Navigating the New NICE Guidance

1. Diagnosis and assessment of osteoarthritis

Osteoarthritis is the form of arthritis that you get from either injury to a joint or wear and tear to joints over time.

It is recommended that your doctor can diagnose osteoarthritis without any other tests if you:

• Are age 45 or older AND

• Have pain in your joints when you do physical activity AND

• Do NOT have stiff joints first thing in the morning, or have stiffness in the morning that lasts for less than 30 minutes after you start moving around

If you have any symptoms other than these, your doctor should arrange for additional tests or imaging.

2. Information and support

The guidance is very clear that all patients should be able to access information and follow recommendations specific to your own set of symptoms. This means that if you have arthritis, you should actively participate in your own care, including sharing any decisions on treatment (in other words, not just rely on your doctor). These decisions need to take into account any other health problems you might have.

3. Treatment

a. This is where the main change in the recommendations has taken place.

NICE is now keen that you try to use exercise as the first port of call in managing your arthritis. You should be provided with an exercise program unique to you and your set of symptoms which can be done with a trained professional if you need support.

They acknowledge that this activity may be painful to start with but doing it regularly and long-term will ultimately have benefits. Combining this with weight loss, if required, will help the most.

b. If you need pain relief at the end of all this, consider the use of a topical non-steroidal anti-inflammatory drug (NSAID), such as a gel, if you have osteoarthritis in your knee or an oral NSAID if you have osteoarthritis in other joints.

If topical medicines are not suitable for you or not working for your osteoarthritis, you can consider taking an oral NSAID, (taking account of potential gastrointestinal, renal, liver and cardiovascular toxicity, any risk factors you have including age, pregnancy along with current medication and comorbidities, as advised by your doctor). Flarin is one example of an oral NSAID, in this case ibuprofen, that may be suitable (other brands are available).

The recommendations say you should not routinely be offered paracetamol, glucosamine or opioids, as there is no evidence they help.

So, in short, exercise first, if that doesn’t help, you can consider pain relief in the form of a topical gel, or an anti-inflammatory over the counter medication, like Flarin.

Flarin, as effective as twice the dose of standard ibuprofen without a prescription