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National Clinical Guideline Centre (UK). Osteoarthritis: Care and Management in Adults. London: National Institute for Health and Care Excellence (UK); 2014 Feb. (NICE Clinical Guidelines, No. 177.)
Update information: December 2020: in the recommendation on adding opioid analgesics NICE added links to other NICE guidelines and resources that support discussion with patients about opioid prescribing and safe withdrawal management. For the current recommendations, see www.nice.org.uk/guidance/CG177/chapter/recommendations.
Q.1. Recommendations to be deleted
The table shows recommendations from 2008 that NICE proposes deleting in the 2014 update. The right-hand column gives the replacement recommendation, or explains the reason for the deletion if there is no replacement recommendation.
| Recommendation in 2008 guideline | Comment |
|---|---|
| R15. Electro-acupuncture should not be used to treat people with osteoarthritis. | Replaced by: 17. Do not offer acupuncture for the management of osteoarthritis. [2014] |
| R19. The use of glucosamine or chondroitin products is not recommended for the treatment of osteoarthritis. | Replaced by: 16. Do not offer glucosamine or chondroitin products for the management of osteoarthritis. [2014] |
Q.2. Amended recommendation wording (change to meaning)
Recommendations are labelled [2008, amended 2014] if the evidence has not been reviewed but changes have been made to the recommendation wording (indicated by highlighted text) that change the meaning.
| Recommendation in 2008 guideline | Recommendation in current guideline | Reason for change |
|---|---|---|
R5. Healthcare professionals should offer all people with clinically symptomatic osteoarthritis advice on the following core treatments.
| 6. Offer advice on the following core treatments to all people with clinical osteoarthritis.
| The GDG feels that the term ‘clinical osteoarthritis’ is accurate. For most clinicians this would mean ‘symptomatic osteoarthritis’ (for which analgesia is offered), but advice on core treatments should also be offered to people with asymptomatic osteoarthritis. |
| R20. Referral for arthroscopic lavage4 and debridement should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (not gelling, ‘giving way’ or X- ray evidence of loose bodies). 4This recommendation is a refinement of the indication in Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis (NICE interventional procedure guidance 230). This guideline reviewed the clinical and cost-effectiveness evidence, which led to this more specific recommendation on the indication for which arthroscopic lavage and debridement is judged to be clinically and cost effective. | 21. Do not refer for arthroscopic lavage and debridement4 as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, ‘giving way’ or X-ray evidence of loose bodies). [2008, amended 2014] 4This recommendation is a refinement of the indication in Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis (NICE interventional procedure guidance 230 [2007]). The clinical and cost-effectiveness evidence for this procedure was reviewed for the original guideline (published in 2008), which led to this more specific recommendation on the indication for which arthroscopic lavage and debridement is judged to be clinically and cost effective. | The GDG felt that ‘as opposed to morning joint stiffness’ is clearer than ‘not gelling’. The footnote wording has also been amended for clarity. |
| R34. Referral for joint replacement surgery should be considered for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. Referral should be made before there is prolonged and established functional limitation and severe pain. R35. Patient-specific factors (including age, gender, smoking, obesity and comorbidities) should not be barriers to referral for joint replacement surgery. | 37. Consider referral for joint surgery for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. [2008, amended 2014] 38. Refer for consideration of joint surgery before there is prolonged and established functional limitation and severe pain. [2008, amended 2014] 39. Patient-specific factors (including age, sex, smoking, obesity and comorbidities) should not be barriers to referral for joint surgery. [2008, amended 2014] | The GDG felt that the message of original recommendation 34 was clearer if it was split into 2 separate recommendations (37 and 38). The GDG removed the word ‘replacement’ from these recommendations, because it noted that the evidence reviewed to inform the recommendations on surgery made in 2008 had included evidence on both joint replacement and arthroplasty (which includes procedures such as joint remodelling or realignment). The GDG therefore felt that using the wording ‘joint replacement’ in the recommendations was unduly restrictive. |
| 36. Decisions on referral thresholds should be based on discussions between patient representatives, referring clinicians and surgeons, rather than using current scoring tools for prioritisation. | 36. Base decisions on referral thresholds on discussions between patient representatives, referring clinicians and surgeons, rather than using scoring tools for prioritisation. [2008, amended 2014] | The word ‘current’ has been removed so that the recommendation remains valid over time. |
Q.3. Changes to recommendation wording for clarification only (no change to meaning)
| Recommendation numbers in current guideline | Comment |
|---|---|
| 3, 4, 5, 6, 7, 9, 10, 12, 14, 18, 20, 21, 24, 29, 36 | Recommendations have been edited into an active style and to ensure consistency. |
| 11, 13, 15, 18, 19, 20, 23, 32 | Change from ‘core treatment’ to ‘core treatments’. |
| 5 | Change to the verb used (‘Discuss…’) and change from a statement to an action (‘Ensure that…). |
| 7, 9, 10 | Change from a statement to an action (‘Ensure that…). |
| 12 | Change from a statement to an action (‘Advise …’). |
| 14 | Change from a statement to an action (‘Offer…’). |
| 24 | Change from statement to an action ‘Rubefacients are not recommended…’ to ‘Do not offer rubefacients…’ |
- Recommendations from NICE clinical guideline 59 (2008) that have been deleted or...Recommendations from NICE clinical guideline 59 (2008) that have been deleted or changed - Osteoarthritis
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