Commentary: controversies in NICE guidance on osteoarthritis

BMJ 2008; 336 doi: (Published 28 February 2008) Cite this as: BMJ 2008;336:504
  1. Nicola Dalbeth, rheumatologist and senior lecturer1,
  2. Bruce Arroll, professor and head of department2
  1. 1Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
  2. 2Department of General Practice and Primary Health Care, University of Auckland
  1. Correspondence to: Bruce Arroll b.arroll{at}

    The major focus of the guideline is management of established pain and disability in patients with existing osteoarthritis. It raises several conundrums for clinicians. Firstly, it identifies as core treatments those that are low risk and low cost. However, these treatments are also generally low in efficacy with low or negligible effect sizes.1 Of the core treatments, only exercise therapy has a moderate effect size for treating pain in osteoarthritis, which is similar to the effect size of the more risky and costly oral non-steroidal anti-inflammatory drugs (NSAIDs). Although these core treatments should be integrated into osteoarthritis management, in clinical practice they are rarely sufficient as …

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