Care and Management of Osteoarthritis in Adults (NICE Guideline)

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.

• 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.