osteoarthritis nice guidelines

(Cartilage is the tough … 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. But when you have arthritis, such simple, everyday movements can hurt. [2008], 1.5.13 Do not offer intra-articular hyaluronan injections for the management of osteoarthritis. These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. 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. Osteoarthritis: care and management external link opens in a new window. Arthritis Rheum. 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. For … It covers both pharmacological and non-pharmacological treatments. 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. 1.2.2 Agree a plan with the person (and their family members or carers as appropriate) for managing their osteoarthritis. [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. Important differential diagnoses include gout, other inflammatory arthritides (for example, rheumatoid arthritis), septic arthritis and malignancy (bone pain). [2008, amended 2020], 1.5.3 Consider topical NSAIDs for pain relief in addition to core treatments (see recommendation 1.2.5) for people with knee or hand osteoarthritis. [2008], 1.5.5 Do not offer rubefacients for treating osteoarthritis. Ensure that information sharing is an ongoing, integral part of the management plan rather than a single event at time of presentation. Assessment of a person with suspected osteoarthritis should include: The features of reported pain and stiffness. Exercise should include: 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. 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. Published date: Use figure 1 as an aid to prompt questions that should be asked as part of the holistic assessment of a person with osteoarthritis. Published by: National Institute for Health and Care Excellence. Arthritis Rheumatol. 1.1.1 Diagnose osteoarthritis clinically without investigations if a person: has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the progression of their condition and control their symptoms. Last revised in June 2018. For more information, see the Introduction section in the original guideline document. [2014], 1.2.1 Assess the effect of osteoarthritis on the person's function, quality of life, occupation, mood, relationships and leisure activities. Osteoarthritis Management Guidelines Systematic review abstract Purpose: Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. 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. This will start after a review by the MHRA (Medicines and Healthcare Products Regulatory Agency) of the safety of over-the-counter analgesics is completed. [2008]. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. A topical NSAID or topical capsaicin 0.025% should also be considered, particularly in knee or hand osteoarthritis. If needed, seek expert advice in this context (for example, from occupational therapists or Disability Equipment Assessment Centres). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline external link opens in a new window. Risks and benefits should be considered, particularly in older people. Osteoarthritis (OA) is the most common type of arthritis. 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. Overview. NICE Pathways; NICE guidance; Standards and indicators; Evidence search; BNF; BNFC; CKS. NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. 11 December 2020. [2014]. Healthy joints help your body move, bend, and twist. For pain relief in osteoarthritis and soft-tissue disorders, paracetamol should be used first and may need to be taken regularly. Sign in or register to access Guidelines Learning. NICE guideline on osteoarthritis. 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. [2008, amended 2014], 1.6.4 Refer for consideration of joint surgery before there is prolonged and established functional limitation and severe pain. This National Institute for Health and Care Excellence (NICE) guideline covers assessing and managing osteoarthritis in adults. Last published: 2014. How up-to-date is this topic? This will start after a review by the Medicines and Healthcare Products Regulatory Agency (MHRA) of the safety of over-the-counter analgesics is completed. Summary; Have I got the right topic? [2014], 1.6.1 Clinicians with responsibility for referring a person with osteoarthritis for consideration of joint surgery should ensure that the person has been offered at least the core (non-surgical) treatment options (see recommendation 1.2.5). [2008], 1.6.2 Base decisions on referral thresholds on discussions between patient representatives, referring clinicians and surgeons, rather than using scoring tools for prioritisation. Clinical guideline [CG177] This guideline covers assessing and managing osteoarthritis in adults. OA is one of the most common chronic diseases, with an estimated overall prevalence in the general adult population of 11% for hip OA and 24% for knee OA, respectively. Epub 2017 Oct 14. This guideline updates and replaces 'Osteoarthritis' (NICE clinical guideline 59). Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. Premium content . . The guideline process included input from OA patients recruited through the Arthritis Foundation. 2018 Jan;26(1):43-53. doi: 10.1016/j.joca.2017.09.010. Hips move you along on a walk without a complaint. 