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Paracetamol given reprieve in NICE arthritis guidance

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The National Institute for Health and Care Excellence has stepped back from recommending against the use of paracetamol as an analgesic for treating osteoarthritis.

The NICE guidelines on the care and management of osteoarthritis in adults, published last week, update a previous version from 2008.

A draft of the update put out for consultation in August had provisionally said paracetamol should no longer be considered as a routine treatment for osteoarthritis because of the risk of side effects.

However, in the final version of the updated guidance, NICE chose not to include the change. It said it would instead wait for a separate review on drug safety by the Medicines and Healthcare products Regulatory Agency.

Therefore, NICE continues to recommend offering paracetamol for pain relief in addition to core treatments, such as exercise. Paracetamol and/or topical non-steroidal anti-inflammatory drugs should be considered ahead of oral NSAIDs, COX-2 inhibitors or opioids.

Professor Mark Baker, director of NICE’s Centre for Clinical Practice, said: “An area that the update initially planned to review was the existing recommendations on pharmacological management of osteoarthritis.

“NICE has decided to wait until the MHRA’s work is complete before reviewing all pharmacological management for osteoarthritis,” he said.  “This will mean that all of the relevant painkillers can be looked at together.

“Until the full pharmacological update is undertaken, the guideline recommendations on drug management for osteoarthritis remain unchanged,” he added.

The new guidance maintains the view of the 2008 version that glucosamine and chondroitin products, and acupuncture should not be offered.

Meanwhile, the updated NICE guidance said that exercise remained the core treatment in managing osteoarthritis. 

Professor Baker said: “The guidance highlights that the core treatment for osteoarthritis remains exercise – this not only helps relieve pain for some people but also improves function.”

Mark Baker

Mark Baker

However, NICE did make new recommendations on diagnosing the condition and on follow-up review. 

For example, it stated that osteoarthritis should be diagnosed clinically without investigations if a person was 45 or over, has activity-related joint pain and has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.

In addition, regular reviews should be offered to all people with symptomatic osteoarthritis. This should cover monitoring the long-term course of the condition, the effectiveness and tolerability of treatments and other points.

Annual reviews should be considered if the person has other illnesses or conditions, troublesome joint pain, more than one joint affected, or is taking any drugs for their osteoarthritis.

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