Oral analgesics

Evidence identified in surveillance suggests that paracetamol may not have a clinically important effect on pain in people with osteoarthritis. A review of oral analgesics was planned as part of the previous update of this guideline in 2014.

The following statement was included in the guideline in 2014: ‘NICE intends to undertake a full review of evidence on the pharmacological management of osteoarthritis. This will start after a review by the MHRA of the safety of over-the-counter analgesics is completed’.

The review from the Medicines and Healthcare products Regulatory Agency (MHRA) has been completed and further new evidence has been identified that may help to inform recommendations. Therefore, the planned full review of oral analgesics should be undertaken in an update to this guideline.

Decision: This section of the guideline should be updated.

Topical agents

The evidence identified in surveillance did not indicate a need to update this section of the guideline. However, part of a recommendation in this section states: ‘Consider topical NSAIDs and/or paracetamol ahead of oral NSAIDs, COX-2 inhibitors or opioids’. Any change to the recommended use of oral analgesics may impact on this recommendation.

Decision: This section of the guideline should be updated.

Intra-articular injections

Evidence identified in surveillance on the effects of both intra-articular hyaluronic acid and corticosteroids was inconsistent. A review of this section of the guideline is necessary to determine whether the recommendations to consider corticosteroids, but not to use hyaluronic acid, remain relevant.

Decision: This section of the guideline should be updated.

Electrotherapy (defined in the guideline as ultrasound, laser, transcutaneous electrical nerve stimulation, pulsed shortwave diathermy and interferential therapy)

New evidence suggested that the evidence-base has grown for some methods of electrotherapy that are not currently recommended in the guideline, particularly ultrasound and electromagnetic field therapy. A review of the evidence on electrotherapies in an update of the guideline is therefore necessary.

Decision: This section of the guideline should be updated.

We also found evidence that supports current recommendations on:

• the holistic approach to osteoarthritis assessment and management
• education and self-management
• other aspects of non-pharmacological management such as exercise, devices (including orthoses), acupuncture and nutritional supplements.

We did not find any evidence related to diagnosis, referral for consideration of joint surgery, or follow-up and review.

The sections of the guideline in which new evidence was found represent a substantial update of the guideline.

Overall, an update of the guideline with modified scope was thought to be necessary. The scoping work should consider:

• the areas in which surveillance found new evidence indicating a need to update the guideline
• whether the remaining areas of the guideline should be retained or included in the update.