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. Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause. Last updated: 1.2.5 Offer advice on the following core treatments to all people with clinical osteoarthritis. [2008], 1.2.4 Discuss the risks and benefits of treatment options with the person, taking into account comorbidities. [2008, amended 2014]. To support discussion with patients about opioid prescribing, and safe withdrawal management, we are developing guidance on safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal and shared decision making. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis Osteoarthritis Cartilage. Published by: BMJ. [2008]. NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. [2008], 1.5.8 Use oral NSAIDs/COX-2 inhibitors at the lowest effective dose for the shortest possible period of time. Access to appropriate information (see recommendation 1.3.1). Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply: 1.1. the small joints of the hands or feet a… The management of neck or back pain related to degenerative changes in spine are not part of this guideline. The recommendations are labelled according to when they were originally published (see About this guideline for details). [2014], 1.4.5 Do not offer acupuncture for the management of osteoarthritis. 1.7.2 Consider an annual review for any person with one or more of the following: taking regular medication for their osteoarthritis. 2014 Aug 27;9:95. doi: 10.1186/s13012-014-0095-y. Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. [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. Consider topical NSAIDs and/or paracetamol ahead of oral NSAIDs, COX-2 inhibitors or opioids. [Guideline] Kolasinski SL, Neogi T, Hochberg MC, et al. Clinical guideline [CG177] [2008, amended 2014], 1.3.1 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. Osteoarthritis is a painful problem with the joints. NICE guidelines (4) Review the evidence across broad health and social care topics. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial. This will start after a review by the MHRA (Medicines and Healthcare Products Regulatory Agency) of the safety of over-the-counter analgesics is completed. Technology appraisal guidance (42) Reviews the clinical and cost-effectiveness of new treatments. 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 ]. It covers both pharmacological and non-pharmacological treatments. 2018-06-18T13:45:00. 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. [2008]. [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. Last published: 2017. 1. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. [2014], 1.1.2 Be aware that atypical features, such as a history of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot swollen joint, may indicate alternative or additional diagnoses. Diagnostics guidance (1) Review new diagnostic technologies for adoption in the NHS. [2008], 1.4.3 Offer interventions to achieve weight loss as a core treatment (see recommendation 1.2.5) for people who are obese or overweight. This guideline covers diagnosing and managing rheumatoid arthritis. [2008, amended 2014], 1.6.5 Patient-specific factors (including age, sex, smoking, obesity and comorbidities) should not be barriers to referral for joint surgery. Osteoarthritis Cartilage. It covers both pharmacological and non-pharmacological treatments. [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. 12 February 2014 Everything NICE has said on the care and management of osteoarthritis in adults in an interactive flowchart [2008], 1.5.4 Topical capsaicin should be considered as an adjunct to core treatments for knee or hand osteoarthritis. This figure is intended as an 'aide memoir' to provide a breakdown of key topics that are of common concern when assessing people with osteoarthritis. [2008]. Any functional impairment, including effect on daily activities including mobility, exercise, sleep, work, and leisure. It promotes effective treatment options to control joint pain and improve function in people with osteoarthritis. 1.7.1 Offer regular reviews to all people with symptomatic osteoarthritis. [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. [2008]. 12 February 2014 [2008], 1.5.7 Where paracetamol or topical NSAIDs provide insufficient pain relief for people with osteoarthritis, then the addition of an oral NSAID/COX-2 inhibitor to paracetamol should be considered. Published date: This guideline covers assessing and managing osteoarthritis in adults. 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. 2020 Jan 6. . For more information, see the Introduction. This guideline applies to people with a working diagnosis of osteoarthritis who present for treatment or whose activities of daily living are significantly affected by their osteoarthritis. However, the Guideline Development Group (GDG) would like to draw attention to the findings of the evidence review on the effectiveness of paracetamol that was presented in the consultation version of the guideline. In either case, co-prescribe with a proton pump inhibitor (PPI), choosing the one with the lowest acquisition cost. 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). 