Commentary: controversies in NICE guidance on osteoarthritis

doi:10.1136/bmj.39496.451898.AD

BMJ 2008;336:504 (1 March), doi:10.1136/bmj.39496.451898.AD

Practice

Commentary: controversies in NICE guidance on osteoarthritis

Nicola Dalbeth, rheumatologist and senior lecturer¹, Bruce Arroll, professor and head of department²

¹ Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand, ² Department of General Practice and Primary Health Care, University of Auckland

Correspondence to: Bruce Arroll b.arroll@auckland.ac.nz

doi: 10.1136/bmj.39490.608009.AD

The first 150 words of the full text of this article appear below.

The major focus of the guideline is management of establishedpain and disability in patients with existing osteoarthritis.It raises several conundrums for clinicians. Firstly, it identifiesas core treatments those that are low risk and low cost. However,these treatments are also generally low in efficacy with lowor negligible effect sizes.¹ Of the core treatments, only exercisetherapy has a moderate effect size for treating pain in osteoarthritis,which is similar to the effect size of the more risky and costlyoral non-steroidal anti-inflammatory drugs (NSAIDs). Althoughthese core treatments should be integrated into osteoarthritismanagement, in clinical practice they are rarely sufficientas sole treatments. Furthermore, many patients with osteoarthritisdo not adhere to long term exercise programmes.² Analysis ofpatient acceptability of the guideline’s core interventionswould be of great interest.

Secondly, the inclusion of topical NSAIDs as a preferable pharmacologicaltreatment for hand and knee . . . [Full text of this article]

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Care and management of osteoarthritis in adults: summary of NICE guidance: Philip G Conaghan, John Dickson, Robert L Grant on behalf of the Guideline Development Group
BMJ 2008 336: 502-503. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Birrell, F., Arden, N. K. (2008). A view on the pathogenesis of osteoarthritis from the shoulders of giants. Rheumatology (Oxford) 47: 1263-1264 [Full text]

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