Diagnosis

• 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 < 30 minutes
• Trauma, hot swollen joint, prolonged morning joint stiffness indicate other diagnosis
• Assess the effect of OA on the person’s function, QoL, occupation, mood, relationships and leisure
• Agree a plan with the person (family, carers as appropriate) for managing their osteoarthritis

Investigation

• n/a

Management

Conservative:

• Education: accurate information to enhance understanding of the condition and its management, and to counter misconceptions, such as that it inevitably progresses and cannot be treated
• Self-care: agree individualised self-management strategies
• Core Therapy:
• Exercise, irrespective of age, comorbidity, pain severity or disability and should include:
  • Local muscle strengthening and
  • General aerobic fitness
• Weight loss: offer interventions to achieve loss (weight multiplies load)
• Adjuncts:
• Thermotherapy: use of local heat or cold should be considered as an adjunct to core treatments
• Electrotherapy: consider the use of transcutaneous electrical nerve stimulation (TENS) as adjunct
• Aids and devices: offer advice on appropriate footwear and bracing for joint instability
• Do Not offer:
  • Nutraceuticals: Do not offer glucosamine or chondroitin for management of OA
  • Acupuncture: Do not offer acupuncture for the management of OA

Pharmacological Therapy:

• NICE not completed review
• Paracetamol regularly for pain relief in addition to core treatments
• NSAID (topical) for pain relief in addition to core treatments with knee or hand osteoarthritis
• NSAID/COX-2 inhibitor if non selective NSAID/Paracet ineffective, lowest dose shortest duration
• NSAID/COX-2 inhibitor: varying gastrointestinal, liver and cardio-renal toxicity
• Intra-articular corticosteroid injections as adjunct to core treatments for moderate to severe pain

Surgical Joint:

• Should be offered core therapies, and discuss risk benefit of surgery
• Referral threshold base on joint discussion between patient, referrer and surgeon
• Refer for joint symptoms (pain, stiffness and reduced function) that have a substantial impact on QoL and refractory to non-surgical treatment, age, sex obesioty are not barriers
• Do not refer for arthroscopic lavage and debridement as treatment unless knee OA with clear history of mechanical locking
• Follow up and review

NICE Source: CG177 Osteoarthritis: care and management. Summary compiled by Dr D P Sheppard MBBS.