Ensure that the information provided can be understood. Arthritis Rheum. NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. [2008]. [2008, amended 2014], 1.6.3 Consider referral for joint surgery for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. 2018 Jan;26(1):43-53. doi: 10.1016/j.joca.2017.09.010. [2014], 1.6.1 Clinicians with responsibility for referring a person with osteoarthritis for consideration of joint surgery should ensure that the person has been offered at least the core (non-surgical) treatment options (see recommendation 1.2.5). 1.4.1 Advise people with osteoarthritis to exercise as a core treatment (see recommendation 1.2.5), irrespective of age, comorbidity, pain severity or disability. [2008], 1.4.4 Do not offer glucosamine or chondroitin products for the management of osteoarthritis. The Arthritis Foundation is proud to have partnered with the American College of Rheumatology (ACR) on the development and release of these guidelines for the management of osteoarthritis (OA) of the hand, knee and hip. [2008], 1.5.11 If a person with osteoarthritis needs to take low-dose aspirin, healthcare professionals should consider other analgesics before substituting or adding an NSAID or COX-2 inhibitor (with a PPI) if pain relief is ineffective or insufficient. The GDG believes that this information should be taken into account in routine prescribing practice until the planned full review of evidence on the pharmacological management of osteoarthritis is published (see the NICE website for further details). The recommendations are labelled according to when they were originally published (see About this guideline for details). Epub 2017 Oct 14. This will start after a review by the MHRA (Medicines and Healthcare Products Regulatory Agency) of the safety of over-the-counter analgesics is completed. (Cartilage is the tough … Use figure 1 as an aid to prompt questions that should be asked as part of the holistic assessment of a person with osteoarthritis. In either case, co-prescribe with a proton pump inhibitor (PPI), choosing the one with the lowest acquisition cost. 1. Last published: 2014. 1.1.1 Diagnose osteoarthritis clinically without investigations if a person: has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes. Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: 1.1. the small joints of the hands or feet a… Activity and exercise (see recommendation 1.4.1). NICE guidelines (4) Review the evidence across broad health and social care topics. Guidelines Learning is a CPD platform where you can test your knowledge on a wide range of clinical topics and gain CPD points. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. It covers both pharmacological and non-pharmacological treatments. Diagnostics guidance (1) Review new diagnostic technologies for adoption in the NHS. [Guideline] Kolasinski SL, Neogi T, Hochberg MC, et al. How up-to-date is this topic? Exercise should include: general aerobic fitness.It has not been specified whether exercise should be provided by the NHS or whether the healthcare professional should provide advice and encouragement to the person to obtain and carry out the intervention themselves. This guideline includes recommendations on: We checked this guideline in August 2017 and plan to update the guideline. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. Any functional impairment, including effect on daily activities including mobility, exercise, sleep, work, and leisure. However, the Guideline Development Group (GDG) would like to draw attention to the findings of the evidence review on the effectiveness of paracetamol that was presented in the consultation version of the guideline. To support discussions with patients about the benefits and harms of opioid treatment, and safe withdrawal management, see: the NICE guideline on patient experience in adult NHS services for recommendations on shared decision making, the NICE guideline on medicines optimisation for recommendations on structured medication reviews, the key therapeutic topic on medicines optimisation in chronic pain, the opioids aware website and the section in the BNF on controlled drugs and drug dependence. 1.6.6 When discussing the possibility of joint surgery, check that the person has been offered at least the core treatments for osteoarthritis (see recommendation 1.2.5), and give them information about: the benefits and risks of surgery and the potential consequences of not having surgery, recovery and rehabilitation after surgery, how having a prosthesis might affect them, how care pathways are organised in their local area. NICE; CKS; Topics A to Z; Osteoarthritis; Management; Osteoarthritis: Management. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Osteoarthritis (OA) is the most common type of arthritis. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. [2008], 1.4.7 People with osteoarthritis who have biomechanical joint pain or instability should be considered for assessment for bracing/joint supports/insoles as an adjunct to their core treatments. Hips move you along on a walk without a complaint. [2008], 1.5.7 Where paracetamol or topical NSAIDs provide insufficient pain relief for people with osteoarthritis, then the addition of an oral NSAID/COX-2 inhibitor to paracetamol should be considered. Objective. Exercise has been found to be beneficial but the clinician needs to make a judgement in each case on how to effectively ensure participation. