{"id":4228,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/osteoarthritis\/"},"modified":"2026-07-30T11:54:48","modified_gmt":"2026-07-30T10:54:48","slug":"osteoarthritis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/osteoarthritis\/","title":{"rendered":"Osteoarthritis"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">History<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Chronic joint pain worse on activity.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Age at onset usually &gt;45.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No morning stiffness or stiffness for &lt;30minutes<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Can affect multiple joints:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pain affecting PIP, DIP and 1<sup>st<\/sup> CMC joints. <\/li>\n\n\n\n<li>Knee pain (worse on descending stairs)<\/li>\n\n\n\n<li>Hip pain worse on weight bearing<\/li>\n\n\n\n<li>Back, neck and shoulders<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Examination<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bony swelling of affected joints in the hands<\/li>\n\n\n\n<li>Crepitus on knee flexion<\/li>\n\n\n\n<li>Limitation of hip movement<\/li>\n\n\n\n<li>Pain on back, shoulder and neck movement<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Investigations<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine bloods (usually normal)<\/li>\n\n\n\n<li>Anti-CCP antibodies (negative) \u2013 <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>do not use this as a screening test<\/strong><\/mark><\/li>\n\n\n\n<li>X-ray of symptomatic joints (loss of joint space, sclerosis and osteophytes<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; H.B\/S.R &#8211; 29-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"has-hazard-yellow-background-color has-background wp-block-paragraph\"><strong>Patients with osteoarthritis should <u>not<\/u> be referred to<\/strong> Rheumatology unless there is uncertainty about the diagnosis.&nbsp; <\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">No therapies are available to slow or halt the progression of osteoarthritis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment is symptomatic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Patient Education:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Making patients aware that this is wear and tear of the joints and that although there is no cure, several treatments can help symptoms.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Non-pharmacologic:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Weight loss<\/strong> can make a big difference in patients with hip or knee OA.<\/li>\n\n\n\n<li><strong>Exercise <\/strong>will improve symptoms<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Nutraceuticals:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Glucosamine and chondroitin may have a weak effect on pain (not recommended by NICE)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Manual therapy:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Only consider for hip and knee osteoarthritis and alongside therapeutic exercise.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pain Management :<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Start with local therapy and add additional medications as necessary. It\u2019s possible to use analgesics, NSAID and anti-neuropathic drugs in combination.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Topical NSAID cream<\/li>\n\n\n\n<li>Paracetamol<\/li>\n\n\n\n<li>Oral NSAID (with PPI)<\/li>\n\n\n\n<li>Compound analgesics<\/li>\n\n\n\n<li>Anti-neuropathic agents (gabapentin or amitriptyline)<\/li>\n\n\n\n<li>Strong opioids as last resort<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Orthopaedic referral:<\/strong> <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consider in patients with x-ray confirmed hip or knee OA (see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/arthroplasty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Arthroplasty \u2013 RefHelp<\/a> for referral criteria)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Please see Resources and links tab for additional information<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.arthritis-uk.org\/information-and-support\/understanding-arthritis\/conditions\/osteoarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Osteoarthritis: Symptoms, causes, types and treatment | Arthritis UK<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng226\" target=\"_blank\" rel=\"noreferrer noopener\">Overview | Osteoarthritis in over 16s: diagnosis and management | Guidance | NICE<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>History Chronic joint pain worse on activity. Age at onset usually &gt;45. No morning stiffness or stiffness for &lt;30minutes Can affect multiple joints: Examination Investigations M.A &amp; H.B\/S.R &ndash; 29-7-26<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[620],"class_list":["post-4228","page","type-page","status-publish","hentry","category-osteoarthritis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/osteoarthritis\/\" rel=\"tag\">Osteoarthritis<\/a>","rttpg_excerpt":"History Chronic joint pain worse on activity. Age at onset usually &gt;45. No morning stiffness or stiffness for &lt;30minutes Can affect multiple joints: Examination Investigations M.A &amp; H.B\/S.R &ndash; 29-7-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4228","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4228"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4228\/revisions"}],"predecessor-version":[{"id":29271,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4228\/revisions\/29271"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4228"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4228"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}