1.2.2 Agree a plan with the person (and their family members or carers as appropriate) for managing their osteoarthritis. Healthy joints help your body move, bend, and twist. It covers both pharmacological and non-pharmacological treatments. [2014], 1.4.5 Do not offer acupuncture for the management of osteoarthritis. Osteoarthritis Management Guidelines Systematic review abstract Purpose: Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. (Cartilage is the tough … [2008], 1.6.2 Base decisions on referral thresholds on discussions between patient representatives, referring clinicians and surgeons, rather than using scoring tools for prioritisation. Reviews should include: monitoring the person's symptoms and the ongoing impact of the condition on their everyday activities and quality of life, monitoring the long-term course of the condition, discussing the person's knowledge of the condition, any concerns they have, their personal preferences and their ability to access services, reviewing the effectiveness and tolerability of all treatments. Epub 2017 Oct 14. [2008], 1.4.9 Do not refer for arthroscopic lavage and debridement as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose bodies). [2008], 1.4.8 Assistive devices (for example, walking sticks and tap turners) should be considered as adjuncts to core treatments for people with osteoarthritis who have specific problems with activities of daily living. [2008], 1.5.7 Where paracetamol or topical NSAIDs provide insufficient pain relief for people with osteoarthritis, then the addition of an oral NSAID/COX-2 inhibitor to paracetamol should be considered. 2014 Aug 27;9:95. doi: 10.1186/s13012-014-0095-y. [2008], Healthcare professionals should consider the use of transcutaneous electrical nerve stimulation (TENS) as an adjunct to core treatments for pain relief.TENS machines are generally loaned to the person by the NHS for a short period, and if effective the person is advised where they can purchase their own. [2014], 1.7.3 Apply the principles in the NICE guideline on patient experience in adult NHS services with regard to an individualised approach to healthcare services and patient views and preferences. Important differential diagnoses include gout, other inflammatory arthritides (for example, rheumatoid arthritis), septic arthritis and malignancy (bone pain). The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA. These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. 1.7.1 Offer regular reviews to all people with symptomatic osteoarthritis. [2014], 1.6.1 Clinicians with responsibility for referring a person with osteoarthritis for consideration of joint surgery should ensure that the person has been offered at least the core (non-surgical) treatment options (see recommendation 1.2.5). This guideline includes recommendations on: We checked this guideline in August 2017 and plan to update the guideline. Guidelines Learning is a CPD platform where you can test your knowledge on a wide range of clinical topics and gain CPD points. Everything NICE has said on the care and management of osteoarthritis in adults in an interactive flowchart The NICE guideline and EULAR expert consensus document note that multiple factors influence a person's experience of pain, including health beliefs, mood, avoidance behaviour, obesity, sleep disturbance, and the pattern of rest and activity through the day [ NICE, 2014; Geenen, 2018 ]. See the guideline in development page for progress on the update. Ensure that the information provided can be understood. Although NSAIDs and COX-2 inhibitors may be regarded as a single drug class of 'NSAIDs', these recommendations use the two terms for clarity and because of the differences in side-effect profile. 11 December 2020. Osteoarthritis (OA) is the most common type of arthritis. This guideline covers assessing and managing osteoarthritis in adults. [2008], 1.3.2 Agree individualised self-management strategies with the person with osteoarthritis. Apply the principles in the NICE guideline on patient experience in adult NHS services in relation to shared decision making. For pain relief in osteoarthritis and soft-tissue disorders, paracetamol should be used first and may need to be taken regularly. [Guideline] Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. [2008], 1.2.4 Discuss the risks and benefits of treatment options with the person, taking into account comorbidities. The guideline process included input from OA patients recruited through the Arthritis Foundation. [2008], 1.5.13 Do not offer intra-articular hyaluronan injections for the management of osteoarthritis. [2008], 1.5.12 Intra-articular corticosteroid injections should be considered as an adjunct to core treatments for the relief of moderate to severe pain in people with osteoarthritis. 1.4.1 Advise people with osteoarthritis to exercise as a core treatment (see recommendation 1.2.5), irrespective of age, comorbidity, pain severity or disability. It covers both pharmacological and non-pharmacological treatments. Access to appropriate information (see recommendation 1.3.1). Interventions to achieve weight loss if the person is overweight or obese (see recommendation 1.4.3 and the NICE guideline on obesity: identification, assessment and management). 1.2.5 Offer advice on the following core treatments to all people with clinical osteoarthritis. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. 2020 Jan 6. . [2014], 1.2.3 Take into account comorbidities that compound the effect of osteoarthritis when formulating the management plan. Any psychosocial impact, including effect on mood, relationships, and any dependents. Guidance by programme. Ensure that positive behavioural changes, such as exercise, weight loss, use of suitable footwear and pacing, are appropriately targeted. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis Osteoarthritis Cartilage. [2008, amended 2014], 1.6.4 Refer for consideration of joint surgery before there is prolonged and established functional limitation and severe pain. [2008, amended 2014], 1.6.5 Patient-specific factors (including age, sex, smoking, obesity and comorbidities) should not be barriers to referral for joint surgery. [2008, amended 2020], 1.5.3 Consider topical NSAIDs for pain relief in addition to core treatments (see recommendation 1.2.5) for people with knee or hand osteoarthritis. OA is a progressive disease of the whole joint that leads to breakdown of joint cartilage and the underlying bone. [2008], 1.4.7 People with osteoarthritis who have biomechanical joint pain or instability should be considered for assessment for bracing/joint supports/insoles as an adjunct to their core treatments. