GPs should prescribe suitable exercises and weight loss to relieve osteoarthritis

NICE’s updated draft guidelines placed more emphasis on exercise and weight loss in patients with osteoarthritis, with the use of strong painkillers not being advised.

GPs should offer tailored therapeutic exercises, such as aerobic activity or muscle strengthening, to all people with the disease and consider offering education or behavior change programmes, NICE said. .

Recommendations submitted for consultation until June 15 say evidence shows that exercise is more beneficial for people with osteoarthritis than other interventions and is safer than prescribing painkillers.

In addition to recommending exercise as a basic treatment for people with osteoarthritis, structured information and support should be provided to help set weight loss goals where appropriate.

General practitioners should recommend therapeutic exercises that are specifically aimed at preventing progression and managing symptoms and they should be tailored to the individual’s needs, such as joint site-specific exercises, the guidelines committee said.

NICE also noted that supervised exercise was likely to be more beneficial for people with osteoarthritis because it can increase adherence and social support.

Patients should be advised that joint pain may initially increase when they begin to exercise, but regular and regular exercise, although it may initially cause discomfort, will benefit patients. joints.

GPs should not routinely offer acupuncture or electrotherapy, but may consider walking aids for people with lower extremity osteoarthritis, according to guidelines.

Pharmacological treatments should be used at the lowest effective dose for the shortest possible duration, and topical NSAIDs should be the first choice for disease-induced joint pain.

Paracetamol and glucosamine should not be offered routinely, strong opioids should not be used, and weak opioids should only be used for short-term pain relief and when all other drug treatments are contraindicated, not tolerated or ineffective .

No changes have been made to previous recommendations that a diagnosis can be made without imaging in people over 45 years of age who have activity-related joint pain and who have either no morning joint stiffness or morning stiffness that lasts no more than 30 minutes.

Dr Paul Chrisp, director of the Center 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 that shows that muscle strengthening and aerobic exercise can have an impact not only on disease management, but also on improving people’s quality of life.

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

He added: “While topical and sometimes oral NSAIDs remain an important treatment option for osteoarthritis, we have made the decision not to recommend certain pain relievers, such as paracetamol and certain opioids for osteoarthritis.

“This is because new evidence has shown there is 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 could cause longer-term harm, including possible addiction. ‘

Draft NICE guideline: assessment and management of osteoarthritis

1.2.2 Explain to people with osteoarthritis that:

  • It is diagnosed clinically and does not require imaging and
  • The main treatments for the condition are therapeutic exercise and weight loss (if appropriate) along with information and support.

1.3.1 Offer therapeutic exercises suitable for all people with osteoarthritis (e.g. local muscle strengthening, general aerobic fitness)

1.3.2 Consider supervised exercise therapy for people with osteoarthritis

1.3.3 Advise people with osteoarthritis that joint pain may increase when they begin therapeutic exercise. Explain this:

  • Exercising regularly and regularly, although it may initially cause discomfort, will benefit their joints
  • Long-term adherence to exercise increases its benefits

1.3.4 Consider combining therapeutic exercise with an education program or behavior change approaches in a structured treatment program

1.3.5 For overweight or obese people with osteoarthritis:

  • Let them know that losing weight will improve their quality of life and physical function, and reduce pain
  • Help them choose a weight loss goal
  • Explain that any weight loss is likely to be beneficial, but losing 10% of body weight is likely to be better than 5%.

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