To the Editor:
We read with great interest the feasibility study done by van Tunen et al, recently published in Arthritis Care & Research. Enabling exercise therapy for osteoarthritis (OA) patients with severe pain is an important and clinically relevant issue that can increase the quality of life for these patients. Exercise therapy has been shown to be the most effective nonpharmacologic therapy for OA patients to improve function and reduce pain. The reality is that patientswith high levels of pain and severe functional limitations are often unable to perform these exercises. Therefore, we applaud this study for its combination of incremental analgesia and exercise therapy, as no multidisciplinary strategy has been previously discussed to help this subgroup of patients. The authors concluded that the combined intervention of standardized analgesics and exercise therapy allows most patients with knee OA and severe pain to participate in exercise therapy, which leads to a reduction of pain and activity limitations. However, some questions remained after reading the article.

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Journal Arthritis Care and Research
Eijkenboom, J.J.F.A, & Runhaar, J. (2017). Exploring the Results of a Pilot Study on the Combination of Exercise Therapy and Analgesics for the Treatment of Osteoarthritis Patients with Severe Pain. Arthritis Care and Research, 69(5). doi:10.1002/acr.23145