Losing excess weight and getting more exercise are the best courses of action for people with arthritis, according to new NHS guidelines.
The draft recommendation from the National Institute for Health and Care Excellence (Nice) says overweight people should be told that if they lose weight, they will experience less pain.
At the same time, aerobic exercise, such as walking, as well as strength training, can relieve symptoms and improve quality of life.
Guidelines suggest that starting an exercise program may initially make the pain worse, but this should stabilize.
The guidelines also give advice on drug use, such as providing non-steroidal anti-inflammatory drugs (NSAIDs), but not paracetamol, glucosamine or potent opioids.
Strong opioids carry a risk of addiction, and new evidence suggests that some drugs offer little benefit when it comes to quality of life and pain levels, Nice said.
In the guidelines, doctors are told that people 45 or older with activity-related joint pain can self-diagnose osteoarthritis — the most common form of arthritis — without further investigation.
Patients should also have no morning joint-related stiffness, or no morning stiffness for more than 30 minutes, to be diagnosed with this modality.
The draft guidelines say that a tailored exercise regimen can be provided for people, explaining that “doing regular and sustained exercise, even if it may initially cause discomfort, can benefit their joints.”
Long-term exercise also increases its benefits, the guideline adds.
When it comes to losing weight, people will be told that “any amount of weight loss can be beneficial, but losing 10% is probably better than losing 5%”.
People can also be referred for hip or knee replacement surgery if their condition cannot be controlled by other means, and should not be denied a referral because of age, gender or obesity.
said Dr Paul Chrisp, director of the Guide Centre in Nice. “Osteoarthritis can cause discomfort to people, preventing them from carrying out some of their normal daily activities.
“However, there is evidence that muscle strengthening and aerobic exercise can not only make a difference in managing the condition, but also provide people with a better quality of life.
“Starting this journey can be uncomfortable for some people at first, and they deserve support and enough information to help them manage their condition for a long time.”
He added: “While topical and sometimes oral NSAIDs remain an important treatment option for osteoarthritis, we have decided not to recommend some pain relievers such as paracetamol and some opioids for osteoarthritis.
“This is because new evidence suggests that there is little benefit to people’s quality of life, pain, or psychological distress, especially for potent opioids, which have evidence of harm in the long term, including possible addiction.”
In the UK, more than 10 million people suffer from arthritis or other similar conditions that affect the joints.
The most affected areas are the knees, hips, and small hand joints.