Intended for healthcare professionals

Practice Guidelines

Osteoarthritis in people over 16: diagnosis and management—updated summary of NICE guidance

BMJ 2023; 380 doi: (Published 24 January 2023) Cite this as: BMJ 2023;380:p24
  1. George Wood, technical analyst1,
  2. Julie Neilson, senior research fellow1,
  3. Elizabeth Cottrell, general practitioner partner2,
  4. Stephen P Hoole, consultant interventional cardiologist3
  5. on behalf of the Guideline Committee
  1. 1National Institute for Health and Care Excellence, Manchester, UK
  2. 2Wolstanton Medical Centre, Newcastle-under-Lyme, UK
  3. 3Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  1. Correspondence to G Wood george.wood{at}

What you need to know

  • Osteoarthritis is a clinical diagnosis that can be made without imaging in people who are 45 or over, have activity related joint pain, and have either no morning joint related stiffness or morning stiffness that lasts no longer than 30 minutes

  • Therapeutic exercise is important for people with osteoarthritis to reduce pain and improve physical function and quality of life

  • Analgesia should only be used for the shortest possible time, primarily to support therapeutic exercise

Osteoarthritis is a common condition that causes joint pain and stiffness and often has a negative impact on a person’s quality of life. More than 8.5 million people have osteoarthritis in the UK.1 Multisite peripheral joint pain is common, with the knee, hip, hand, and foot joint sites being most commonly affected.2 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) guideline for the diagnosis and management of osteoarthritis.3 The recommendations cover all joint sites apart from spinal osteoarthritis. The update emphasises the importance of core treatments of therapeutic exercise and weight management in the management of osteoarthritis, alongside information and support and the use of pharmacological management only if needed to support non-pharmacological treatments.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Committee’s (GC) experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. Definitions of evidence certainty are given in box 1.

Box 1

GRADE Working Group grades of evidence

  • High certainty—we are very confident that the true effect lies close to that of the estimate of the effect

  • Moderate certainty—we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate …

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