Excerpt

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. The management of neck or back pain related to degenerative changes in spine are not part of this guideline.

People presenting to health professionals with osteoarthritis complain of joint pain, they do not complain of radiological change. Thus, these guidelines are primarily about the management of older patients presenting for treatment of peripheral joint pain, treatment of the pain itself and of the consequences of such pain for patients who have a working diagnosis of osteoarthritis. The Guideline Development Group (GDG) recognised that many of the studies reviewed will have only included participants with symptomatic radiological osteoarthritis and that they are inferring any positive or negative treatment effects apply equally to those with or without radiological change.

The GDG considered the following to represent a clinician’s working diagnosis of peripheral joint osteoarthritis: persistent joint pain that is worse with use, age 45 years old and over, morning stiffness lasting no more than half an hour.

Contents

• Members of the Guideline Development Group
• Acknowledgements
• Preface
• Abbreviations
• Glossary
• Development of the Guideline
  • 1. Introduction
    • 1.1 What is osteoarthritis?
    • 1.2 Risk factors for osteoarthritis
    • 1.3 The epidemiology of osteoarthritis pain and structural pathology
    • 1.4 Prognosis and outcome
    • 1.5 The impact on the individual
    • 1.6 The impact on society
    • 1.7 Features of the evidence base for osteoarthritis
    • 1.8 The working diagnosis of osteoarthritis
    • 1.9 This guideline and the previous technology appraisal on COX-2 inhibitors
  • 2. Methodology
    • 2.1 Aim
    • 2.2 Scope
    • 2.3 Audience
    • 2.4 Involvement of people with osteoarthritis
    • 2.5 Guideline limitations
    • 2.6 Other work relevant to the guideline
    • 2.7 Background
    • 2.8 The process of guideline development
    • 2.9 Disclaimer
    • 2.10 Funding
  • 3. Key messages of the guideline
    • 3.1 Key priorities for implementation
    • 3.2 Algorithms
• The Guideline
  • 4. Holistic approach to oesteoarthritis assessment and management
    • 4.1 Principles of good osteoarthritis care
    • 4.2 Patient experience and perceptions
  • 5. Education and self-management
    • 5.1 Patient information
    • 5.2 Patient self-management interventions
    • 5.3 Rest, relaxation and pacing
    • 5.4 Thermotherapy
  • 6. Non-pharmacological management of osteoarthritis
    • 6.1 Exercise and manual therapy
    • 6.2 Weight loss
    • 6.3 Electrotherapy
    • 6.4 Acupuncture
    • 6.5 Aids and devices
    • 6.6 Nutraceuticals
    • 6.7 Invasive treatments for knee osteoarthritis
  • 7. Pharmacological management of osteoarthritis
    • 7.1 Oral analgesics
    • 7.2 Topical treatments
    • 7.3 NSAIDs and highly selective COX-2 inhibitors
    • 7.4 Intra-articular injections
  • 8. Referral for specialist services
    • 8.1 Referral criteria for surgery
  • 9. Areas for future research
• References
• Appendices
  • Appendix A Clinical questions and search strategies
  • Appendix B Scope of the guideline
  • Appendix C Details of the health economic cost-consequence table
  • Appendix D Details of the NSAID/COX-2 inhibitor health economic model
  • Appendix E Declarations of interests by Guideline Development Group members
  • References
• Evidence Tables
  • Compiled evidence tables - Chapter 4
  • Compiled evidence tables - Chapter 5
  • Compiled evidence tables - Chapter 6
  • Compiled evidence tables - Chapter 7
  • Compiled evidence tables - Chapter 8

Mission statement: The Royal College of Physicians plays a leading role in the delivery of high quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 20,000 Fellows and Members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.

The National Collaborating Centre for Chronic Conditions: The National Collaborating Centre for Chronic Conditions (NCC-CC) is a collaborative, multiprofessional centre undertaking commissions to develop clinical guidance for the NHS in England and Wales. The NCC-CC was established in 2001. It is an independent body, housed within the Clinical Standards Department at the Royal College of Physicians of London. The NCC-CC is funded by the National Institute for Health and Clinical Excellence (NICE) to undertake commissions for national clinical guidelines on an annual rolling programme.

Suggested citation:

National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults. London: Royal College of Physicians, 2008.