Core OA Treatment — SCE Rheumatology MCQ

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EasyOsteoarthritisCore OA TreatmentSCE Rheumatology

A 55-year-old man with clinically diagnosed knee osteoarthritis has mild intermittent symptoms and a BMI of 32 kg/m². Which management plan should form the core of his treatment according to NICE?

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Correct answer: B — Offer tailored therapeutic exercise and weight-management support

NICE identifies tailored therapeutic exercise—including local muscle strengthening and general aerobic fitness—as a core treatment for everyone with osteoarthritis. Because this patient is living with obesity, he should also receive support to lose weight; any weight loss is likely to help, with 10% generally producing greater symptomatic and functional benefit than 5%. Joint replacement is considered only when symptoms substantially impair quality of life and non-surgical management is ineffective or unsuitable. Oral NSAIDs are not core disease-modifying treatment and, if required, should be used at the lowest effective dose for the shortest possible time. NICE advises against glucosamine because there is no strong evidence of benefit. Complete rest conflicts with the recommendation for regular therapeutic exercise.

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, 1.4.1–1.4.7 and 1.6.1. 2022. https://www.nice.org.uk/guidance/ng226/chapter/recommendations