Knee pain should never be considered in isolation. It must be effectively investigated and accurately diagnosed where possible, to differentiate the various forms of arthritis, identify causes of inflammation and exclude metabolic and other factors.
Surgical treatment, including arthroscopy and joint replacement, is a very effective option and should now be considered at an earlier stage before severe deformity has occurred. Non-steroidal anti-inflammatory drugs should generally be avoided except in topical form. Intra-articular steroid injection may often be used after diagnostic aspiration of the joint.
Acupuncture is very acceptable to patients but must be viewed as part of an overall treatment plan. It is effective in acute and anterior knee pain. In chronic pain it should logically be used where the diagnosis is known and where joint aspiration is not necessary, and it is the treatment of choice for advanced rheumatoid patients who are inadequately controlled on other therapy - 60% have lasting benefit. The drawback is that clinics may be overwhelmed by the demand for repeated courses of treatment, since the relief is often excellent but rarely permanent.
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