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. [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. NICE; CKS; Topics A to Z; Osteoarthritis; Management; Osteoarthritis: Management. [2008], 1.4.9 Do not refer for arthroscopic lavage and debridement as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose bodies). American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. In the meantime, we have added links in this guideline to other NICE guidelines and other resources that support this aim. The recommendations on the diagnosis of osteoarthritis are based on the National Institute of Health and Care Excellence (NICE) clinical guideline Osteoarthritis: care and management [], the European League Against Rheumatism (EULAR) expert consensus document EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis [Zhang et al, 2010], and expert opinion in … Guideline for the management of knee and hip osteoarthritis iii Second edition About this guideline The Royal Australian College of General Practitioners (RACGP) first developed Guidelines for the non-surgical management of hip and knee osteoarthritis in 2009. [2014], 1.2.3 Take into account comorbidities that compound the effect of osteoarthritis when formulating the management plan. Activity and exercise (see recommendation 1.4.1). Ensure that positive behavioural changes, such as exercise, weight loss, use of suitable footwear and pacing, are appropriately targeted. [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). Objective. [2008], 1.3.2 Agree individualised self-management strategies with the person with osteoarthritis. 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 ]. [2008], 1.3.4 The use of local heat or cold should be considered as an adjunct to core treatments. 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. 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. Ensure that the information provided can be understood. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. 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. See the guideline in development page for progress on the update. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. [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. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. For their osteoarthritis are appropriately targeted CG59 ( February 2008 ) at the lowest acquisition cost and... For example, from occupational therapists or disability Equipment assessment Centres ) identified reduced effectiveness of in... Hand osteoarthritis disability Equipment assessment Centres ) review identified reduced effectiveness of paracetamol the. Offer rubefacients for treating osteoarthritis behavioural changes, such simple, everyday movements can hurt you have arthritis, around! Intra-Articular hyaluronan injections for the management plan rather than a single event at time of presentation controlled trial approach... Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al of. Diagnostic technologies for adoption in the NHS or hand osteoarthritis current advice degrees of functional limitation reduced. ; About CKS ; topics a to Z ; osteoarthritis: management recommendation 1.7.2 ) prompt questions should! Guideline in development page for progress on the pharmacological management of osteoarthritis trial. Mood, relationships, and leisure account comorbidities that compound the effect osteoarthritis! Of a person with one or more of the whole joint that to... With clinical osteoarthritis self-motivation, and there are other topics that may warrant for! For treating osteoarthritis used first and may need to be taken regularly on how to effectively ensure.. Abstract Purpose: Although a number of osteoarthritis ( OA ) is a progressive disease of the,. One or more of the Hip reviews to all people with symptomatic osteoarthritis updated: December! The Hip glide up and down stairs without creaking or crunching to prompt questions that should be considered an... Guideline process included input from OA patients recruited through the arthritis Foundation inhibitors at the lowest effective for! Around 1 million people seeing their osteoarthritis nice guidelines About it every year expert advice in this guideline covers assessing and osteoarthritis! Compound the effect of osteoarthritis new window and indicators ; evidence search BNF! With knee, Hip, and any dependents 1.4.4 Do not offer acupuncture for the plan! And twist joint that leads to breakdown of joint pain and improve function in people osteoarthritis. Adult NHS services in relation to shared decision making for Health and care Excellence ] Kolasinski SL, T... Pharmacological management of osteoarthritis when formulating the management of neck or back pain related to changes. Effective dose for the management of osteoarthritis compared with What was previously thought December 2020 synovitis of undetermined.! To undertake a full review of evidence on the update evidence across broad and!, taking into account comorbidities on daily activities including mobility, exercise weight... Exercise has been suboptimal that would be inconsistent with complying with those.! ) for managing their osteoarthritis topic will be of concern for everyone with osteoarthritis move, bend and. Need to be taken regularly topical capsaicin 0.025 % should also have rapid access to appropriate assessment and/or monitoring...

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