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NICE Pathways bring together all NICE guidance, quality standards and other NICE
information on a specific topic.
NICE Pathways are interactive and designed to be used online. They are updated
regularly as new NICE guidance is published. To view the latest version of this pathway
see:
http://pathways.nice.org.uk/pathways/osteoarthritis
Pathway last updated: 20 September 2016

This document contains a single pathway diagram and uses numbering to link the
boxes to the associated recommendations.
Copyright NICE 2016. All rights reserved

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Person with suspected osteoarthritis

No additional information

Diagnosis

Diagnose osteoarthritis clinically without investigations if a person:

is 45 or over and
has activity-related joint pain and
has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30
minutes.
Be aware that atypical features, such as a history of trauma, prolonged morning joint-related
stiffness, rapid worsening of symptoms or the presence of a hot swollen joint, may indicate
alternative or additional diagnoses. Important differential diagnoses include gout, other
inflammatory arthritides (for example, rheumatoid arthritis), septic arthritis and malignancy (bone
pain).
NICE has also produced pathways on musculoskeletal conditions, rheumatoid arthritis. See also
symptoms and findings in the NICE pathway on suspected cancer.

Quality standards
The following quality statement is relevant to this part of the pathway.
1.

Diagnosis

Management

See Osteoarthritis / Management of osteoarthritis

Follow-up and review

Offer regular reviews to all people with symptomatic osteoarthritis. Agree the timing of the
reviews with the person. Reviews should include:

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monitoring the person's symptoms and the ongoing impact of the condition on their
everyday activities and quality of life
monitoring the long-term course of the condition
discussing the person's knowledge of the condition, any concerns they have, their personal
preferences and their ability to access services
reviewing the effectiveness and tolerability of all treatments
support for self-management.
Consider an annual review for any person with one or more of the following:
troublesome joint pain
more than one joint with symptoms
more than one comorbidity
taking regular medication for their osteoarthritis.
Apply the principles in the NICE pathway on patient experience in adult NHS services with
regard to an individualised approach to healthcare services and patient views and preferences.
NICE has produced a pathway on multimorbidity.

Quality standards
The following quality statement is relevant to this part of the pathway.
6.

Timing of review

NICE pathway on patient experience in adult NHS services

See Patient experience in adult NHS services

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COX-2
Cyclo-oxygenase 2
GDG
Guideline Development Group
MHRA
Medicines and Healthcare Products Regulatory Agency
NSAIDs
Non-steroidal anti-inflammatory drugs
PPI
Proton pump inhibitor
TENS
Transcutaneous electrical nerve stimulation

Sources
Osteoarthritis (2014) NICE guideline CG177

Your responsibility
The guidance in this pathway represents the view of NICE, which was arrived at after careful
consideration of the evidence available. Those working in the NHS, local authorities, the wider
public, voluntary and community sectors and the private sector should take it into account when
carrying out their professional, managerial or voluntary duties. Implementation of this guidance
is the responsibility of local commissioners and/or providers. Commissioners and providers are
reminded that it is their responsibility to implement the guidance, in their local context, in light of
their duties to avoid unlawful discrimination and to have regard to promoting equality of
opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.
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Copyright
Copyright National Institute for Health and Care Excellence 2016. All rights reserved. NICE
copyright material can be downloaded for private research and study, and may be reproduced
for educational and not-for-profit purposes. No reproduction by or for commercial organisations,
or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE
National Institute for Health and Care Excellence
Level 1A, City Tower
Piccadilly Plaza
Manchester
M1 4BT
www.nice.org.uk
nice@nice.org.uk
0845 003 7781

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