Rheumatology International

, Volume 39, Issue 7, pp 1145–1157 | Cite as

Modifiable risk factors in knee osteoarthritis: treatment implications

  • Tsvetoslav GeorgievEmail author
  • Alexander Krasimirov Angelov


Optimal management of knee osteoarthritis (KOA) should include, where possible, modification of risk factors through targeted interventions. The objectives of the present narrative review were to identify, summarize, and cluster all the potentially modifiable risk factors that influence the course of KOA, and discuss their susceptibility to alteration via personal, clinical, and public strategy. For this purpose, Pubmed and Scopus databases were queried using the terms “knee osteoarthritis”, “risk factors” and “improvement”. Six main categories of modifiable risk factors were identified: (1) obesity and overweight, (2) comorbidity, (3) occupational factors, (4) physical activity, (5) biomechanical factors, (6) dietary exposures. In the era of age- and obesity-related diseases, the combined effects of local and systemic risk factors should be managed by combined measures. Femoral muscle-strengthening physical activities, complemented with proper diet, weight loss, vocational rehabilitation, management of comorbidities (especially diabetes and depression), and biomechanical support may add up to the holistic therapeutic approach towards the patient with KOA. An individual risk factor modification program should be developed in accordance with patient preferences and habits, workplace, medical history, and overall health condition. Due to its great impact on a wide range of functions and tissues, interventions on modifiable risk factors improve not only the symptoms of KOA but also affect the osteoarthritic joint as a whole.


Osteoarthritis Knee Risk factors Occupational diseases Rehabilitation Overweight Obesity Biomechanics Comorbidity Diet Disease management 


Author contributions

Both TG and AKA took part in the conception and design of the study, data management, analysis, and logical interpretation. TG drafted the introduction, search strategy, overweight and obesity, comorbidity, occupational factors, biomechanical factors, and conclusion sections, while AKA—physical activity and dietary exposures. Both authors revised the manuscript critically for important intellectual content and approved its final version.


No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

296_2019_4290_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinic of RheumatologyUniversity Hospital “St. Ivan Rilski”, Medical University-SofiaSofiaBulgaria
  2. 2.Diagnostic Consulting Center 2–SofiaSofiaBulgaria

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