Management of Knee Osteoarthritis and Depression
Non-Pharmacological Interventions
- The American College of Rheumatology recommends exercise as a first-line treatment for patients with knee osteoarthritis, regardless of the presence of depression 1, 2, 3
- Aerobic, strengthening, and balance exercises should be tailored to the patient's preferences and accessibility, with walking being one of the most studied forms of exercise for knee osteoarthritis 2, 3, 4
- Self-efficacy and self-management programs are strongly recommended to improve disease understanding and develop coping strategies, combining skill-building sessions and disease education 5, 6
- Cognitive-behavioral therapy (CBT) is conditionally recommended for patients with knee osteoarthritis and depression, with benefits including improved pain, quality of life, negative mood, fatigue, and functional capacity 5, 6
- Tai Chi is strongly recommended for patients with knee osteoarthritis, combining meditation with slow movements, deep breathing, and relaxation, with a holistic impact on strength, balance, fall prevention, depression, and self-efficacy 5, 7
- Weight loss is strongly recommended for patients with knee osteoarthritis who are overweight, with a loss of ≥5% body weight associated with clinical and mechanistic changes, and enhanced by a concurrent exercise program 6
Pharmacological Interventions
- The initial approach to pain management should use medications with lower systemic exposure or toxicity, with acetaminophen (paracetamol) recommended for pain relief with minimal systemic effects 1, 8