Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Alicia Quella PhD PA-C


Objective To compare the efficacy of other modalities and interventions versus standard first-line therapy of nonsteroidal anti-inflammatory drugs for pain management in patients with symptomatic knee osteoarthritis

Methods Perform literature reviews outlining patients suffering from Grade II or higher KOA using the Kellgren-Lawrence classification system and currently experiencing symptoms of pain, stiffness, and impaired physical functioning. Use data and results from various studies to compare improvement of symptoms from these modalities versus improvement of NSAIDs alone.

Results Weight loss and physical activity should remain the mainstay of early osteoarthritis treatment to help slow disease progression and symptoms of KOA. Duloxetine has been shown to be non-inferior to treatment with NSAIDs and improved patient physical functioning and quality of life. Oral and intra-articular corticosteroids remain superior or equal in pain reduction but have a shorter duration of action and greater adverse reactions when taken long term. Ozone therapy is best used in post-operative pain management or severe flares of osteoarthritis to quickly reduce pain and inflammation, long term therapy is not recommended over NSAIDs. Glucosamine does not decrease pain related to KOA but when used concomitantly with NSAIDs can increase physical function, quality of life, and also slow disease progression. LP-PRP injections have greater efficacy and resulted in lower WOMAC total scores at three, six, and twelve-month intervals when compared to ozone, hyaluronic acid, and corticosteroid injections. LP-PRP injections also have greater or equal efficacy of hyaluronic acid plus oral NSAIDs at one year. PRP therapy also has some evidence to suggest disease modifying potential. Hyaluronic acid injections resulted in less joint line tenderness and better physical functioning when compared to NSAID therapy alone, however, reduction in pain was not statistically significant. Prolotherapy was shown to be equally effective as PRP injections at pain reduction but requires serial injections. Benefit of prolotherapy is its safety profile and cost effectiveness. Finally, stem cell therapy resulted in lower WOMAC total scores when compared to hyaluronic acid injections. T2 MRI mapping indicates the ability of mesenchymal stem cells to regenerate cartilage and slow disease progression.


SC 11.PAS.2020.Schmitz.N

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