Intended for healthcare professionals


Osteoarthritis of the knee in primary care

BMJ 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:105
  1. Paul Dieppe, Medical Research Council senior scientist
  1. 1Nuffield Department of Orthopaedic Surgery, University of Oxford, Oxford OX3 7LD
  1. paul.dieppe{at}

    Topical NSAIDS are as effective as oral NSAIDs, and patients prefer them

    Many older people have pain in one or both knees from time to time, and the most likely cause is osteoarthritis. In some people the symptoms are severe or intrusive enough to consider an intervention.

    The National Institute for Health and Clinical Excellence (NICE) has just published its draft guideline on the management of osteoarthritis.1 It lists five interventions regarded as “core treatments” for osteoarthritis of the knee—paracetamol; education and information; exercises; weight loss (if the patient is overweight); and topical non-steroidal anti-inflammatory drugs (NSAIDs). The guideline lists another 14 interventions, ranging from those that are safe (such as alterations to footwear or local heat and cold), to those that are potentially harmful (such as oral NSAIDs, opioids, and surgery). The first sentence of the draft guideline says, “Treatment and care should take into account the patients’ needs and preferences.” So what choices are available and …

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