Quality statement 1: Diagnosis

Quality statement

Adults aged 45 or over are diagnosed with osteoarthritis clinically without investigations if they have activity‑related joint pain and any morning joint stiffness lasts no longer than 30 minutes.

Rationale

There is often a poor link between changes visible on an X‑ray, MRI or ultrasound scan and the symptoms of osteoarthritis: minimal changes can be associated with substantial pain, or modest structural changes to joints can occur with minimal accompanying symptoms. It is recommended that a clinical diagnosis of osteoarthritis is made for adults aged 45 years or over with typical symptoms without the need for further investigations. This will reduce both potential harm from exposure to radiation from X‑rays and costs of unnecessary imaging procedures. However, if an alternative diagnosis is possible it may be necessary to carry out further investigations, including imaging, to aid diagnosis.

Quality measures

Structure

Evidence of local arrangements to ensure that adults aged 45 or over are diagnosed with osteoarthritis clinically without investigations if they have activity‑related joint pain and any morning joint stiffness lasts no longer than 30 minutes.

Data source: Local data collection.

Process

Proportion of adults aged 45 years or over who have activity‑related joint pain and in whom any morning joint stiffness lasts no longer than 30 minutes who are diagnosed with osteoarthritis clinically without investigations.

Numerator – the number in the denominator who are diagnosed with osteoarthritis clinically without investigations.

Denominator – the number of adults aged 45 years or over who have activity‑related joint pain and in whom any morning joint stiffness lasts no longer than 30 minutes who are diagnosed with osteoarthritis.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GPs and community healthcare providers) ensure that they have clear policies and processes for diagnosing osteoarthritis clinically. Service providers should also monitor the use of imaging for diagnosing osteoarthritis in adults to ensure that it is not being used inappropriately.

Healthcare professionals diagnose osteoarthritis in adults aged 45 years or over clinically without investigations if the person has typical symptoms.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services with clear policies and processes for diagnosing osteoarthritis clinically. Commissioners should also require providers to show that imaging is not being used inappropriately for diagnosing osteoarthritis in adults.

What the quality statement means for patients, service users and carers

Adults aged 45 years or over who go to their GP with joint pain that is typical of osteoarthritis are usually diagnosed with osteoarthritis without the need for an X‑ray or a scan. This is because the results of X‑rays and scans do not explain symptoms or help when deciding about treatment, and will mean that people do not have unnecessary X‑rays or scans.

Source guidance

  • Osteoarthritis (2014) NICE guideline CG177, recommendation 1.1.1 (key priority for implementation)

Definitions of terms used in this quality statement

Alternative diagnosis

If an alternative diagnosis is possible, it may be necessary to carry out imaging or other investigations to confirm the diagnosis. Alternative diagnoses include gout, other inflammatory arthritides such as rheumatoid arthritis, septic arthritis and malignancy. A history of trauma, prolonged morning joint‑related stiffness, rapid worsening of symptoms or the presence of a hot swollen joint may indicate the need for further investigations to identify possible additional or alternative diagnoses.

[Adapted from Osteoarthritis (NICE guideline CG177) recommendation 1.1.2, and expert opinion]