Don’t wait for pain to replace joints say health experts

Experts at the National Institute for Health and Care Excellence (Nice) said there was a “mistaken belief” that osteoarthritis is an inevitable part of ageing and will only get worse.

The “core treatment” for the condition, which is the most common type of arthritis in the UK, is exercise, which can help relieve pain for some people and improve function, Nice said in new guidance for the NHS.

Those who are overweight should be encouraged to lose weight while drugs such as paracetamol and ibuprofen gel should be considered for pain relief.

The guidance said patients should be referred for consideration of replacement surgery for hips or knees before mobility is reduced over a long period of time and patients are in severe pain.

Nice warns doctors that a patient’s age, sex, smoking history or whether they are obese “should not be barriers to referral for joint surgery”.

Around a million people see their GP about osteoarthritis every year and it accounts for 115,000 hospital admissions. The NHS in England and Wales performs over 140,000 hip and knee replacement operations annually.

The guidance said GPs can diagnose osteoarthritis in the practice if a person is 45 or over and has activity-related joint pain with either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.

Philip Conaghan, professor of musculoskeletal medicine at Leeds University, said: “The symptoms often caused by osteoarthritis, such as pain and limited joint movement, can be managed with muscle strengthening, exercise and weight loss if people are overweight. If a person is still experiencing pain that interferes with their daily life despite addressing these core treatments and use of analgesics as appropriate, then the guideline makes a new recommendation that the person be referred for consideration of joint surgery before there is prolonged limited joint movement and severe pain.

Prof Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “These guidelines should help challenge the perception that many people often have about osteoarthritis being a normal part of ageing and that ‘nothing can be done’.”

Prof Alan Silman, who is the medical director of Arthritis Research UK, said: “Joint replacement can make an enormous difference to people with severe osteoarthritis, and we’re very pleased that the new guidelines recommend surgery before their pain becomes severe and restricts their everyday activities, rather than having to wait until they are incapacitated.

“Exercise and keeping moving is one of the most effective ways in which people with osteoarthritis can help themselves.

“It’s important that people with osteoarthritis find a type of exercise they enjoy doing and keep doing it.”