Prioritise exercise to manage osteoarthritis, says NICE

Exercise has an important role to play in helping people to manage osteoarthritis, the National Institute for Health and Care Excellence (NICE) has emphasised in updated guidance.

The draft guideline says clinical evidence shows that, when people with osteoarthritis are offered tailored exercises (such as muscle strengthening and aerobic exercise), they can achieve good health outcomes.

Osteoarthritis is the most common form of arthritis, and one of the leading causes of pain and disability worldwide.

It is estimated there are approximately 7.4 million people in England over the age of 45 who have been identified as having osteoarthritis. The most affected joints are the knees, hips and small hand joints

NICE has recommended as a result that, rather than offering painkillers or other medication, healthcare professionals should consider exercise, alongside providing evidence-based information to support those with the condition in a structured way.

For people who are also overweight, the priority should be helping them choose a weight loss goal to help manage symptoms, NICE has added.

This is because losing weight can help to reduce joint pain for people with osteoarthritis, as well as of course having a significant impact on health outcomes for a range of conditions.

Dr Paul Chrisp, director for the Centre for Guidelines at NICE, said: “Osteoarthritis can cause people discomfort and prevent them from undertaking some of their normal daily activities.

“However, there is evidence which shows muscle strengthening and aerobic exercise can have an impact on not just managing the condition, but also providing people with an improved quality of life.

“Beginning that journey can be uncomfortable for some people at first, and they should be supported and provided with enough information to help them to manage their condition over a long period of time,” he added.

The guidance also makes the point that, while topical and oral non-steroidal anti-inflammatory drugs (NSAIDs) remain an important treatment option for osteoarthritis, some painkillers, such as paracetamol, and some opioids are now not recommended for osteoarthritis.

“This is because new evidence has shown there was little or no benefit to people’s quality of life, pain or psychological distress and, particularly in the case of strong opioids, there was evidence that they can cause harm in the longer term, including possible addiction,” said Dr Chrisp.

The draft guideline also recommends diagnosing osteoarthritis clinically without the need for imaging in people who are over 45, have activity-related joint pain and have either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.

The draft guideline is now open for public consultation until 15 June.