Evidence-based clinical guidelines

• National Institute for Health Care and Excellence (NICE)⁶ – OA 2014
• American College of Rheumatology¹³ – hip, knee & hand OA 2019
• European League against Rheumatism (EULAR)¹⁴ – hip & knee OA 2013
• Osteoarthritis Research Society International (OARSI)¹⁵ – knee OA 2019
• Royal Australian College of GP’s¹⁶ – hip & knee OA 2018

All guidelines are consistent in recommending:

• Education, advice and information, exercise and weight loss (if appropriate) for ALL patients as the first-line treatment
• Pharmacological strategies (such as analgesia and anti-inflammatories), passive clinician-delivered therapies, aids and devices for SOME patients
• Surgical intervention for a FEW patients only if an appropriate course of other non-surgical strategies has been unsuccessful

_{(Adapted from: Dieppe et al, 2005)}²⁶

Management should start at the bottom of the pyramid and work upwards if required