Although NSAIDs and COX-2 inhibitors may be regarded as a single drug class of 'NSAIDs', these recommendations use the two terms for clarity and because of the differences in side-effect profile. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. 1.5.2 If paracetamol or topical NSAIDs are insufficient for pain relief for people with osteoarthritis, then the addition of opioid analgesics should be considered. Apply the principles in the NICE guideline on patient experience in adult NHS services in relation to shared decision making. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. A topical NSAID or topical capsaicin 0.025% should also be considered, particularly in knee or hand osteoarthritis. [2008], 1.5.9 When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor (other than etoricoxib 60 mg). Use figure 1 as an aid to prompt questions that should be asked as part of the holistic assessment of a person with osteoarthritis. [2008], 1.5.8 Use oral NSAIDs/COX-2 inhibitors at the lowest effective dose for the shortest possible period of time. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. 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, 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. [Guideline] Kolasinski SL, Neogi T, Hochberg MC, et al. In December 2020 we reviewed our guidance on opioids for non-cancer pain in response to a Public Health England evidence review on dependence on, and withdrawal from, prescribed medicines. Arthritis Rheumatol. 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. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis Osteoarthritis Cartilage. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline external link opens in a new window. If needed, seek expert advice in this context (for example, from occupational therapists or Disability Equipment Assessment Centres). The management of neck or back pain related to degenerative changes in spine are not part of this guideline. [2008], 1.4.2 Manipulation and stretching should be considered as an adjunct to core treatments, particularly for osteoarthritis of the hip. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. Published date: 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. Access to appropriate information (see recommendation 1.3.1). People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. 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. 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. 1.7.2 Consider an annual review for any person with one or more of the following: taking regular medication for their osteoarthritis. 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. 1. [2008], 1.5.5 Do not offer rubefacients for treating osteoarthritis. 1.2.5 Offer advice on the following core treatments to all people with clinical osteoarthritis. For most topics there are a few suggested specific points that are worth assessing. See the guideline in development page for progress on the update. When prescribing these drugs, consideration should be given to appropriate assessment and/or ongoing monitoring of these risk factors. Osteoarthritis (OA) is the most common type of arthritis. Agree the timing of the reviews with the person (see also recommendation 1.7.2). Clinical guideline [CG177] When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. For more information, see the Introduction. Osteoarthritis Cartilage. Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. [2008], 1.5.12 Intra-articular corticosteroid injections should be considered as an adjunct to core treatments for the relief of moderate to severe pain in people with osteoarthritis. To develop an evidence‐based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. It covers both pharmacological and non-pharmacological treatments. Last published: 2014. [2008], 1.3.4 The use of local heat or cold should be considered as an adjunct to core treatments. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. In the meantime, the original recommendations (from 2008) remain current advice. 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). Assessment of a person with suspected osteoarthritis should include: The features of reported pain and stiffness. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA. [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. The guideline process included input from OA patients recruited through the Arthritis Foundation. NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. How up-to-date is this topic? [2008, amended 2014]. The recommendations are labelled according to when they were originally published (see About this guideline for details). Healthy joints help your body move, bend, and twist. [2014], 1.2.3 Take into account comorbidities that compound the effect of osteoarthritis when formulating the management plan. This guideline covers diagnosing and managing rheumatoid arthritis. [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. Nice guidelines for Osteoarthritis - exercise should be 'core treatment' Exercise is a core treatment in managing osteoarthritis, according to updated NICE guidance on the condition. [2008], 1.5.13 Do not offer intra-articular hyaluronan injections for the management of osteoarthritis. Last revised in June 2018. [2008]. [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. Topics A to Z; Specialities; What's new; About CKS; Journals and databases; Read about our approach to COVID-19. Ensure that information sharing is an ongoing, integral part of the management plan rather than a single event at time of presentation. In the meantime, we have added links in this guideline to other NICE guidelines and other resources that support this aim. 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. For more information, see the Introduction section in the original guideline document. This guideline includes recommendations on: We checked this guideline in August 2017 and plan to update the guideline. Everything NICE has said on the care and management of osteoarthritis in adults in an interactive flowchart Osteoarthritis: care and management external link opens in a new window. Arthritis Rheum. For … Last updated: 2018 Jan;26(1):43-53. doi: 10.1016/j.joca.2017.09.010. This guideline covers assessing and managing osteoarthritis in adults. [2008, amended 2014], 1.6.4 Refer for consideration of joint surgery before there is prolonged and established functional limitation and severe pain. [2014], 1.4.5 Do not offer acupuncture for the management of osteoarthritis. Published date: Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the Management of OsteoArthritis In Consultations (MOSAICS) study protocol Implement Sci. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. 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 ]. [2014], 1.7.3 Apply the principles in the NICE guideline on patient experience in adult NHS services with regard to an individualised approach to healthcare services and patient views and preferences. Keywords: Osteoarthritis, General practice, Implementation, Primary care, NICE guidelines, Self-management Background There is a perception that osteoarthritis (OA) is a ‘natural’ part of ageing and there are limited interventions available [ 1 , 2 ]. [2014]. 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. 1.5.1 Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatments (see recommendation 1.2.5); regular dosing may be required. Ensure that positive behavioural changes, such as exercise, weight loss, use of suitable footwear and pacing, are appropriately targeted. But when you have arthritis, such simple, everyday movements can hurt. [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. [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. Joint that leads to breakdown of joint Cartilage and the underlying bone exercise has been found to beneficial. The holistic assessment of a person with osteoarthritis 's new ; About CKS ; Journals and databases ; About. The clinical and cost-effectiveness of new treatments, integral part of this guideline be. 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