Quality standard

Quality statement 1: Diagnosis

Quality statement 1: Diagnosis

Quality statement

Adults aged 45 or over are diagnosed with osteoarthritis clinically without imaging if they have activity‑related joint pain and any morning joint stiffness that lasts no longer than 30 minutes.

Rationale

There is often a poor link between changes visible on an X‑ray, MRI or ultrasound scan and the symptoms of osteoarthritis; minimal changes can be associated with substantial pain, or modest structural changes to joints can occur with minimal accompanying symptoms. It is recommended that a clinical diagnosis of osteoarthritis is made for adults aged 45 years or over with typical symptoms without the need for further imaging. This will reduce both potential harm from exposure to radiation from X‑rays and costs of unnecessary imaging procedures. However, if an alternative diagnosis is possible, it may be necessary to carry out further investigations, including imaging, to aid diagnosis.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults aged 45 or over are diagnosed with osteoarthritis clinically without imaging if they have activity‑related joint pain and any morning joint stiffness that lasts no longer than 30 minutes.

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of adults aged 45 years or over who have activity‑related joint pain and in whom any morning joint stiffness lasts no longer than 30 minutes who are diagnosed with osteoarthritis clinically without imaging.

Numerator – the number in the denominator who are diagnosed with osteoarthritis clinically without imaging.

Denominator – the number of adults aged 45 years or over who have activity‑related joint pain and in whom any morning joint stiffness lasts no longer than 30 minutes who are diagnosed with osteoarthritis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as GPs and community healthcare providers) ensure that they have clear policies and processes for diagnosing osteoarthritis clinically. Service providers should also monitor the use of imaging for diagnosing osteoarthritis in adults to ensure that it is not being used inappropriately.

Healthcare professionals diagnose osteoarthritis in adults aged 45 years or over clinically without imaging if the person has typical symptoms.

Commissioners ensure that they commission services with clear policies and processes for diagnosing osteoarthritis clinically. Commissioners should also require providers to show that imaging is not being used inappropriately for diagnosing osteoarthritis in adults.

Adults aged 45 years or over who go to their GP with joint pain that is typical of osteoarthritis are usually diagnosed with osteoarthritis without the need for an X‑ray or a scan. This is because the results of X‑rays and scans do not explain symptoms or help when deciding about treatment, and will mean that people do not have unnecessary X‑rays or scans.

Definitions of terms used in this quality statement

Alternative diagnosis

If an alternative diagnosis is possible, it may be necessary to carry out imaging to confirm the diagnosis. Alternative diagnoses include gout, other inflammatory arthritides such as rheumatoid arthritis and septic arthritis, and cancer. A history of trauma, prolonged morning joint‑related stiffness, rapid worsening of symptoms or deformity, or the presence of a hot swollen joint may indicate the need for further imaging to identify possible additional or alternative diagnoses. [Adapted from NICE's guideline on osteoarthritis in over 16s, recommendation 1.1.2, terms used in this guideline (atypical features); and expert opinion]