Exercise is a core treatment in managing osteoarthritis, says updated NICE guidance on the condition, published this last week. The clinical guideline on the care and management of osteoarthritis in adults reviews and updates a range of recommendations from the original 2008 guidance. It also includes new recommendations on diagnosing the condition, advice on joint surgery, and on follow-up and review.
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.
Professor Mark Baker, Centre for Clinical Practice Director at NICE, said: "The guidance highlights that the core treatment for osteoarthritis remains exercise - this not only helps relieve pain for some people but also improves function."
- 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 [new recommendation]
- Offer advice on these core treatments to all people with clinical osteoarthritis: access to appropriate information, activity and exercise, interventions to lose weight if the person is overweight or obese [updated]
- Consider offering paracetamol for pain relief in addition to core treatments. Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclo-oxygenase (COX-2) inhibitors or opioids [unchanged]
- Refer for consideration of joint replacement surgery before there is prolonged and established functional limitation and severe pain, and patient-specific factors (including age, sex, smoking, obesity) should not be barriers to referral for joint surgery [updated]
- Offer regular reviews 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 [new].