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Guidelines - Osteoarthritis
This tool provides information to facilitate the management of osteoarthritis (general) in adults.
Focused examination
1. Patient History
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Rule out risk factors for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.
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Address prognostic factors that may delay recovery.
Major structural or other pathologies (red flags):
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History of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms or the presence of a hot, swollen joint, history of malignancy, vertebral infection, osteoporotic fractures, traumatic fracture, myelopathy, brain haemmorrhage/mass lesion, inflammatory arthritis
Examples of other conditions/co-morbidities:
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Physical conditions: back pain, headache
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Psychological symptoms: depression, anxiety
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Co-morbidities: diabetes, heart disease
Examples of prognostic factors that may delay recovery:
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Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization
2. Physical Examination
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Rule out major structural or other pathologies.
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Diagnose osteoarthritis clinically without investigations if a person is over 45 years of age AND has activity-related joint pain AND has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.
3. Management
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Offer information on nature, management, and the course of osteoarthritis.
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Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.
Non-pharmacological management of osteoarthritis
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider local muscle strengthening and general aerobic exercise
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Consider heat/cold
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Consider manipulation and stretching (particularly for osteoarthritis of the hip)
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Consider interventions to achieve weight loss for those who are overweight or obese
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Consider transcutaneous electrical nerve stimulation (TENS) for pain relief
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Consider appropriate footwear with shock-absorbing properties
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Consider assessment for bracing/joint supports/insoles
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Consider assistive devices (e.g., walking sticks and tap turners)
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Do not offer acupuncture
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Do not offer glucosamine or chondrotin products
Pharmacological management of osteoarthritis
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider oral analgesics
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Consider topical treatments
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Consider non-steroidal anti-inflammatory drugs and highly selective COX-2 inhibitors
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Consider intra-articular injections
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Do not offer intra-articular hyaluronan injections
Invasive management of osteoarthritis
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice):
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Do not refer for arthroscopic lavage and debridement 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)
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
Care Pathway for the management of osteoarthritis
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors that may delay recovery.
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms or new physical or psychological symptoms.