Osteoarthritis: The care and management of osteoarthritis in adults
This is an extract from the guidance and may be misleading if read alone. The complete guidance is available at guidance.nice.org.uk/cg59
Introduction
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This clinical guideline updates and partially replaces 'Cox II inhibitors for the treatment of osteoarthritis and rheumatoid arthritis' (NICE technology appraisal 27). |
Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis and one of the leading causes of pain and disability worldwide. Knees, hips and small hand joints are most commonly affected. Although pain, reduced function and participation restriction can be important consequences of osteoarthritis, structural changes often occur without accompanying symptoms. Contrary to popular belief, osteoarthritis is not caused by ageing and does not necessarily deteriorate. There are a number of treatment options, which this guideline addresses.
Osteoarthritis is a metabolically active repair process that takes place in all joint tissues and involves localised loss of cartilage and remodelling of adjacent bone. A variety of joint traumas may trigger the need to repair. Osteoarthritis is a slow but efficient repair process that often compensates for the initial trauma, resulting in a structurally altered but symptom-free joint. In some people, either because of overwhelming trauma or compromised repair potential, the process cannot compensate, resulting in continuing tissue damage and eventual presentation with symptomatic osteoarthritis or 'joint failure'. This explains the extreme variability in clinical presentation and outcome that can be observed between people and also at different joints in the same person.
The majority of the published evidence relates to osteoarthritis of the knee. 'Osteoarthritis: the care and management of osteoarthritis in adults' has tried, where possible, to highlight where the evidence pertains to a particular joint. Many trials have looked at single joint involvement when in reality many patients have multiple joint involvement, which may well alter the reported efficacy of a particular therapeutic intervention.
The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.