Which statement best reflects initial management for osteoarthritis of the knee?

• A. NSAIDs
• B. Total knee replacement
• C. Corticosteroid injections
• D. Bed rest

Answer: (B)

Initial management of knee osteoarthritis concentrates on nonoperative strategies to reduce pain and preserve function. The first-line approach combines nonpharmacologic measures with analgesia. Regular, low-impact exercise and a program to strengthen the quadriceps help stabilize the knee and improve mobility, while weight loss if overweight decreases joint load. Physical therapy can guide technique and ensure safe, effective activity. Nonpharmacologic care sets the foundation before considering surgical options.

For symptom relief, nonsteroidal anti-inflammatory drugs are a common first pharmacologic choice, provided there are no contraindications. They can reduce pain and improve function, making daily activities easier. If NSAIDs are not suitable, acetaminophen is an alternative, or topical NSAIDs can be used for local relief with a lower systemic risk. Intra-articular corticosteroid injections may be helpful for short-term relief in patients who continue to have significant pain despite initial measures, but they are not considered initial therapy and are generally used when conservative measures aren’t sufficient. Bed rest is not recommended, as immobility can worsen stiffness and muscle weakness, and total knee replacement is reserved for advanced disease that fails conservative management.

So, the best initial management is NSAIDs as part of a broader nonoperative plan emphasizing activity modification, physical therapy, and weight management.