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GPs reassured over treatment of hip arthritis

Standard practice in the treatment of arthritis of the hip has received the backing of new Europe-wide guidelines.

GPs should use opioids if NSAID therapy fails to control symptoms, the European League Against Rheumatism has advised.

It said GPs should use up to 4mg of paracetamol first-line, before moving to an NSAID or a Cox-2 inhibitor if symptoms are not controlled. Opioids should then be used if other drugs fail or are contraindicated.

The new guidance will give GPs renewed confidence in treating patients with arthritis of the hip, according to Dr Graham Davenport, president of the Primary Care Rheumatology Society and a GP in Wrenbury, Cheshire. He said: 'It's good to have this down

in print as reassurance that what we are doing is right.'

He added that the use of opioids outside of palliative care had worried GPs, but those concerns were now easing and GPs were using them to appropriately treat osteo-arthritis.

GPs have also been advised that supplements such as glucosamine and avocado soybean are safe and have a proven symptomatic effect, although Dr Davenport said studies on glucosamine had only been done in knee osteoarthritis.

The new advice on managing hip osteoarthritis was introduced at the annual European congress of rheu- matology in Berlin last week. It follows guidance from NICE, which also recommended Cox-2s inhibitors in patients at high risk of gastrointestinal problems.

Main EULAR recommendations

lStep up therapy from paracetamol to NSAID (or Cox-2 inhibitors) and then opioids

lAdvise weight loss, exercise and appliances

if necessary

lSteroid injections in secondary care for

flare-ups

lJoint replacements to be considered for pain and disability

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