The National Institute for Health and Care Excellence (NICE) has opened a public consultation on the update of its clinical guideline on the care and management of osteoarthritis in adults.

Osteoarthritis is the most common form of arthritis, with around 1 million people seeing their GP about it every year. The condition affects the joints, most commonly the knees, hips, spine and small joints of the hands, but it can also occur in other joints. The main characteristics of osteoarthritis are loss of, or damage to, cartilage; inflammation of the tissues around the joint; and tiny spurs of bone growing around the edge of the joint. The condition can affect people’s ability to undertake daily activities, and is one of the leading causes of pain and disability worldwide.
Professor Mark Baker, Centre for Clinical Practice Director at NICE, said: “Osteoarthritis is a common condition with associated pain, joint stiffness and reduced quality of life. In 2008 NICE published the first national guideline to provide evidence-based recommendations on the most effective ways of diagnosing and managing osteoarthritis, to help improve the lives of people affected by it. Since the original guideline was issued new information has become available, so the guideline is being updated. New draft recommendations have been made on the diagnosis of the condition, including diagnosing osteoarthritis clinically without the need for investigation in people aged 45 and over with specific symptoms. 

“There are also some new draft recommendations on the use of some treatments used in managing osteoarthritis. This includes a draft recommendation that glucosamine and chondroitin products shouldn’t be offered to manage osteoarthritis as the evidence on their clinical effectiveness is very limited and u certain. Based on a new consideration of the evidence, another draft recommendation is that paracetamol shouldn’t routinely be offered as it may not be helpful in relieving the symptoms of osteoarthritis, and taking the maximum daily dose for a long period of time may be linked to side effects. If it is prescribed, it should be for the lowest effective dose for the shortest possible period. Asking people about their use of over-the-counter medicines is a further new draft recommendation.

“Original recommendations to advise people with osteoarthritis to exercise as a core treatment remain unchanged, along with advising people to lose weight if they are overweight or obese. We now welcome comments from stakeholders on the draft recommendations as part of our public consultation.” Some draft recommendations are the same as in the original guideline, but there are also a number of new and updated recommendations, including:

  • 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 no longer than 30 minutes [new] When prescribing oral analgesics, be aware of the risks, benefits and contraindications of the different drugs, and prescribe with caution in older people [new]
  • Refer for consideration of joint replacement surgery before there is prolonged and established functional limitation and severe pain [updated]
  • Offer regular reviews to all people with symptomatic osteoarthritis. Agree the timing of the reviews with the person, taking into account other illnesses or conditions a person may have, whether they have troublesome joint pain, whether more than one joint is affected and whether they are taking any drugs for their osteoarthritis [new].