National Institute for Health and Clinical Excellence (NICE)
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Exercise key to managing osteoarthritis
Exercise is a core treatment in managing osteoarthritis, according to updated NICE guidance on the condition.
Osteoarthritis is the most common form of arthritis, with around 1 million people seeing their GP about it every year. It accounts for 115,000 hospital admissions in the UK each year. The condition can affect people's ability to undertake daily activities, and is one of the leading causes of pain and disability worldwide.
In an update to the original 2008 guidance, NICE recommends that healthcare professionals offer advice on activity and exercise to all people with clinical osteoarthritis, as well as interventions to lose weight for those who are overweight or obese.
The guidance also includes new recommendations on diagnosing the condition, advice on joint surgery, and on follow-up and review.
Healthcare professionals should diagnose osteoarthritis clinically without investigations if a person is 45 or over and has activity-related joint pain and has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes, says NICE.
Regular reviews should be offered to all people with symptomatic osteoarthritis, which should cover monitoring the long-term course of the condition, reviewing the effectiveness and tolerability of treatments and other points. Annual reviews should be considered if the person has one or more of: other illnesses or conditions, troublesome joint pain, more than one joint affected, or are taking any drugs for their osteoarthritis.
NICE had planned to update the existing recommendations on pharmacological management of osteoarthritis. However, as the Medicines and Healthcare products Regulatory Agency (MHRA) intends to undertake a wide review on use of drug treatments including paracetamol, which would be helpful in informing the NICE guideline, NICE has decided to wait until the MHRA's work is complete before reviewing all pharmacological management for osteoarthritis.
This will mean that all of the relevant painkillers can be looked at together. Until the full pharmacological update is undertaken, the guideline recommendations on drug management for osteoarthritis remain unchanged.
Professor Mark Baker, Centre for Clinical Practice Director at NICE, said: “There's a common but mistaken belief that osteoarthritis is an inevitable part of ageing and that it will get worse, but that's not the case. This updated guidance provides evidence-based recommendations on the most effective ways of diagnosing and managing osteoarthritis, to help improve the lives of people affected by it.
"The guidance highlights that the core treatment for osteoarthritis remains exercise - this not only helps relieve pain for some people but also improves function. For people with osteoarthritis who are overweight or obese, offering advice on ways to lose weight as part of helping them self-manage their condition, is another amended original recommendation.”
Professor Philip Conaghan, Chair of the NICE Guideline Development Group, and Professor of Musculoskeletal Medicine at the University of Leeds, said: “The symptoms often caused by osteoarthritis, such as pain and limited joint movement, can be managed with muscle strengthening, exercise and weight loss if people are overweight.
“If a person is still experiencing pain that interferes with their daily life despite addressing these core treatments and use of analgesics as appropriate, then the guideline makes a new recommendation that the person be referred for consideration of joint surgery before there is prolonged limited joint movement and severe pain. The guideline is also clear that factors such as the person's age, smoking status and obesity should not affect referral for joint surgery.”