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The national institute for health and care excellence (NICE) has just released their updated guidelines for the management of arthritis for doctors to follow. It has some profound recommendations and implications for patients, stating treatments previously recommended for all patients with arthritis should no longer be used due to safety and lack of effectiveness.

Close to Sore spine15 % of Australians suffer from Arthritis. Osteoarthritis is by far the most common, this is sometimes referred to as “degeneration” or “wear and tear” and can be found in any joint in the body particularly areas that have suffered direct, indirect or repetitive trauma. It is most commonly found in the spine, hips and knees.
Australian Bureau of Statistics

Paracetamol (brand names Tylenol, panadol) have been routinely offered and recommended for this condition for decades, even more since the study published in the American Journal of Medicine found that approximately 107,000 patients are hospitalized each year in the US for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal internal bleeding and at least 16,500 NSAID-related deaths occur each yearamong arthritis patients. (NSAIDs are drugs like Ibuprofen, asprin etc)
American Journal of Medicine 1998 (Jul 27);105(1B):31–38

It was believed until now that paracetamol is relatively safe and effective however new research has proven it to be quite the opposite. Long term use is associated with increased risk of serious adverse events including increased risk of heart attack and is not clinically more effective than placebo in improving pain, stiffness or function of Arthritis.
http://www.nice.org.uk/nicemedia/live/13505/64904/64904.pdf

NICE concluded that…
“No clinically important difference was demonstrated between paracetamol
3000-4000mg/day and placebo across all outcomes for knee OA and mixed joint OA (hip/knee).”

See below for excerpt from the new guidelines –

Other new recommendations for Arthrtis patients in the new Guidelines for medical Doctors are:

  • Do not offer acupuncture for the management of osteoarthritis. [new 2014]
  • Do not refer for arthroscopic lavage and debridement (commonly known as an Arthroscope) unless the person has knee osteoarthritis with a clear history of mechanical locking (amended 2014)
  • Do not offer intra-articular injections (cortisone etc) for the management of osteoarthritis (new 2014)

Effective treatments recommended in the new guidelines include:

  • Offer interventions to achieve weight-loss as a core treatment.
    The new treatment for Arthritis: Exercise.

    The new treatment for Arthritis: Exercise.

  • Advise people to exercise as a core treatment irrespective of age, co morbidity, pain severity or disability. Exercise should include: local muscle strengthening and general aerobic fitness.
  • Manipulation and stretching should be considered as an adjunct to core treatments, particularly for osteoarthritis of the hip. [Since 2008]
  • In a large randomized clinical trial done in 2004 Manipulation was shown to be even more effective than exercise for patients with hip arthritis. (3)

It is interesting to think that what we were once so certain of, we are now most certain is not.

Quote of the day “ “If we doctors threw all our medicines into the sea, it would be that much better for our patients and that much worse for the fishes.”Supreme Court Justice Oliver Wendel Holmes, MD

 

Yours in health,

Dr. Scott

 References:

1. American Journal of Medicine 1998 (Jul 27);105(1B):31–38

2. Osteoarthritis: the care and management of osteoarthritis in adults, Clinical guideline Methods, evidence and recommendations 9 August 2013  viewed 1/09/2013 at http://www.nice.org.uk/nicemedia/live/13505/64904/64904.pdf

3. 2004 Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis & Rheumatism 51 (5): 722–9.