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Osteoarthritis — SCE Rheumatology MCQ

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EasyOsteoarthritisOsteoarthritisSCE Rheumatology

A 65-year-old woman has knee osteoarthritis that substantially impairs her mobility and quality of life. Her symptoms persist despite education, an adequate trial of tailored therapeutic exercise and appropriate weight management, topical and oral NSAIDs with gastroprotection, and an intra-articular corticosteroid injection. What is the most appropriate next step according to NICE?

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Correct answer: E — Referral for orthopaedic assessment for knee joint replacement

The correct answer is E. NICE recommends considering referral for joint replacement when osteoarthritis symptoms substantially affect quality of life and appropriate non-surgical management has been ineffective or unsuitable. This patient has persistent mobility and quality-of-life impairment despite core treatments and appropriate pharmacological options, so orthopaedic assessment is indicated; referral does not predetermine whether total or partial knee replacement will ultimately be performed. NICE advises against intra-articular hyaluronan, glucosamine and acupuncture because evidence does not support their use. Strong opioids should not be offered for osteoarthritis because their risks outweigh their benefits, while weak opioids are reserved, at most, for infrequent short-term relief when other pharmacological treatments cannot be used.

Reference: NICE guideline NG226, Osteoarthritis in over 16s: diagnosis and management, sections 1.3, 1.4 and 1.6, 2022. https://www.nice.org.uk/guidance/ng226/chapter/recommendations