The care and management of osteoarthritis in adults

At-a-glance summary of NICE advice on assessment, management and referral of OA. Adapted from: NICE Clinical Guideline 59 (February 2008) - The care and management of osteoarthritis in adults.

The care and management of osteoarthritis in adults
Holistic assessment
Assess effect of osteoarthritis (OA) on patient's: Function Quality of life Occupation Mood Relationships Leisure activities
Management
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
Adjunctive treatment 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.
Self-management Exercise Weight loss (if overweight) Suitable footwear Heat and cold packs TENS
Referral for surgery
Consider referral to joint surgery if symptoms continue to substantially affect quality of life despite medical treatment. Refer before there is 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.