ADVANCES IN NON-SURGICAL MANAGEMENT OF GONARTHROSIS: A SYSTEMATIC REVIEW

Objectives: Knee osteoarthritis (KOA) is typically the result of wear and tear andprogressive loss of articular cartilage and may eventually lead to disability. Treatment forKOA begins with conservative methods and progresses to surgical treatmentoptions when conservative treatment fails. This systematic review aims to highlight the latestadvancements in non-surgical interventions to improve the management of this commonmusculoskeletal disorder.

Methods: A comprehensive search of sources available in both English and Frenchencompassing various databases such as PubMed, Google Scholar, and relevant medicaljournals in addition to recommendations provided by prominent organizations(EULAR, ACR, SFR, SOFMER, OARSI, ESCEO, NICE, PANLAR, AAOS). Inclusion criteria were good quality systematic reviews, meta-analyses, practice guidelinesexcludingsurgicalKOA treatment.

Results:We thoroughly examined a large set of 545 articles and meticulously selected 117 for detailed analysis. This carefully selected set comprised randomized controlled trials, consensus statements, international guidelines, systematic reviews, meta-analyses, cohort studies, and reviews. Qualitative synthesis revealed widely approved nonpharmacological therapies such as information/education programs, weight loss, and physicalactivity. Most agreed on pharmacological therapies were oral and local NSAIDs, Paracetamol, and intra articular corticosteroid injection. Other treatment options were subject to controversy.

Conclusion:Various options are available for the treatment of KOA. However, KOA remains a commonglobal health challenge, affecting millions and compromising the quality of life through pain, functional limitations, and associated morbidities. A comprehensive and personalized approach seems crucial in order to reduce pain, improve knee function over the long term.

研究目的：膝骨关节炎（Knee osteoarthritis, KOA）多由关节磨损及退行性关节软骨丢失引发，最终可导致患者残疾。该病的治疗通常先采用保守治疗方案，若保守治疗无效则逐步过渡至手术治疗。本系统综述旨在梳理当前非手术干预手段的最新进展，以优化这一常见肌肉骨骼疾病的临床管理策略。
研究方法：本研究对英文及法文文献开展全面检索，涵盖PubMed、Google Scholar等多个数据库及相关医学期刊，同时纳入欧洲抗风湿病联盟（EULAR）、美国风湿病学会（ACR）、法国风湿病学会（SFR）、法国骨科学会（SOFMER）、国际骨关节炎研究协会（OARSI）、欧洲老年医学与老年病学会（ESCEO）、英国国家卫生与临床优化研究所（NICE）、泛拉丁美洲风湿病联盟（PANLAR）、美国骨科医师学会（AAOS）等权威机构发布的相关指南。纳入标准为高质量系统综述、荟萃分析及临床实践指南，且需排除涉及膝骨关节炎手术治疗的相关文献。
研究结果：本研究共检索筛选得到545篇文献，最终经严格遴选纳入117篇进行详细分析，纳入文献类型包括随机对照试验、共识声明、国际指南、系统综述、荟萃分析、队列研究及综述类文章。定性综合分析结果显示，临床广泛认可的非药物治疗手段包括健康宣教项目、体重管理及运动疗法；多数共识推荐的药物治疗方案包括口服与局部外用非甾体抗炎药（Non-Steroidal Anti-Inflammatory Drugs, NSAIDs）、对乙酰氨基酚以及关节腔内糖皮质激素注射；其余治疗手段则存在较大争议。
研究结论：目前膝骨关节炎的治疗手段多样，但该病仍是全球性常见健康难题，影响全球数百万人群的生活质量，可引发疼痛、功能障碍及相关并发症。临床需采用综合化、个体化的治疗方案，以长期缓解疼痛、改善膝关节功能。