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the Management of OsteoArthritis In Consultations (MOSAICS) study protocol Implement Sci. Last updated: [2014], 1.1.2 Be aware that atypical features, such as a history of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot swollen joint, may indicate alternative or additional diagnoses. NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. [2014], 1.2.1 Assess the effect of osteoarthritis on the person's function, quality of life, occupation, mood, relationships and leisure activities. To develop an evidence‐based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. The recommendations are labelled according to when they were originally published (see About this guideline for details). NICE interactive flowchart - Osteoarthritis, Finding more information and committee details, Public Health England evidence review on dependence on, and withdrawal from, prescribed medicines, guidance on safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal, assess and reduce the environmental impact of implementing NICE recommendations, Adults with osteoarthritis and their families and carers. [Guideline] Kolasinski SL, Neogi T, Hochberg MC, et al. [2008], 1.4.2 Manipulation and stretching should be considered as an adjunct to core treatments, particularly for osteoarthritis of the hip. Published date: Assessment of a person with suspected osteoarthritis should include: The features of reported pain and stiffness. Clinical guideline [CG177] It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the progression of their condition and control their symptoms. [2008]. [2008, amended 2014]. Objective. Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. In December 2020 we reviewed our guidance on opioids for non-cancer pain in response to a Public Health England evidence review on dependence on, and withdrawal from, prescribed medicines. Last updated: 12 February 2014 [2014], 1.4.6 Offer advice on appropriate footwear (including shock-absorbing properties) as part of core treatments (see recommendation 1.2.5) for people with lower limb osteoarthritis. 2018-06-18T13:45:00. But when you have arthritis, such simple, everyday movements can hurt. Hips move you along on a walk without a complaint. It affects more Canadians than all other forms of arthritis combined. 1.5.2 If paracetamol or topical NSAIDs are insufficient for pain relief for people with osteoarthritis, then the addition of opioid analgesics should be considered. Technology appraisal guidance (42) Reviews the clinical and cost-effectiveness of new treatments. [2008], 1.3.3 Ensure that self-management programmes for people with osteoarthritis, either individually or in groups, emphasise the recommended core treatments (see recommendation 1.2.5), especially exercise. This will start after a review by the MHRA (Medicines and Healthcare Products Regulatory Agency) of the safety of over-the-counter analgesics is completed. The recommendations on the diagnosis of osteoarthritis are based on the National Institute of Health and Care Excellence (NICE) clinical guideline Osteoarthritis: care and management [], the European League Against Rheumatism (EULAR) expert consensus document EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis [Zhang et al, 2010], and expert opinion in … This figure is intended as an 'aide memoir' to provide a breakdown of key topics that are of common concern when assessing people with osteoarthritis. That review identified reduced effectiveness of paracetamol in the management of osteoarthritis compared with what was previously thought. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. Using the stairs can be painful. To support discussions with patients about the benefits and harms of opioid treatment, and safe withdrawal management, see: the NICE guideline on patient experience in adult NHS services for recommendations on shared decision making, the NICE guideline on medicines optimisation for recommendations on structured medication reviews, the key therapeutic topic on medicines optimisation in chronic pain, the opioids aware website and the section in the BNF on controlled drugs and drug dependence. [2008, amended 2014], 1.6.3 Consider referral for joint surgery for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. [2014], Finding more information and committee details, 1.2 Holistic approach to osteoarthritis assessment and management, 1.6 Referral for consideration of joint surgery, NICE's information on making decisions about your care, NICE guideline on patient experience in adult NHS services, NICE guideline on obesity: identification, assessment and management, NICE guideline on patient experience in adult NHS services for recommendations on shared decision making, NICE guideline on medicines optimisation for recommendations on structured medication reviews, key therapeutic topic on medicines optimisation in chronic pain, section in the BNF on controlled drugs and drug dependence. Osteoarthritis: care and management external link opens in a new window. Ensure that information sharing is an ongoing, integral part of the management plan rather than a single event at time of presentation. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline external link opens in a new window. NICE Pathways; NICE guidance; Standards and indicators; Evidence search; BNF; BNFC; CKS. 2018 Jan;26(1):43-53. doi: 10.1016/j.joca.2017.09.010. Last revised in June 2018. Osteoarthritis is the most common form of arthritis, with around 1 million people seeing their GP about it every year. In the meantime, we have added links in this guideline to other NICE guidelines and other resources that support this aim. Overview. 1.5.6 Where paracetamol or topical NSAIDs are ineffective for pain relief for people with osteoarthritis, then substitution with an oral NSAID/COX-2 inhibitor should be considered. Any functional impairment, including effect on daily activities including mobility, exercise, sleep, work, and leisure. