Exercise: the key to living with osteoarthritis 

Updated national guidelines on what people with osteoarthritis can expect from the NHS have been published. Arthritis Today tells you what you need to know.
The importance of exercise as a core treatment for people with osteoarthritis was underlined in guidance issued by the National Institute for Health and Care Excellence (NICE) in February. 

Physical activity can not only help to relieve pain for some people but also improves function, says NICE. Meanwhile, another recommendation details the benefits of offering advice on ways to lose weight for people with osteoarthritis who are overweight or obese, helping them self-manage their condition. Patients should be referred for consideration of joint replacement surgery – such as hips or knees – before their mobility is reduced over a long period of time and they 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". Patients will also be offered regular reviews, monitoring symptoms and the impact of the condition on everyday activities and other issues, plus annual reviews for people with osteoarthritis in specific situations. 

Professor Alan Silman, medical director of Arthritis Research UK, broadly welcomed the new guidelines as providing clear, positive messages for people with osteoarthritis. 

He said: “Exercise and keeping moving is one of the most effective ways in which people with osteoarthritis can help themselves, and the core treatments in the guidelines reinforce the importance of keeping active, keeping to a healthy weight, and having access to the right information. 

“It’s important that people with osteoarthritis find a type of exercise they enjoy doing and keep doing it. Everyone can benefit from some sort of exercise, regardless of their condition. Stretching, strengthening and aerobic exercises are the ideal combination to ease stiffness, improve movement in the joints and strengthen muscles. 

“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.” 

NICE is currently reviewing recommendations on the use of paracetamol for the condition after draft guidance published last year said the drug should be used cautiously and was less effective than previously thought. 

At that time, NICE warned of "extreme concern" that higher doses of paracetamol could lead to multiple adverse effects, including heart, kidney and intestinal problems, and recommended GPs only prescribe the lowest effective dose for the shortest possible time. 

However, the Medicines and Healthcare products Regulatory Agency (MHRA) is now carrying out a wide-ranging review of over-the-counter medication for osteoarthritis, and until that work is completed NICE has said it will continue to recommend paracetamol as an option. 

Dr Tom Margham, primary care lead for Arthritis Research UK and a GP in London, commented: “The new guidelines underline the importance of tailoring care to the needs of the individual. A regular review between the GP or nurse and the patient can be used to understand the impact osteoarthritis is having on them. Once these needs are known patients can be given the support they need, whether that be information and education about their condition, specific treatments and support to help them manage their joint pain. 

However, in real life many people with osteoarthritis are not routinely offered a review by their GP. Often people with osteoarthritis suffer in silence, thinking nothing much can be done – but there are lot of things that can be done to help them manage their joint pains, which can be explored during a review.” 

NICE has also recommended a new key area for research – looking at ways to delay disease progression. Arthritis Research UK is currently investing a considerable amount of research in developing new treatments that could delay the need for joint replacement surgery and also lead to better pain relief. 

NICE guidelines in a nutshell

 Core treatment:

• information, advice and education to support self-management
• exercise – irrespective of someone’s age, pain severity or disability – to include muscle strengthening and general aerobic fitness
• weight loss for those who are overweight

Other approaches should include: 

• paracetamol and topical non-steroidal anti-inflammatory creams; manipulation and stretching; the use of hot and cold treatments; capsaicin cream; advice on appropriate footwear and bracing, joint supports and insoles; steroid injections, TENS machines, non-steroidal anti-inflammatory drugs (NSAIDs) prescribed with a stomach-protecting drug called a PPI, and the use of assistive devices such as tap-turners and walking sticks 
• patients being referred for joint replacement surgery before pain becomes severe and their ability to perform everyday activities is limited 
• regular reviews with a GP to discuss treatment and monitor the course of the condition.

What’s not recommended: 

• hyaluronic acid injections 
• glucosamine 
• acupuncture

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