Home Forums General Medicine OSTEO ARTHRITIS IN ADULTS- CARE AND MANAGEMENT.

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      Anonymous
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      The 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 activities

      Management

      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 OA

      Adjunctive 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 treatment

      Consider 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
      TENS

      Referral 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.

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