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NICE Guideline for Osteoarthritis Emphasises Exercise, Weight Loss, and Pain Relief

LONDON -- February 27, 2008 -- New national standards for osteoarthritis encourage core lifestyle changes to help ease patients' pain and symptoms. The guideline, issued by the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care, also outlines effective pharmaceutical treatments.

The guidelines also call for healthcare professionals to provide verbal and written information to all people with osteoarthritis to enhance understanding of the condition and its management and to counter patient misconceptions, such as the notion that osteoarthritis is part of aging and cannot be treated.

Key recommendations from the guideline include:
· An exercise regimen that includes local muscle strengthening and aerobic exercise should be a core treatment for people with osteoarthritis, irrespective of age, other illnesses or conditions, pain, or disability.

· People with osteoarthritis who are overweight or obese should be supported to lose weight.

· Healthcare professionals should consider offering topical NSAIDs for pain relief in addition to core treatment to people with knee or hand osteoarthritis. Topical NSAIDs and/or paracetamol should be considered ahead of oral NSAIDs, COX-2 inhibitors, or opioids.

· Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatment.

· When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor. In either case, these should be co-prescribed with a proton pump inhibitor (PPI) to reduce unwanted side effects.

· Referral for joint replacement surgery should be considered for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and do not respond to nonsurgical treatment. Referral should be made before there is prolonged and established functional limitation and severe pain.


SOURCE: National Institute for Health and Clinical Excellence

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