Scope and Target Population:
This guideline is intended for use with established patients who complain of a painful knee that may be due to degenerative joint disease/osteoarthritis. An established patient is one who has been seen at his or her primary clinic or medical group at least once. This guideline includes criteria for referral to a rheumatologist or orthopedic specialist.

Clinical Highlights and Recommendations:

• Schedule a same-day appointment if a patient reports the following: hot, swollen joint with or without fever and/or feeling ill, cannot bear weight on leg, leg or foot is cool or blue, deformity, severe pain, locked knee, and/or patient demands to be seen the same day.
  
• For patients who are not scheduled for a same-day visit, provide advice on basic techniques to reduce pain and inflammation in the knee. These include rest, ice, compression, elevation, and the use of appropriate over-the-counter analgesics.
  
• When a patient is diagnosed with degenerative joint disease of the knee, avoid obtaining an x-ray on the first visit unless specifically indicated.
  
• Educate the patient regarding overall goals of treatment. These include education regarding the disease and self-management, pain reduction, exercise that promotes joint health, and improvement in patient functioning and safety. Consider referral to physical therapy.

Priority Aims:

1. Improve the efficacy of diagnostic imaging for evaluating degenerative joint disease.
   
2. Increase the use of recommended conservative approach as first-line treatment for degenerative joint disease.
   
3. Increase patient education for patients with degenerative joint disease.

Additional Background:
DJD is a heterogenous class of joint disorders characterized by degeneration and loss of cartilage, alteration of subchondral bone, and associated soft tissue changes that may be due to a variety of causes. These changes, which are the result of cartilage injury exceeding the rate of cartilage repair, occur gradually over time. Clinical criteria for the definitive diagnosis of degenerative joint disease of the knee are based on history, physical examination, and roentgenologic findings that may occur late after the onset of pathologic findings. Degenerative joint disease, for the purposes of this guideline, includes patients in whom cartilage injury may exceed the rate of repair, resulting in the potential for progressive joint destruction.