Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Diagnosis

  • Diagnose osteoarthritis clinically without investigations if a person:

    • is 45 or over and

    • has activity-related joint pain and

    • has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30¬†minutes.¬†[new 2014]

Holistic approach to osteoarthritis assessment and management

  • Offer advice on the following core treatments to all people with clinical osteoarthritis.

    • Access to appropriate information (see recommendation 1.3.1).

    • Activity and exercise (see recommendation 1.4.1).

    • Interventions to achieve weight loss if the person is overweight or obese (see recommendation 1.4.3 and Obesity [NICE clinical guideline¬†43]). [2008, amended 2014]

Education and self-management

  • Offer accurate verbal and written information to all people with osteoarthritis to enhance understanding of the condition and its management, and to counter misconceptions, such as that it inevitably progresses and cannot be treated. Ensure that information sharing is an ongoing, integral part of the management plan rather than a single event at time of presentation. [2008]

  • Agree individualised self-management strategies with the person with osteoarthritis. Ensure that positive behavioural changes, such as exercise, weight loss, use of suitable footwear and pacing, are appropriately targeted. [2008]

Non-pharmacological management

  • Advise people with osteoarthritis to exercise as a core treatment (see recommendation 1.2.5), irrespective of age, comorbidity, pain severity or disability. Exercise should include:

    • local muscle strengthening and

    • 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. Exercise has been found to be beneficial but the clinician needs to make a judgement in each case on how to effectively ensure participation. This will depend upon the person's individual needs, circumstances and self-motivation, and the availability of local facilities. [2008]

Referral for consideration of joint surgery

  • Base decisions on referral thresholds on discussions between patient representatives, referring clinicians and surgeons, rather than using scoring tools for prioritisation. [2008, amended 2014]

  • Refer for consideration of joint surgery before there is prolonged and established functional limitation and severe pain. [2008, amended 2014]

Follow-up and review

  • Offer regular reviews to all people with symptomatic osteoarthritis. Agree the timing of the reviews with the person (see also recommendation 1.7.2). Reviews should include:

    • monitoring the person's symptoms and the ongoing impact of the condition on their everyday activities and quality of life

    • monitoring the long-term course of the condition

    • discussing the person's knowledge of the condition, any concerns they have, their personal preferences and their ability to access services

    • reviewing the effectiveness and tolerability of all treatments

    • support for self-management. [new 2014]

  • Consider an annual review for any person with one or more of the following:

    • troublesome joint pain

    • more than one joint with symptoms

    • more than one comorbidity

    • taking regular medication for their osteoarthritis. [new 2014]

  • National Institute for Health and Care Excellence (NICE)