Review. Medicina (Kaunas). 2021 Jul 7; 57 (7): 696.

22. Perlman A. I., Sabina A., Williams A. L., Njike V. Y., Katz D. L. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med. 2006; 166 (22): 2533–2538. PM: 17159021.

23. Xu Q, Chen B, Wang Y. et al. The effectiveness of manual therapy for relieving pain, stiffness, and dysfunction in knee osteoarthritis: A systematic review and meta-analysis. Pain Physician. 2017 May; 20 (4): 229–43.

24. Williamson L., Wyatt M. R., Yein K., Melton J. T. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford). 2007; 46 (9): 1445–1449.

25. Wu Q, Zhao J, Guo W. Efficacy of massage therapy in improving outcomes in knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Clin Pract. 2022 Feb; 46: 101522.

26. Mokhov A. D., Belyaeva I. B., Mokhov D. E., Gavrilova T. A. Manual medical technologies in complex treatment and rehabilitation of patients with primary osteoarthritis (literature review). Russian Osteopathic Journal. 2024; 4 (67): 102–115. (In Russ.).