Home › Forums › General Medicine › OSTEO ARTHRITIS IN ADULTS- CARE AND MANAGEMENT.
- This topic has 0 replies, 1 voice, and was last updated 1 year, 1 month ago by
Anonymous.
-
AuthorPosts
-
-
December 21, 2023 at 1:45 pm #2356
Anonymous
InactiveThe care and management of osteoarthritis in adults.- SHORT SUMMARY.
Holistic assessment
Assess effect of osteoarthritis (OA) on patient’s:
Function
Quality of life
Occupation
Mood
Relationships
Leisure activitiesManagement
In partnership with the patient, formulate and regularly review a management plan that includes core symptom-relieving treatment, adjunctive treatment and self-management.
Core symptom-relieving treatment
Offer verbal and written advice on:
OA and its management, to enhance understanding
Need for exercise to strengthen local muscle and improve aerobic fitness (irrespective of age, comorbidities and severity of OA)
Interventions to aid weight loss (if overweight)
Appropriate footwear in lower limb OAAdjunctive treatment
Consider the following pharmacological options:
Paracetamol (given regularly if needed)
Topical NSAIDs for knee or hand OA
Topical capsaicin for knee or hand OA
Intra-articular corticosteroid injections for moderate to severe pain
If paracetamol and/or topical NSAIDs are ineffective, consider:Adding opioid
Prescribing oral NSAID or COX-2 inhibitor in addition to paracetamol or instead of topical NSAID:
Co-prescribe with a proton pump inhibitor
Use lowest effective dose for shortest possible duration
Choose agent and dose on basis of risk factors for GI, liver and cardiorenal toxicity; monitor for any such effects
If patient is already taking low-dose aspirin for another condition, consider an alternative analgesic
Do not prescribe etoricoxib 60mg as first-line treatmentConsider the following non-pharmacological options:
Heat and cold packs
Transcutaneous electrical nerve stimulation (TENS)
Manipulation and stretching (particularly for hip OA)
Assessment for bracing, joint supports or insoles (for biomechanical joint pain or instability)
Assistive devices (eg, walking sticks, tap turners) to address specific problems. Seek expert advice if needed.Self-management
Exercise
Weight loss (if overweight)
Suitable footwear
Heat and cold packs
TENSReferral for surgery
Consider referral to joint surgery if symptoms continue to substantially affect quality of life despite medical treatment. Refer before there is prolonged and established functional limitation and severe pain.Consider referral for arthroscopic lavage and debridement only in patients with knee OA and clear history of mechnical locking in the knee.
Do not use scoring tools for prioritisation or refuse referral on grounds of age, gender, smoking, obesity, etc.
Treatments not recommended
Rubefacients
Intra-articular hyaluronan injections
Acupuncture
Chondroitin or glucosamine.NICE- Feb 2014.
G Mohan.
-
-
AuthorPosts
- You must be logged in to reply to this topic.