Britons with arthritis are being urged to lose weight and exercise more rather than relying on painkillers as the main therapies for their condition.
NHS guidelines from the National Institute for Health and Care Excellence (Nice) say that overweight people should be told that their pain can be reduced if they lose the pounds.
Aerobic exercises such as walking, as well as strength training, can relieve symptoms and improve quality of life. Exercise programs may make the pain worse at first, but this should calm down, the guidance suggests.
The guidelines also provide recommendations on drug use, such as offering non-steroidal anti-inflammatory drugs (NSAIDs) but not offering acetaminophen, glucosamine, or strong opioids.
Nice said there was a risk of addiction with strong opioids, while there are little or no benefits to some drugs when it comes to quality of life and pain levels.
The guidance tells doctors to diagnose osteoarthritis — the most common form of arthritis — without further testing in people age 45 or older who have activity-related joint pain.
Patients should not have morning joint stiffness, or morning stiffness lasting more than 30 minutes, to be diagnosed in this way.
The draft guidelines state that people can receive customized exercise programs, explaining “regular and consistent exercise, even if it may cause discomfort at first, will be beneficial to their joints.”
Prolonged exercise also increases health benefits, the guideline adds.
When it comes to weight loss, people are told “any amount of weight loss is probably beneficial, but losing 10% of their body weight is probably better than 5%”.
People may also be referred for hip or knee replacement if their condition cannot be treated by other means, and referrals should not be delayed due to age, gender, or obesity.
dr. Paul Chrisp, director of the center for guidelines in Nice, said: “Osteoarthritis can cause discomfort and prevent people from doing some of their normal daily activities.
“However, there is evidence to show that strengthening and aerobic exercise can have an impact not only on managing the condition, but also improving people’s quality of life.
“The start of that journey can be uncomfortable for some people at first, and they need to be supported and provided with enough information to help them manage their condition for a long period of time.
“While topical and sometimes oral NSAIDs remain an important treatment option for osteoarthritis, we have made the decision not to recommend some pain medications, such as acetaminophen and some opioids for osteoarthritis.
“This is because new evidence has shown that there are few, if any, benefits to people’s quality of life, pain or psychological distress, and particularly in the case of strong opioids, there was evidence that they may cause longer-term harm, including possible addiction. †
In the UK, more than 10 million people have arthritis or other similar conditions that affect the joints. The most affected areas are the knees, hips and small wrists.
Tracey Loftis, director of policy and public affairs at the charity Versus Arthritis, said: “We’ve seen firsthand the benefits people with osteoarthritis can get by accessing appropriate physical activity, especially in groups. Something like exercise can help improve the health of people with osteoarthritis. improve a person’s mobility, help manage their pain and reduce feelings of isolation.
“But our own research on support for people with osteoarthritis found that far too many people did not have their condition regularly assessed by health care professionals, and even fewer had the opportunity to access support with physical activity.
“The lack of alternatives means that in many cases many people are stuck on painkillers that don’t help them live a pain-free life.
“While we welcome the draft guidelines from Nice, healthcare professionals need more resources and support to better understand their role in promoting treatments such as physical activity for people with osteoarthritis.
“Clearly, people with arthritis need to be given a bigger voice so that their health needs aren’t ignored.”