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. Ensure that positive behavioural changes, such as exercise, weight loss, use of suitable footwear and pacing, are appropriately targeted. [2008]. These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. [Guideline] Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. Last revised in June 2018. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. But when you have arthritis, such simple, everyday movements can hurt. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.7.1 Offer regular reviews to all people with symptomatic osteoarthritis. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. [2008], Healthcare professionals should consider the use of transcutaneous electrical nerve stimulation (TENS) as an adjunct to core treatments for pain relief.TENS machines are generally loaned to the person by the NHS for a short period, and if effective the person is advised where they can purchase their own. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. NICE interactive flowchart - Osteoarthritis, Finding more information and committee details, Public Health England evidence review on dependence on, and withdrawal from, prescribed medicines, guidance on safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal, assess and reduce the environmental impact of implementing NICE recommendations, Adults with osteoarthritis and their families and carers. [2008], 1.3.3 Ensure that self-management programmes for people with osteoarthritis, either individually or in groups, emphasise the recommended core treatments (see recommendation 1.2.5), especially exercise. Everything NICE has said on the care and management of osteoarthritis in adults in an interactive flowchart The NICE guideline and EULAR expert consensus document note that multiple factors influence a person's experience of pain, including health beliefs, mood, avoidance behaviour, obesity, sleep disturbance, and the pattern of rest and activity through the day [ NICE, 2014; Geenen, 2018 ]. Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclo-oxygenase 2 (COX-2) inhibitors or opioids. Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. [2008], 1.4.8 Assistive devices (for example, walking sticks and tap turners) should be considered as adjuncts to core treatments for people with osteoarthritis who have specific problems with activities of daily living. 1.5.6 Where paracetamol or topical NSAIDs are ineffective for pain relief for people with osteoarthritis, then substitution with an oral NSAID/COX-2 inhibitor should be considered. Osteoarthritis Cartilage. Any psychosocial impact, including effect on mood, relationships, and any dependents. The management of neck or back pain related to degenerative changes in spine are not part of this guideline. Published by: National Institute for Health and Care Excellence. Guidance by programme. 2020 Jan 6. . To support discussion with patients about opioid prescribing, and safe withdrawal management, we are developing guidance on safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal and shared decision making. 11 December 2020. When prescribing these drugs, consideration should be given to appropriate assessment and/or ongoing monitoring of these risk factors. [2014], 1.4.6 Offer advice on appropriate footwear (including shock-absorbing properties) as part of core treatments (see recommendation 1.2.5) for people with lower limb osteoarthritis. In the meantime, the original recommendations (from 2008) remain current advice. For most topics there are a few suggested specific points that are worth assessing. The recommendations on the diagnosis of osteoarthritis are based on the National Institute of Health and Care Excellence (NICE) clinical guideline Osteoarthritis: care and management [], the European League Against Rheumatism (EULAR) expert consensus document EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis [Zhang et al, 2010], and expert opinion in … Background: Osteoarthritis (OA) is a leading cause of pain and disability. This guideline applies to people with a working diagnosis of osteoarthritis who present for treatment or whose activities of daily living are significantly affected by their osteoarthritis. Last updated: It covers both pharmacological and non-pharmacological treatments. This guideline covers diagnosing and managing rheumatoid arthritis. For more information, see the Introduction. [2014], Finding more information and committee details, 1.2 Holistic approach to osteoarthritis assessment and management, 1.6 Referral for consideration of joint surgery, NICE's information on making decisions about your care, NICE guideline on patient experience in adult NHS services, NICE guideline on obesity: identification, assessment and management, NICE guideline on patient experience in adult NHS services for recommendations on shared decision making, NICE guideline on medicines optimisation for recommendations on structured medication reviews, key therapeutic topic on medicines optimisation in chronic pain, section in the BNF on controlled drugs and drug dependence. [2008], 1.4.9 Do not refer for arthroscopic lavage and debridement as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose bodies). 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