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CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Osteoarthritis - How up-to-date is this topic?
Changes

Version 1.4, revision planned in 2012.

Last revised in August 2008

September 2010 — minor update. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis have been cited in the Diagnosis section [Zhang et al, 2010]. The Medicines and Healthcare products Regulatory Agency (MHRA) has also recently advised that topical ketoprofen is associated with a risk of photosensitivity reactions [MHRA, 2010]. Issued in September 2010.

June 2010 — minor update. In people at risk of cardiovascular adverse events, ibuprofen up to 1200 mg per day or naproxen up to 1000 mg per day are recommended as first-line NSAIDs. Glucosamine sulphate is now available as a licensed medicinal product. Issued in July 2010.

July 2009 — minor update. The Medicines and Healthcare products Regulatory Agency (MHRA) has issued advice on the interaction between clopidogrel and proton pump inhibitors. Healthcare professionals are advised to avoid concomitant use of these drugs unless considered essential [MHRA, 2009]. Issued in July 2009.

June 2009 — minor update. The Medicines and Healthcare products Regulatory Agency (MHRA) has recently reminded prescribers of the risk of photosensitivity reactions for people using topical ketoprofen. The prescriptions for intra-articular corticosteroids have also been updated. Issued in June 2009.

April to August 2008 — converted from PRODIGY guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. Information on management of suspected infection of a prosthetic joint is no longer included. The major changes to recommendations reflect NICE guidance:

  • A proton pump inhibitor should be co-prescribed as gastroprotection whenever a standard nonsteroidal anti-inflammatory drug or a coxib is prescribed for osteoarthritis.
  • Emphasis on the core treatment to be given to all people with osteoarthritis: (i) education, advice, and access to information; (ii) strengthening exercise, and aerobic fitness training; and (iii) weight loss if overweight/obese.
  • Treatments that are specifically not recommended:
    • Glucosamine sulfate and glucosamine hydrochloride.
    • Chondroitin products.
    • Topical rubefacients.
    • Intra-articular hyaluronan injections.
    • Electro-acupuncture.
    • Arthroscopic lavage and debridement for knee osteoarthritis unless there is a clear history of mechanical locking.

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