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Osteoarthritis (OA) is a joint degenerative disease that seriously affects patients' quality of life, which puts a heavy burden on patients, families and society. OA can not only cause joint pain, malformation and dysfunction, but also significantly increase the risk of cardiovascular events, deep vein thromboembolism in the lower limbs, hip fracture and all-cause mortality. According to literature reports, there are currently more than 300 million OA patients worldwide, and the overall prevalence of primary OA among people over 40 years old in my country has reached 46.3%. At the same time, with the increasing aging of my country's population, the prevalence of OA has gradually increased. Therefore, standardized OA diagnosis and treatment are of great significance to clinical work and social development.
In recent years, my country has successively formulated and issued the "Clinical Practice Guidelines for the Management of Osteoarthritis in China (2020 Edition), "Guidelines for the Diagnosis and Treatment of Osteoarthritis (2021 Edition)" and "Expert Consensus on Clinical Drug Treatment of Osteoarthritis" to promote the standardized diagnosis and treatment of OA. On October 19, , the UK National Institute of Health and Clinical Optimization (NICE) released the "Guidelines for Diagnosis and Management of Osteoarthritis in for people older than 16 years old " to provide the latest OA diagnosis and treatment recommendations. This article mainly introduces the NICE guideline diagnosis, non-drug therapy, drug therapy and surgical treatment recommendations for OA for readers.
Diagnosis recommendations
1. Imaging examination is not required when diagnosing OA clinically: ≥45 years old, with joint pain related to activity, and no signs of morning stiffness, or the duration of morning stiffness does not exceed 30 minutes.
2. Do not routinely use imaging tests to diagnose OA unless there are atypical features or features that suggest additional diagnosis.
Non-drug treatment recommendations
Exercise therapy
1. For all OA patients, exercise therapy should be provided to them according to their respective needs (such as local muscle strengthening, aerobic fitness , etc.).
2. Consider supervised exercise therapy for OA patients.
3. Explain to OA patients that joint pain may increase when they start exercising:
➤Although it may cause pain or discomfort at the beginning, sticking to exercise is good for joints
➤Long-term adherence to exercise programs can reduce pain, improve body function and quality of life, thereby increasing the benefits of exercise
4. Consider combining exercise therapy with educational programs or behavioral change methods in a structured treatment program.
Control weight
5. For overweight or obese OA patients:
➤Suggest them to lose weight will improve their quality of life and body function and reduce pain
➤Support them to determine a weight loss target
➤ Explain to them that weight loss may be beneficial, but losing 10% may be better than losing 5%
Manual therapy (Manual therapy)
6.Popular people who consider manual therapy (such as operation, activity, or soft tissue technology): Hip or knee osteoarthritis, and are performed with exercise therapy.
7. When discussing whether to use manual therapy, it is necessary to explain to OA patients. There is insufficient evidence to support the use of manual therapy alone to treat OA.
acupuncture therapy
8. Do not use acupuncture or dry acupuncture therapy to treat OA.
electrotherapy
9. Because there is not enough evidence to prove its benefits, do not provide any of the following electrotherapy for OA patients:
➤ Percutaneous electrical nerve stimulation (TENS)
➤ Ultrasound therapy
➤ Interference wave therapy
➤ Laser therapy
➤ Pulse shortwave therapy
➤ Neuromuscular electrical stimulation (NMES)
Drug treatment recommendations
topical, oral and transdermal medication
1. If drug treatment is needed to control OA, please use:
➤ combined with non-drug treatment, support exercise therapy
➤ Use the lowest effective dose
2. Provide local non-steroidal anti-inflammatory drugs for patients with knee osteoarthritis.
3. For OA patients who involve other joints, local nonsteroidal anti-inflammatory drugs can be considered.
4. If topical medications are ineffective or inappropriate, consider oral NSAIDs to patients with OA and consider:
➤ Potential gastrointestinal, kidney, liver and cardiovascular toxicity
➤ Any risk factors that patients may have, including age, pregnancy, existing drug treatment and comorbidity
(providing gastroprotective treatment, such as proton pump inhibitors, for patients who are taking NSAIDs).
5. Do not prescribe paracetamol or weak opioids routinely unless:
➤ Use only for short-term pain relief
➤ All other medications are contraindications, intolerance or ineffective
6. Do not provide glucosamine or strong opioids for OA patients.
7. If an OA patient asks about glucosamine or strong opioids, the explanation is as follows:
➤ There is no strong evidence that glucosamine is beneficial to the human body
➤ The risk of strong opioids is greater than the benefit of treatment
8. Work with the patient to decide whether to continue treatment. Determine the frequency of reexamination according to clinical needs.
Intra-articular injection of
9. Do not provide intra-articular injection of hyaluronic acid to treat OA.
10. When other drugs are ineffective or inappropriate, consider intra-articular injection of glucocorticoid or induce exercise therapy. And explain to the patients that these methods can only achieve short-term remission (2-10 weeks).
Surgery treatment recommendations
1. If the following conditions are present, consider joint replacement in patients with hip arthritis , knee arthritis or shoulder osteoarthritis:
➤ Joint symptoms (such as pain, stiffness, hypofunction or progressive joint deformity) seriously affect the patient's quality of life
➤ Non-surgical treatment (e.g., exercise therapy, weight loss, pain relief) is ineffective or inappropriate
2. When deciding to recommend a patient to undergo joint replacement, clinical evaluation should be used instead of numerical scoring systems to evaluate the severity of the disease.
3. Do not exclude OA patients from arthroplasty for the following reasons:
Age, gender, smoking, comorbidity, overweight or obesity (based on measurements of body mass index [BMI], etc.).
4. When discussing joint replacement, explaining the risk of joint replacement to the patient may depend on the factors listed in the above 3 items.
5. Do not provide arthroscopic lavage or debridement treatment for OA patients.
download link : https://www.nice.org.uk/guidance/ng226/resources/osteoarthritis-in-over-16s-diagnosis-and-management-pdf-66143839026373
References:
1. Articulation Surgery Group of the Orthopedic Branch of the Chinese Medical Association, Osteoarthritis Group of the Orthopedic Physicians Branch of the Chinese Medical Association, National Clinical Medical Research Center for Elderly Diseases (Xiangya Hospital), et al. Guidelines for Diagnosis and Treatment of Osteoarthritis (2021 Edition) [J]. Chinese Journal of Orthopedics, 2021, 41(18):1291-1314. DOI:10.3760/cma.j.cn121113-20210624-00424.
2.NICE guideline. Published: 19 October 2022.www.nice.org.uk/guidance/ng226.
