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OA Core Treatment — SCE Rheumatology MCQ

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EasyOsteoarthritisOA Core TreatmentSCE Rheumatology

A 72-year-old woman with a BMI of 31 kg/m² has bilateral knee pain that is worse on walking and climbing stairs, with morning stiffness lasting 10 minutes. Examination reveals bony enlargement, crepitus and small cool effusions. Radiographs show medial compartment joint-space narrowing and osteophytes. Which initial management approach best represents the NICE core treatments for osteoarthritis?

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Correct answer: E — Offer tailored therapeutic exercise, weight-management support and information

The correct answer is E. NICE identifies tailored therapeutic exercise, information and support, and weight management when appropriate as the core treatments for osteoarthritis. Her BMI makes weight-management support specifically appropriate. Exercise should include local muscle strengthening and general aerobic fitness; patients should be advised that discomfort may initially increase but consistent exercise improves pain and function. A topical NSAID should also be offered for symptomatic knee osteoarthritis if medication is needed, but it is an adjunct rather than a core treatment. NICE advises against intra-articular hyaluronan and strong opioids. Systemic corticosteroids are not standard osteoarthritis therapy. Joint replacement is considered only when symptoms substantially impair quality of life and non-surgical management is ineffective or unsuitable.

Reference: National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226), recommendations 1.2.2, 1.3.1, 1.3.5 and 1.4.1–1.4.2. 2022. https://www.nice.org.uk/guidance/ng226/chapter/Recommendations