Patient handout

Osteoarthritis (knee / hip / hand — clinical dx → management)

PRODUCTION

1. Your condition

This handout is for osteoarthritis (knee / hip / hand — clinical dx → management). Your care team identified this based on: activity-related knee pain, worse with use / better with rest (acr/af 2019; nice ng226 2022).

Other reasons your team may use this plan: groin / lateral hip pain on weight-bearing, reduced internal rotation (acr/af 2019); hand pain + bony enlargement (heberden dip / bouchard pip / 1st cmc) (acr/af 2019); morning stiffness ≤30 min and post-rest "gelling" (nice ng226 2022).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
structured patient education & self-management program	—	—	—	ACR/AF 2019 STRONG; OARSI 2019 Core treatment — improves self-efficacy and pain coping (PMID 31908163; 31278997)
structured land-based exercise (strengthening + aerobic + ROM)	—	—	—	ACR/AF 2019 STRONG; OARSI Core. Knee pain SMD −0.49 (95% CI −0.39 to −0.59) ≈ 12/100-pt; function SMD −0.52; benefit sustained 2–6 mo; magnitude comparable to NSAIDs (Fransen Cochrane 2015 PMID 25569281; hip PMID 26405113)
dietary weight loss ≥5–10% of body weight	—	—	—	ACR/AF 2019 STRONG for overweight/obese knee/hip OA. Diet+exercise (−11.4% weight) reduced pain & improved function vs exercise alone; 1 kg loss ≈ 4 kg/step less knee load (IDEA Messier JAMA 2013 PMID 24065013)
assistive devices / bracing / hand orthoses	—	—	—	ACR/AF 2019 STRONG: cane, tibiofemoral brace (medial knee OA), 1st-CMC hand orthosis; conditional patellofemoral brace (PMID 31908163)

Plan: OA core non-pharm → topical NSAID → comorbidity-gated oral NSAID → adjuncts → recommend-against → arthroplasty (ACR/AF 2019; OARSI 2019; NICE NG226 2022)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — controlled on self-management

If you have:

Pain manageable with exercise + topical NSAID PRN
Maintaining or losing weight (if overweight)
Function preserved for daily activities

Do this:

Keep doing your exercise program — it is as effective as anti-inflammatory tablets and the benefit fades if you stop (Fransen Cochrane 2015)
Continue weight management — every kilogram lost takes ~4 kg of load off the knee per step (IDEA Messier JAMA 2013)
Use topical anti-inflammatory gel as needed rather than tablets when possible (ACR/AF 2019)
Do NOT spend money on glucosamine, chondroitin, or hyaluronic acid injections — high-quality trials show no real benefit (ACR/AF 2019; GAIT)

YELLOW — Flare or rising symptoms

If you have:

Increased joint pain / swelling limiting usual activity
Needing pain medication most days
Exercise becoming difficult

Do this:

Keep moving within comfort — short-term relative rest is fine but avoid deconditioning (ACR/AF 2019)
Optimise topical NSAID; only add an oral NSAID at the lowest dose if your kidney/heart/stomach history allows (discuss first) (OARSI 2019)
Ask about a single intra-articular steroid injection for a knee flare — short-term help, not a repeated long-term plan (Jüni Cochrane 2015; McAlindon JAMA 2017)
Contact your clinician to review the plan and exclude another cause

Call your provider if:

Pain not improving within 2–4 weeks of optimised therapy
New joint swelling or a single very painful joint
Side effects from medication (stomach pain, swelling, BP rise)

RED — Possible non-OA emergency or surgical threshold

If you have:

Hot, swollen, very painful joint with fever (possible joint infection)
Joint locking / giving way / unable to bear weight
Severe constant pain that stops you sleeping or walking despite full treatment

Do this:

A hot swollen joint with fever — seek urgent medical care now (this is NOT osteoarthritis until infection is excluded)
Joint locking or sudden inability to bear weight — urgent assessment for a mechanical problem
Discuss orthopaedic referral for joint replacement if pain is life-limiting despite full conservative treatment (Skou NEJM 2015)

Call your provider if:

Always seek emergency care for fever + a hot swollen joint (ACR/AF 2019)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Acute hot swollen joint + fever / immunocompromise — septic arthritis until excluded (NOT an OA pathway) (ACR/AF 2019)(life-threatening)
Morning stiffness >60 min, symmetric MCP/wrist synovitis, elevated ESR/CRP, or positive RF/anti-CCP — re-route to inflammatory-arthritis engine (Altman 1986 PMID 3741515)
eGFR <30 (CKD-EPI 2021), established CVD/HF/uncontrolled HTN, active PUD/recent GI bleed, or concurrent anticoagulant — oral NSAID gated OFF (OARSI 2019 PMID 31278997)
Persistent life-limiting pain/function loss despite optimised core non-pharm + appropriate pharmacotherapy, with concordant KL grade — arthroplasty-referral threshold (Skou NEJM 2015 PMID 26488691)

5. Follow-up

Chronic self-management with periodic reassessment; deprescribe analgesics that lack benefit (especially opioids — ACR/AF 2019 against); maintain exercise + weight; re-refer to orthopaedics if progressive functional decline; revisit surgical timing using shared decision-making (benefit vs serious-AE trade-off — Skou NEJM 2015 PMID 26488691)

6. Sources

Guideline: 2019 ACR/Arthritis Foundation OA Guideline (Kolasinski, Arthritis Rheumatol/Arthritis Care Res 2020) + OARSI 2019 (Bannuru, Osteoarthritis Cartilage) + NICE NG226 2022 + AAOS 2021 (knee)