Britons with arthritis are being urged to lose weight and exercise more rather than rely on painkillers as the main therapy for their condition.
NHS Guidance National Institute for Excellence in Health and Care (Nice) says that overweight people should be told that their pain can be reduced if they lose weight.
Aerobic exercise, such as walking, as well as strength training, can relieve symptoms and improve quality of life. Exercise programs may initially worsen the pain, but this should subside, the guide suggests.
The guidelines also make recommendations about medication use, such as offering nonsteroidal anti-inflammatory drugs (NSAIDs), but not offering acetaminophen, glucosamine, or strong opioids.
Nice said there was a risk of addiction with strong opioids, while evidence suggests little or no benefit from some drugs when it comes to quality of life and pain levels.
In the guide, doctors are told to diagnose osteoarthritis, the most common form of arthritis, without further investigation in people aged 45 and older who have activity-related joint pain.
Patients must not have joint-related morning stiffness, or morning stiffness lasting more than 30 minutes, to be diagnosed in this way.
The draft guidelines say that people can be offered personalized exercise programswith the explanation that “performing regular and constant exercise, although it may initially cause discomfort, will be beneficial for your joints”.
Long-term exercise also increases health benefits, the guideline adds.
When it comes to weight loss, people are told that “any amount of weight loss is likely to be beneficial, but losing 10% of your body weight is probably better than 5%.”
People may also be referred for hip or knee replacement if their condition cannot be managed otherwise, and referrals should not be delayed due to age, gender, or obesity.
Dr Paul Chrisp, director of the Nice guidelines centre, said: “Osteoarthritis can cause discomfort and prevent people from carrying out some of their normal daily activities.
“However, there is evidence to show that muscle strengthening and aerobic exercise can have an impact not only in managing the condition, but also in giving people a better quality of life.
“Beginning that journey can be uncomfortable for some people at first, and they need to be supported and given enough information to help them manage their condition over a long period of time.
“While topical and sometimes oral NSAIDs remain an important treatment option for osteoarthritis, we have made the decision not to recommend some pain relievers, such as acetaminophen and some opiates for osteoarthritis.
“This is because new evidence has shown there was little or no benefit to people’s quality of life, pain or psychological distress, and particularly for strong opioids, there was evidence that they can cause harm to long term, including possible addiction. ”
In the UK, more than 10 million people have arthritis or other similar conditions that affect the joints. The most affected areas are the knees, hips and the small joints of the hands.
Tracey Loftis, director of policy and public affairs at the Versus Arthritis charity, said: “We have seen first-hand the benefits that people with osteoarthritis can reap from being able to access appropriate physical activity, especially when in a group setting. Something like exercise can improve a person’s mobility, help control their pain, and reduce feelings of isolation.
“But our own research into the support provided to people with osteoarthritis showed that many do not have their conditions checked regularly by healthcare professionals, and even fewer have had the opportunity to access physical activity support.
“The lack of alternatives means that, in many cases, many people are stuck on painkillers that don’t help them live a pain-free life.
“While we welcome the Nice draft guidelines, health professionals need more resources and support to better understand their role in promoting treatments such as physical activity for people with osteoarthritis.
“Clearly, there is a need for people with arthritis to have more of a voice so that their health needs are not ignored.”
