The care and management of osteoarthritis in adults
Assess effect of osteoarthritis (OA) on patient's:
- Quality of life
- Leisure activities
|In partnership with the patient, formulate and regularly review a management plan that includes core symptom-relieving treatment, adjunctive treatment and self-management.
Core symptom-relieving treatment
Offer verbal and written advice on:
- OA and its management, to enhance understanding
- Need for exercise to strengthen local muscle and improve aerobic fitness (irrespective of age, comorbidities and severity of OA)
- Interventions to aid weight loss (if overweight)
- Appropriate footwear in lower limb OA
Consider the following pharmacological options:
- Paracetamol (given regularly if needed)
- Topical NSAIDs for knee or hand OA
- Topical capsaicin for knee or hand OA
- Intra-articular corticosteroid injections for moderate to severe pain
If paracetamol and/or topical NSAIDs are ineffective, consider:
- Adding opioid
- Prescribing oral NSAID or COX-2 inhibitor in addition to paracetamol or instead of topical NSAID:
- Co-prescribe with a proton pump inhibitor
- Use lowest effective dose for shortest possible duration
- Choose agent and dose on basis of risk factors for GI, liver and cardiorenal toxicity; monitor for any such effects
- If patient is already taking low-dose aspirin for another condition, consider an alternative analgesic
- Do not prescribe etoricoxib 60mg as first-line treatment
Consider the following non-pharmacological options:
- Heat and cold packs
- Transcutaneous electrical nerve stimulation (TENS)
- Manipulation and stretching (particularly for hip OA)
- Assessment for bracing, joint supports or insoles (for biomechanical joint pain or instability)
- Assistive devices (eg, walking sticks, tap turners) to address specific problems. Seek expert advice if needed.
- Weight loss (if overweight)
- Suitable footwear
- Heat and cold packs
|Referral for surgery
- Consider referral to joint surgery if symptoms continue to substantially affect quality of life despite medical treatment. Refer before there is prolonged and established functional limitation and severe pain.
- Consider referral for arthroscopic lavage and debridement only in patients with knee OA and clear history of mechnical locking in the knee.
- Do not use scoring tools for prioritisation or refuse referral on grounds of age, gender, smoking, obesity, etc.
|Treatments not recommended
- Intra-articular hyaluronan injections
- Chondroitin or glucosamine
Adapted from: NICE Clinical Guideline 177 (February 2014) - The care and management of osteoarthritis in adults.