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Guideline of the month – NICE osteoarthritis quality standards

The guideline

NICE has released a series of quality standards for osteoarthritis patients to improve the care of adults with OA, including symptom control, self-management and the referral pathways for joint surgery.

Key points for GPs

• Patients newly diagnosed with OA should have an assessment that includes pain, impact on daily activities and quality of life.

• Patients should participate in developing a self-management plan that directs them to any support they need.

• Non-surgical core treatments should be the mainstay for at least three months before any referral for consideration of joint surgery.

• GPs should not use scoring tools to identify which patients with OA are eligible for referral for consideration of joint surgery, as there is no evidence to support them.

• The timing of the patient’s next review should be discussed and agreed between GP and patient.

Practical issues

Although the quality standards recommend against the use of scoring tools for referral for consideration of surgery, some CCGs still insist on an Oxford hip or knee score before referring eligible patients.

Expert comment

Dr Jens Foell, a GPSI in musculoskeletal medicine in London: ‘The quality standards promote physical activity, weight loss (if needed), information about the condition and exercises as core treatments: a de-medicalising strategy in a medical setting.

‘[But] these standards are highly political in the way they ask for an infrastructure of healthcare services that move away from crisis management and ad hoc care to organised, timed reviews, goal-setting and proactive monitoring.

‘We will need to be patient to see in 15 years’ time what happened to the current cohort of adults over 45 years who present in primary care with joint pain and stiffness lasting less than 30 minutes, and a follower of these OA standards diagnoses them clinically and has the support to help them in their self-management.’

The guideline

NICE 2015. Osteoarthritis quality standard.


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