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. The GDG believes that this information should be taken into account in routine prescribing practice until the planned full review of evidence on the pharmacological management of osteoarthritis is published (see the NICE website for further details). Clinical guideline [CG177] [2008], 1.4.3 Offer interventions to achieve weight loss as a core treatment (see recommendation 1.2.5) for people who are obese or overweight. Arthritis Rheumatol. People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. In the meantime, the original recommendations (from 2008) remain current advice. Diagnostics guidance (1) Review new diagnostic technologies for adoption in the NHS. How up-to-date is this topic? Topics A to Z; Specialities; What's new; About CKS; Journals and databases; Read about our approach to COVID-19. For more information, see the Introduction. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. 1.5.1 Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatments (see recommendation 1.2.5); regular dosing may be required. A topical NSAID or topical capsaicin 0.025% should also be considered, particularly in knee or hand osteoarthritis. The management of neck or back pain related to degenerative changes in spine are not part of this guideline. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. Guideline for the management of knee and hip osteoarthritis iii Second edition About this guideline The Royal Australian College of General Practitioners (RACGP) first developed Guidelines for the non-surgical management of hip and knee osteoarthritis in 2009. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. NICE guideline on osteoarthritis. Osteoarthritis Cartilage. [2008], 1.5.5 Do not offer rubefacients for treating osteoarthritis. NICE; CKS; Topics A to Z; Osteoarthritis; Management; Osteoarthritis: Management. If needed, seek expert advice in this context (for example, from occupational therapists or Disability Equipment Assessment Centres). This guideline applies to people with a working diagnosis of osteoarthritis who present for treatment or whose activities of daily living are significantly affected by their osteoarthritis. Osteoarthritis is a painful problem with the joints. For most topics there are a few suggested specific points that are worth assessing. Knees glide up and down stairs without creaking or crunching. Last published: 2017. The Arthritis Foundation is proud to have partnered with the American College of Rheumatology (ACR) on the development and release of these guidelines for the management of osteoarthritis (OA) of the hand, knee and hip. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. 1.7.2 Consider an annual review for any person with one or more of the following: taking regular medication for their osteoarthritis. [2008]. When prescribing these drugs, consideration should be given to appropriate assessment and/or ongoing monitoring of these risk factors. This will start after a review by the MHRA (Medicines and Healthcare Products Regulatory Agency) of the safety of over-the-counter analgesics is completed. Keywords: Osteoarthritis, General practice, Implementation, Primary care, NICE guidelines, Self-management Background There is a perception that osteoarthritis (OA) is a ‘natural’ part of ageing and there are limited interventions available [ 1 , 2 ]. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. Activity and exercise (see recommendation 1.4.1). [2008], 1.5.11 If a person with osteoarthritis needs to take low-dose aspirin, healthcare professionals should consider other analgesics before substituting or adding an NSAID or COX-2 inhibitor (with a PPI) if pain relief is ineffective or insufficient. [2008], 1.5.9 When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor (other than etoricoxib 60 mg). [2008], 1.5.4 Topical capsaicin should be considered as an adjunct to core treatments for knee or hand osteoarthritis. This will depend upon the person's individual needs, circumstances and self-motivation, and the availability of local facilities. [2008], 1.3.4 The use of local heat or cold should be considered as an adjunct to core treatments. This will start after a review by the Medicines and Healthcare Products Regulatory Agency (MHRA) of the safety of over-the-counter analgesics is completed. Exercise has been found to be beneficial but the clinician needs to make a judgement in each case on how to effectively ensure participation. Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: 1.1. the small joints of the hands or feet a… [2008], 1.4.4 Do not offer glucosamine or chondroitin products for the management of osteoarthritis. For more information, see the Introduction section in the original guideline document. People should also have rapid access to specialist care if their condition suddenly worsens. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Risks and benefits should be considered, particularly in older people. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. Sign in or register to access Guidelines Learning. OA is one of the most common chronic diseases, with an estimated overall prevalence in the general adult population of 11% for hip OA and 24% for knee OA, respectively. NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. For … Last published: 2014. [2008], 1.5.8 Use oral NSAIDs/COX-2 inhibitors at the lowest effective dose for the shortest possible period of time. Nice guidelines for Osteoarthritis - exercise should be 'core treatment' Exercise is a core treatment in managing osteoarthritis, according to updated NICE guidance on the condition. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. 1.6.6 When discussing the possibility of joint surgery, check that the person has been offered at least the core treatments for osteoarthritis (see recommendation 1.2.5), and give them information about: the benefits and risks of surgery and the potential consequences of not having surgery, recovery and rehabilitation after surgery, how having a prosthesis might affect them, how care pathways are organised in their local area. 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