OA Guidelines

NICE has produced the following key guidelines for osteoarthritis:

  • Exercise* should be a core treatment (see recommendation 1.1.5) for people with osteoarthritis, irrespective of age, co-morbidity, pain severity or disability. Exercise should include local muscle strengthening and general aerobic fitness
  • Referral for arthroscopic lavage and debridement† should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (not gelling, ‘giving way’ or X-ray evidence of loose bodies)
  • Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatment; regular dosing may be required. Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclo-oxygenase 2 (COX-2) inhibitors or opioids
  • Healthcare professionals should consider offering topical NSAIDs for pain relief in addition to core treatment for people with knee or hand osteoarthritis. Topical NSAIDs and/or paracetamol should be considered ahead of oral NSAIDs, COX-2 inhibitors or opioids
  • When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor (other than etoricoxib 60 mg). In either case, these should be co-prescribed with a proton pump inhibitor (PPI), choosing the one with the lowest acquisition cost
  • 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 are refractory to non-surgical treatment. Referral should be made before there is prolonged and established functional limitation and severe pain.

* It has not been specified whether exercise should be provided by the NHS or whether the healthcare professional should provide advice and encouragement to the patient to obtain and carry out the intervention themselves. Exercise has been found to be beneficial but the clinician needs to make a judgement in each case on how to effectively ensure patient participation. This will depend upon the patient’s individual needs, circumstances, self-motivation and the availability of local facilities.

† This recommendation is a refinement of the indication in ‘arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis’ (NICE interventional procedure guidance 230). This guideline has reviewed the clinical and cost-effectiveness evidence, which has led to this more specific recommendation on the indication for which arthroscopic lavage and debridement is judged to be clinically and cost effective.

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