1. Background and Purpose
Osteoarthritis (OA) is a non-inflammatory joint disease that occurs frequently in middle or old age, dose mainly in the articular cartilage of the hip and knee joints which are subject to weight load. The prevalence of OA is reported about 50% of patients over 60 years old and about 70% in people over 65 years old. It is the eighth leading cause of disability worldwide. Among them, Knee Osteoarthritis (KOA) is radiologically present in 33% of people over 60 years of age, which is more likely to cause disability than other chronic diseases. the number of patients visit medical institutions is increasing every year in Health Insurance Review & Assessment Service (HIRA) statistics.
Consequently, this study aims to create a Korean medicine clinical practice guideline (CPG) regarding KOA that is suitable for the medical condition of Korea. We created this CPG by analyzing materials with evidence-based methods such as the systematic literature review methodology. The CPG also includes opinions from experts in Korea. We develop this CPG based on ‘Acupunctural Clinical Guideline for Knee Pain’ Korean Acupuncture & Moxibustion Medicine Society made in 2013. It provides general information about the diagnosis, examination, prognosis, prevention and management, and treatment of diseases to korean medicine doctor who treat patients with KOA. It is intended to present guidance on effective treatment direction that can improve patient’s symptoms and quality of life at various clinical status.
2. Overview of disease
OA is a non-inflammatory disease characterized by degenerative changes in the articular cartilage and excess bone formation in the joints. KOA occurs usually in the knee joints where is weight-bearing, resulting in sti ness, sound, pain, and dysfunction such as limitation in fully exetension or standing.
KOA shows a high rate in korean medical market, ranking 4th (inpatient) and 12th (outpatient) of the medical care expenditure in the multi-occurrence diseases ranking of korean medicine outpatient department among the 2018 HIRA statistical indicators. According to the 2017 survey on the use of korean medical care conducted by the Ministry of Health and Welfare, arthritis and arthropathy were main diseases show the second highest rate, 38.4%, in using outpatient medical care. And the ratio tended to increase as age is growing older. So, the prevalence of KOA is a high frequency disease in the elderly is expected to increase gradually in an aging society. It is a major cause of severe pain and limited activity in patients, and has a very serious effect on daily life and quality of life. Socially, this is a major cause of lost productivity.
In most KOA patient, the application of korean medicine or western medicine are considered because intermittent pain or limitation of joint movement affects quality of life despite maintaining daily life. the use of medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs), selective COX-2 inhibitors (Cyclo-oxygenase 2 specific inhibitors) and opioids may help relief of symptoms in KOA as a chronic disease.
However, repetitive administration has a risk of side effects such as upper gastrointestinal complications, so care must be taken in the prescription. therefore, it is necessary to investigate korean medicine treatments because they has a high preference as a conservative and alternative treatment.
