Osteoarthritis in over 16s: diagnosis and management

Research recommendations coming out of this guidance

• Exercise: What is the clinical and cost effectiveness of supervised group and individual exercise compared with unsupervised exercise for people with osteoarthritis?

• Devices: What is the clinical and cost effectiveness of devices compared with usual care for the management of painful foot and or ankle osteoarthritis?

• Topical medicines: What is the clinical and cost effectiveness of topical non-steroidal anti-inflammatory drugs and topical capsaicin for osteoarthritis-affected joints other than the knee?

• Follow-up strategies: What is the clinical and cost effectiveness of patient-initiated follow-up compared with routine follow-up for people with osteoarthritis?

• Patient information:

  - What information on the management of flares do people with osteoarthritis, their family and carers need after diagnosis?

  - What information do people with osteoarthritis from different ethnic and socioeconomic groups, and those with learning disabilities, issues with health literacy and severe mental illness (and their family and carers), need?

• Manual therapy: What is the clinical and cost effectiveness of manual therapy for people with osteoarthritis, when used alone and when in combination with therapeutic exercise?

• Electroacupuncture: Is electroacupuncture a clinically and cost-effective treatment for any subgroup of people with osteoarthritis?

• Extracorporeal shockwave therapy: What is the clinical and cost effectiveness of extracorporeal shockwave therapy for managing osteoarthritis?

• Footwear: What is the clinical and cost effectiveness of footwear for managing lower limb osteoarthritis?

• Topical and oral medicines:
  - What is the clinical and cost effectiveness of topical local anaesthetics for people with osteoarthritis?

  - What is the clinical and cost effectiveness of antiepileptics and antidepressants (other than duloxetine) for people with osteoarthritis?

  - What is the clinical and cost effectiveness of weak oral opioids for people with osteoarthritis?

• Intra-articular injections:
  - What is the clinical and cost effectiveness of intra-articular corticosteroids for managing osteoarthritis-affected joints other than the knee?

  - What is the clinical and cost effectiveness of intra-articular stem cells for managing osteoarthritis?

• Referral criteria for joint replacement: What are the most important indicators that someone with osteoarthritis (including shoulder osteoarthritis) would benefit from joint replacement? For example:

  - presence of night pain

  - non-response to non-pharmacological interventions

  - joint instability symptoms

  - presence of flares

  - numerical summary scores.

• Imaging for management of osteoarthritis:
  - What is the clinical and cost effectiveness of imaging for informing non-surgical management (for example, exercise or weight loss) in primary care for people with osteoarthritis?

  - What is the clinical and cost effectiveness of imaging for use at different parts of the care pathway (for example, primary care, intermediate care or secondary care) before surgery for people with osteoarthritis?