NICE guideline to improve care and management of osteoarthritis in adults

27 Feb 2008 05:08 PM The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care have today (27 February 2008) issued a guideline on the care and treatment of people with osteoarthritis. Osteoarthritis is the commonest 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% of people over the age of 55 have knee pain, and 10% of people in this age range will have moderate problems due to knee osteoarthritis.

These 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 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, Chief Executive, and Executive Lead for this guidance says: “People's perception of osteoarthritis is often that it is part of the normal ageing process and 'nothing can be done'. 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.”

Professor Philip Conaghan, consultant rheumatologist and Guideline Development Group chair: “By the age of 65, at least 10% of people will have some degree of disability related to painful osteoarthritic joints. In recognition of this, the guideline calls for healthcare professionals to holistically assess a person with osteoarthritis and take into account not only pain levels but how it is affecting their job, quality of sleep and family life and tailor their treatment accordingly – whether this includes strengthening exercises, advice on weight loss, appropriate footwear or appropriate pain relief. By considering the ‘whole picture’ and placing patients at the centre of their care, we know that something can be done to help everyone with osteoarthritis.”

Susan Oliver, nurse consultant in rheumatology and Guideline Development Group member: “Osteoarthritis has a massive impact on the quality of life of the individual and can prevent them from doing things they once took for granted, such as going to work, climbing the stairs, or even getting out of bed easily. This guideline is good news for people with osteoarthritis– for the first time, patients can be reassured that they will be offered core symptom-relieving therapies to help them take control of their condition. If these do not work, patients can be confident that they can return to their GP and continue to explore other treatment options, until they
find a treatment that is right for them. If patients are able to deal with pain confidently and quickly, they will be able to maintain the best possible quality of life.”

Dr John Dickson, primary care rheumatologist and Guideline Development Group member says: “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.”

Jo Cumming, patient representative and Guideline Development Group member says: “As someone who has lived with osteoarthritis for over fifteen years, I know that getting medical help and treatment is important, but so too is helping yourself. The exercise recommendations in this guideline do not mean that people with osteoarthritis are expected to join a gym and burn endless calories – instead they simply need to incorporate activities into their routine to improve joint movement, stamina and strength. For some people this may involve fitting walking into their daily routine, others may choose to ride an exercise bike whilst watching their favourite soaps. I have noticed a massive improvement in my condition since I started exercising and I would encourage others with the condition to do the same. Although there is no cure for osteoarthritis, exercise is one of the most effective ways of minimising the unpleasant stiffness, helping with the pain that arthritis can cause and in limiting its effect on your everyday life.”

Notes to Editors

1.The guidance is available at www.nice.org.uk/CG59 .

About NICE

2.The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3.NICE produces guidance in three areas of health:

•public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

•health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS

•clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.