Care and Management of Osteoarthritis in Adults ( UK Guidelines)

Summary:
on OA assessment and treatment in Adults.

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.

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

G MOHAN.