Care and management of osteoarthritis in adults: summary of NICE guidance

doi:10.1136/bmj.39490.608009.AD

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Philip G Conaghan, professor of musculoskeletal medicine1,
John Dickson, community physician in rheumatology 2,
Robert L Grant, senior technical adviser at National Collaborating Centre for Chronic Conditions, and medical statistician3
on behalf of the Guideline Development Group

¹Section of Musculoskeletal Disease, University of Leeds, Leeds LS7 4SA
²Redcar and Cleveland Primary Care Trust, Guisborough Primary Care Hospital, Guisborough TS14 6HZ
³Royal College of Physicians of London, London NW1 4LE

Correspondence to: P Conaghan, Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds LS7 4SA p.conaghan{at}leeds.ac.uk

Why read this summary?

Osteoarthritis refers to a syndrome of joint pain accompanied by functional limitation and reduced quality of life. It is the most common form of arthritis and one of the leading causes of pain and disability in the United Kingdom. The published evidence for osteoarthritis treatment has many limitations—typically, short duration studies using single drug treatments. However, people with osteoarthritis need to be aware of the treatments that represent core management and of the range of additional treatments available. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care and management of osteoarthritis in adults.1

Recommendations

NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Holistic assessment and management of symptomatic osteoarthritis

Assess the effect of osteoarthritis on the individual’s function, quality of life, occupation, mood, relationships, and leisure activities.
Provide periodic review tailored to an individual’s needs.
Formulate a management plan in partnership with the person with osteoarthritis, taking into consideration comorbidities that compound the effect of osteoarthritis.
Communicate the risks and benefits of treatment options in ways that can be understood.

Core treatments

Provide advice on the following to all people with symptomatic osteoarthritis:

Access to appropriate information, oral and written, to enhance understanding of the condition and to counter misconceptions (such as osteoarthritis is inevitably progressive and cannot be treated). [Based on moderate quality evidence from meta-analyses, randomised controlled trials (RCTs), and small observational studies] Good sources of patient information exist online at www.arc.org.uk (Arthritis Research Campaign), www.move.uk.net (Move), and www.arthritiscare.org.uk (Arthritis Care).
Activity and exercise, including local muscle strengthening and general aerobic fitness. [Based on moderate quality evidence from RCTs …