Arthritis Research UK welcomes new NICE guidelines to improve care and management of osteoarthritis

Published on 01 April 2008

The Arthritis Research UK has welcomed new NICE guidelines on the care and treatment of osteoarthritis and called on GPs and other health care professionals to make sure they are implemented across the UK.

Chief executive Fergus Logan said: “These new national standards will, we hope, mean that people with the most common form of arthritis can expect the same uniformly high level of treatment from their GPs and other health professionals.

“For too long patients have been told that nothing can be done about their condition, and that they just have to learn to live with it. But NICE has now made official what we have been telling people for many years – that exercise and weight loss play a major part in treating osteoarthritis effectively. We hope that healthcare professionals now implement these guidelines.”

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care issued the guidelines on the care and treatment of people with osteoarthritis on February 27.

The new national standards outline core lifestyle changes that should be encouraged to help ease pain and symptoms as well as effective pharmaceutical treatments. The guidelines also call for healthcare professionals to provide verbal and written information to all people with osteoarthritis to enhance understanding of the condition and its management and to counter misconceptions, such as that it cannot be treated. Key recommendations from the guideline include:

  • Exercise should be a core treatment for people with osteoarthritis, irrespective of age, other illnesses or conditions, pain or disability. Exercise should include local muscle strengthening, and general aerobic fitness.
  • People with osteoarthritis should be supported to lose weight if they are overweight or obese.
  • Healthcare professionals should consider offering topical non-steroidal anti-infrlammatory drugs (NSAIDs) for pain relief in addition to core treatment to people with knee or hand osteoarthritis. Topical NSAIDs and/or paracetamol should be considered ahead of oral NSAIDs, COX-2 inhibitors or opioids.
  • Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatment. When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor. In either case, these should be co-prescribed with a proton pump inhibitor (PPI).
  • Referral for joint replacement surgery should be considered for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and do not respond to non-surgical treatment. Referral should be made before there is prolonged and established functional limitation and severe pain.

Andrew Dillon, NICE chief executive, and executive lead for the guidance said: “People's perception of osteoarthritis is often that it is part of the normal ageing process. This is the first national guideline to provide evidence-based recommendations on how the lives of people with osteoarthritis can be improved, whether their symptoms are mild or severe. Up until now, treatment for the condition may have varied but now for the first time, clear advice is provided to the NHS and individuals, no matter where they live in England and Wales.”

Osteoarthritis is the most common type of arthritis, causing major problems with joint pain, loss of performing daily activities and poor quality of life. One or more joints may be involved, especially knees, hips and hands. It is increasingly common with age: 25 per cent of people over the age of 55 have knee pain, and 10 per cent of people in this age range will have moderate problems due to knee osteoarthritis.

Dr John Dickson, primary care rheumatologist and Guideline Development Group member added: “People need to be informed about the benefits and risks of lifestyle changes, drugs and treatments so that they can make informed decisions with their healthcare professionals about what is right for them as an individual. The best available evidence tells us that even simple lifestyle changes can have a positive impact on the symptoms of osteoarthritis. For example, making exercise part of an every day routine, even if this is low impact, and losing weight if necessary. There are a number of effective pharmaceutical treatments available for osteoarthritis including paracetamol and oral NSAIDs, which should now be prescribed with a proton pump inhibitor to limit unwanted side-effects.”

Read the NICE guidelines in osteoarthritis.

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