Recommendation ID
CG177/2
Question
Combinations of treatments for osteoarthritis:- What are the benefits of combinations of treatments for osteoarthritis, and how can these be included in clinically useful, cost-effective algorithms for long-term care?
Any explanatory notes
(if applicable)
Why this is important:- Most people with osteoarthritis have symptoms for many years, and over this time they will receive several treatments, sometimes in combination. This may involve a combination of non-pharmacological and pharmacological treatments, such as using a walking stick and taking analgesics at the same time. Perhaps more commonly, a person may take different analgesics at the same time (for example, NSAIDs and opioids). However, most of the osteoarthritis trial evidence only evaluates single treatments, and often such trials are of short duration (for example, 6 weeks). We need to understand the benefits of combination treatments relevant to particular anatomical sites of osteoarthritis (for example, hand compared with knee) and whether particular combinations provide synergistic benefit in terms of symptom relief. Also needed is an understanding of how combinations of treatments can be included in algorithms (for example, dose escalation or substitution designs) for use in clinical practice. Trials to address this area may need to utilise complex intervention methodologies with health economic evaluations, and will need to stratify for comorbidities that affect the use of a particular intervention.

Source guidance details

Comes from guidance
Osteoarthritis: care and management
Number
CG177
Date issued
February 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 13/03/2014