Non-pharmacological interventions in OA can include recommendations about exercise (muscle-strengthening and general aerobic fitness), weight loss, the use of suitable footwear with shock-absorbing properties, and braces/joint supports, as well as using aids such as walking sticks or tap turners.5
NICE says transcutaneous electrical nerve stimulation (TENS) can support pain relief, and suggests using local heat or cold alongside core treatments. However, it advises against offering glucosamine or chondroitin, or acupuncture.
Medication should be stepped up, depending on response. While the original guidelines from 2008 recommended paracetamol for pain relief, NICE now says that a subsequent review identified “reduced effectiveness of paracetamol in the management of OA compared with what was previously thought”.
Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) are the initial treatment options, ahead of oral NSAIDs, COX-2 inhibitors or opioids. Topical capsaicin may be offered, but rubefacients should be avoided.
Injecting corticosteroids into the joint may be suitable for moderate to severe pain, but intra-articular hyaluronan injections are not recommended. Joint surgery may be appropriate where there is a significant impact on quality of life and other treatments are not working. It can also be considered before there is prolonged and established functional limitation and severe pain.