Integrated approach may be best for knee arthritis

NEW YORK (Reuters Health) - Therapy that includes exercise, ultrasound and hyaluronan injections appears to be effective for relieving the pain and disability caused by knee osteoarthritis, according to a report by Taiwanese researchers.

Hyaluronan injected into affected joints basically provides lubrication and eases pain. Exercise and ultrasound have also been shown to be helpful. To see if an integrated approach combining a variety of methods would increase the benefits, Dr. Mao-Hsiung Huang and colleagues at Kaohsiung Medical University Hospital evaluated 140 patients with moderate osteoarthritis in both knees.

The participants were randomly assigned to receive their usual care (the control group); to receive muscular strengthening exercises alone or in combination with pulse ultrasound; or to receive both of these interventions as well as hyaluronan injections into the knee joints. Treatments sessions were conducted three times per week for 8 weeks.

All patients who received treatment showed increased muscle peak torque and significant reductions in pain and disability after treatment and after 8 weeks, the researchers report in the medical journal Arthritis and Rheumatism.

Patients in groups with two or three interventions showed significant improvements in range of motion and ambulation as well as significant gains in muscular strength.

Patients in groups with three interventions had the greatest gains in muscle strength and also showed the greatest increase in walking speed and decrease in disability.

"Osteoarthritis is not a simple wear-and-tear phenomenon," the researchers say. Therefore, they conclude, a combination strategy with multiple interventions may be necessary for successful treatment.

SOURCE: Arthritis and Rheumatism, December 15, 2005.