NICE updated osteoarthritis guideline highlights importance of exercise

Exercise is a core treatment in managing osteoarthritis, says updated NICE guidance on the condition, published today (Wednesday 12 February). The clinical guideline on the care and management of osteoarthritis in adults reviews and updates a range of recommendations from the original 2008 guidance. It also includes new recommendations on diagnosing the condition, advice on joint surgery, and on follow-up and review.

Osteoarthritis is a common condition with associated pain, joint stiffness and reduced quality of life. It affects the joints, most commonly the knees, hips, spine and small joints of the hands, but it can also occur in other joints. Damage and loss of joint-lining cartilage, damage to adjacent bone, and inflammation of the tissues around the joint are the main characteristics of the condition. Osteoarthritis is the most common form of arthritis, with around 1 million people seeing their GP about it every year. It accounts for 115,000 hospital admissions in the UK each year. The condition can affect people's ability to undertake daily activities, and is one of the leading causes of pain and disability worldwide.

Professor Mark Baker, Centre for Clinical Practice Director at NICE, said: "There's a common but mistaken belief that osteoarthritis is an inevitable part of ageing and that it will get worse, but that's not the case. This updated guidance provides evidence-based recommendations on the most effective ways of diagnosing and managing osteoarthritis, to help improve the lives of people affected by it. The guidance highlights that the core treatment for osteoarthritis remains exercise - this not only helps relieve pain for some people but also improves function. For people with osteoarthritis who are overweight or obese, offering advice on ways to lose weight as part of helping them self-manage their condition, is another amended original recommendation.

"Building on the original 2008 guideline, a new recommendation in this update is around diagnosis. The guideline advises that in people aged 45 and over, osteoarthritis can be diagnosed without the need for clinical investigations if the activity causes joint pain but the person has either only brief or no joint stiffness in the mornings.

"An area that the update initially planned to review was the existing recommendations on pharmacological management of osteoarthritis. As the Medicines and Healthcare products Regulatory Agency intends to undertake a wide review on use of drug treatments including paracetamol, which would be helpful in informing the NICE guideline, NICE has decided to wait until the MHRA's work is complete before reviewing all pharmacological management for osteoarthritis. This will mean that all of the relevant painkillers can be looked at together. Until the full pharmacological update is undertaken, the guideline recommendations on drug management for osteoarthritis remain unchanged."

Professor Philip Conaghan, Chair of the NICE Guideline Development Group, and Professor of Musculoskeletal Medicine at the University of Leeds, said: "The symptoms often caused by osteoarthritis, such as pain and limited joint movement, can be managed with muscle strengthening, exercise and weight loss if people are overweight. If a person is still experiencing pain that interferes with their daily life despite addressing these core treatments and use of analgesics as appropriate, then the guideline makes a new recommendation that the person be referred for consideration of joint surgery before there is prolonged limited joint movement and severe pain. The guideline is also clear that factors such as the person's age, smoking status and obesity should not affect referral for joint surgery.

"Based on updated evidence, the guideline includes a recommendation that glucosamine and chondroitin products shouldn't be offered to manage osteoarthritis as the evidence on their clinical effectiveness is uncertain. The update also makes a recommendation that acupuncture shouldn't be offered, as the evidence reviewed indicates that it's not effective for treating the symptoms of osteoarthritis. Although new evidence was considered in making these update recommendations, the original guideline also didn't recommend these options.

"The guideline also has new recommendations on review and follow-up for all people with symptomatic osteoarthritis. This includes offering regular reviews which should cover monitoring the person's symptoms and the impact of the condition on everyday activities and other issues, and annual reviews for people with osteoarthritis in specific situations. We hope that this updated guideline will help clinicians to provide the best care for people with osteoarthritis, as well as encouraging people with the condition to seek advice from their doctors on managing osteoarthritis."

Recommendations include:

  • 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 recommendation]
  • Offer advice on these core treatments to all people with clinical osteoarthritis: access to appropriate information, activity and exercise, interventions to lose weight if the person is overweight or obese [updated]
  • Consider offering paracetamol for pain relief in addition to core treatments. Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclo-oxygenase (COX-2) inhibitors or opioids [unchanged]
  • Refer for consideration of joint replacement surgery before there is prolonged and established functional limitation and severe pain, and patient-specific factors (including age, sex, smoking, obesity) should not be barriers to referral for joint surgery [updated]
  • Offer regular reviews to all people with symptomatic osteoarthritis, which should cover monitoring the long-term course of the condition, reviewing the effectiveness and tolerability of treatments and other points. Annual reviews should be considered if the person has one or more of: other illnesses or conditions, troublesome joint pain, more than one joint affected, or are taking any drugs for their osteoarthritis [new].


For more information call Dr Tonya Gillis at the NICE press office on 0845 003 7782, or out of hours on 07775 583 813.

Notes to Editors

About the NICE guideline, Osteoarthritis: the care and management of osteoarthritis in adults

1. The guideline is available on the NICE website from Wednesday 12 February.

2. Osteoarthritis usually develops in people over 50 years of age and is more common in women than in men.

3. Cartilage is the smooth tissue which covers the surface of joints, acting as a cushion and allowing the joints to move smoothly. Osteoarthritis develops in a joint when changes occur in the cartilage.

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This page was last updated: 11 February 2014