Knee Osteoarthritis: Symptoms, Diagnosis And Treatment

WEDNESDAY, Nov. 4, 2026 (HealthDay News) — Knee osteoarthritis (OA) is the most common type of arthritis, affecting about 528 million adults worldwide. 

It is more than “old age” or “wear and tear.” OA affects the entire joint, not just the cartilage and bone, and includes the soft tissue structures around the knee (ligaments and tendons), and the muscles around the knee. 

In my work as a rheumatologist, patients often ask me about how to manage their knee arthritis. It’s an important question because this is the most common type of arthritis in adults worldwide, and here’s what I tell them based on my clinical experience and the latest medical evidence. 

Symptoms And Diagnosis 

Symptoms start with pain or discomfort with activities, like climbing the stairs. Over time, the pain can become more constant with episodes of more intense pain, described as “flares.”  

Pain, interference with activities and limitations in physical function are common reasons for people to seek medical care. 

The diagnosis of knee OA can be made by a primary care provider, though they may also refer to specialists in sports medicine, rheumatology and orthopedic surgery. For patients who see a rheumatologist, the discussion may include the need for additional testing for conditions other than OA. 

Some people confuse rheumatoid arthritis (RA) with OA. The main difference is that RA belongs to a group of conditions in which a dysfunctional immune system is the main driver of pain and swelling in the joints. These types of inflammatory arthritis often need to be treated with medicines that directly target those parts of the immune system that aren't working normally. 

Imaging like X-rays and MRIs may be done to help with the diagnosis, but they are not needed to make it. Some people may have been told they have “bone-on-bone” disease based on what is seen on the knee X-ray, meaning that the cartilage has worn away within the joint. But what the X-ray shows does not translate directly to the same severity of symptoms for everyone. Some people can have X-rays that look “bone on bone” but live without having a lot of knee pain and or limitations on their daily life. 

Treatment – General Overview

No medication cures OA, and there is no one-size-fits-all treatment approach. When patients see a rheumatologist for knee OA, the conversation may start with education about the disease and the different treatment options. Your physician will go over what you've tried, whether those things helped and what else could be tried. Treatment is often comprehensive, using more than one treatment at a time, while understanding what is important to each patient and working to set goals.

Physical activity and exercise are important cornerstones of maintaining function and mobility. The recommended 150 minutes a week of moderate intensity exercise applies to all adults, though this goal is difficult to meet for some people who have OA. 

A good recommendation is starting slowly and working your way up. Walking is very important. You don’t have to start in the gym or with very intense exercise. Start with what you can do. Monitoring your progress may help — with digital health apps or devices to track your steps. 

Most people with knee OA would benefit from a referral to physical therapy (PT) at least once. A physical therapist can work with you directly on different types of exercise. This should include strength training (to strengthen weak muscles, which can make knee pain worse); aerobic exercise (to improve heart and lung health, which can also improve general health); range of motion/flexibility exercises; and balance exercises. 

Biomechanical aids, like taping, bracing and canes can be offered and discussed with your PT therapist. These all help address joint loading, or how stresses act on the knee joint. 

For those who are overweight or obese, weight loss is recommended to reduce the mechanical load on the knee joint. Excess body weight is a known risk factor for developing knee OA. Newer clinical trial data suggest added benefits on knee pain and function with weight loss medications like semaglutide. However, the long-term benefits versus safety of these medications is not known. 

Treatment – Non-Surgical 

Current clinical guidelines strongly recommend using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Many people will not be able to use NSAIDs either due to side effects like gastritis, or other medical conditions like heart or kidney disease. If this is the case, a topical NSAID (diclofenac) can be rubbed on the skin up to four times a day, as needed. Little of it is absorbed into the rest of the body, which makes it safer than taking an NSAID by mouth. 

Other topicals can be tried, including lidocaine (a numbing medicine), capsaicin (which comes from hot chili peppers) and patches. With capsaicin, avoid rubbing your face or eyes after use. 

Guidelines also recommend steroid injections into the joint (commonly called cortisone shots), if NSAIDs and other options do not help pain enough. These can be done in the office, though not all primary care providers do them. There is a risk of pain, bleeding and infection, which are minimized during the procedure. Some studies have suggested a more rapid deterioration of the cartilage with these types of injections, but the amount of cartilage that is worn away does not appear to be clinically meaningful. At this time, with the current evidence, giving these injections as often as every three months, or less frequently, is still considered safe. 

An antidepressant that is commonly used for chronic pain conditions, duloxetine, may be tried in some people with persistent pain. A careful review of other medications is done to ensure there is no interaction. 

Treatment – Surgical 

Seeing an orthopedic surgeon to discuss knee replacement may be recommended if the options above have been discussed and tried, and there is still persistent knee pain that negatively impacts quality of life. The main consideration for patients will be whether they are interested in surgery and whether they have the support needed to engage in physical therapy afterwards. 

Some patients have had MRIs that show tears or other damage to the meniscus in the knee. This is often seen in conjunction with other findings of knee OA. Surgically treating the meniscus is not additionally helpful — a large clinical trial in The New England Journal of Medicine showed that one type of surgery, arthroscopic partial meniscectomy (APM), performed no better than PT with long-term outcomes. APM is not recommended for people with knee OA. 

Other Treatment Options  

Patients often ask about other options besides surgery and the treatments discussed above. 

Mind-body modalities, which work to relax the body and mind, can complement physical and medication options described above. These include yoga, tai chi (which helps with balance), massage, acupuncture and cognitive behavioral therapy with a therapist. However, cost, access and insurance coverage may limit what is available. 

Radiofrequency ablation can be offered to some patients when other treatments have not provided enough benefit and where surgery is not a desired option. An interventionalist, such as a pain management specialist, can use hot or cold to ablate (cut off) the nerves responsible for sensing pain in the knee. 

Guidelines warn against several once-popular treatments because clinical trials showed they work no better than a dummy pill (placebo). These include injections of hyaluronic acid, glucosamine and chondroitin; anti-inflammatory medications used in conditions like RA; and vitamin D and fish oil supplements. 

Clinical guidelines also recommend against other treatments such as platelet-rich plasma and stem cell therapy,  because there is not enough data available to recommend a standard dose of this treatment. 

Patients may ask about other vitamins and supplements, and about diet. Turmeric is a natural remedy recommended in some OA clinical guidelines because of its anti-inflammatory properties. The best dose is still unclear. 

In terms of diet, because people with OA may often have other health conditions as well, trying a “heart healthy diet” can be helpful. A Mediterranean diet is one option that has been studied for people with, or at risk for, heart disease. Some studies show that a diet low in high-fiber foods is associated with worse knee pain and knee OA outcomes. Increasing high-fiber foods in your diet may be helpful for both your knee pain, as well as for the benefits of other chronic conditions like cardiovascular disease. 

These options are typically safe to try, though if there is no benefit after several months, it may not be worth it in terms of cost and time to keep going. 

More information

UCLA Health has more on knee osteoarthritis.

About the expert

Dr. Jean Liew earned her MD from the University of Texas Medical Branch. She completed her internal medicine residency at Oregon Health & Science University and her rheumatology fellowship at the University of Washington, where she also received an MS in epidemiology. She is currently an assistant professor of medicine in the Section of Rheumatology at Boston University Chobanian & Avedisian School of Medicine, with clinical research interests spanning knee osteoarthritis and axial spondyloarthritis.