Health

Health

In guidelines hailed by Arthritis Care as a giant leap towards more patient-centred services, the National Institute of Health and Clinical Excellence (NICE) today (27 Feb 2008) recommends that osteoarthritis (OA) patients needing NHS joint surgery are referred promptly when other treatments have failed them.

For the first time, NICE stipulates that age, obesity, gender, smoking, or people’s other illnesses should not dissuade GPs from referring them for joint replacement surgery where this is clinically appropriate.

Breaking with a past in which people were often kept waiting until their joints had worn out, the new NICE guidelines for England and Wales recommend action before people experience severe pain or prolonged loss of function. This may include consideration for surgery once osteoarthritis starts having a ‘substantial impact’ on quality of life.

‘It’s fantastic news for people with OA. Surgery may be the kindest cut when other treatments have failed, especially as modern techniques mean you needn’t wait to lose a joint to save it. The clarity of these guidelines should bring some much-needed consistency’, said Neil Betteridge, chief executive of Arthritis Care, the UK’s leading organisation for people with any form of arthritis.

Some 8.5 million people in the UK have osteoarthritis. Symptoms include pain and stiffness in the joints, often resulting in sleeplessness, fatigue, and depression. Mobility and ability to work may be compromised. With a plummeting income, involvement in sport and social life can diminish, leading to isolation, depression, and a loss of self-esteem.

'Osteoarthritis can hit you like a truck. Many people develop it quite early. One day you have a life brimming with opportunity, and bustling with activity, the next, you are painfully aware that your skeleton is on strike. You're wondering how to take your shoes off, do the shopping, lift the kids, get into work. This guidance will help people with OA and doctors work together to take charge of the condition - with the right medical support, having osteoarthritis doesn't mean you have to lose your get-up-and-go, just find new ways of maximising it,' said Jo Cumming, Arthritis Care's helplines manager, who was diagnosed with osteoarthritis in her early 40s and was a patient representative on the NICE osteoarthritis Guideline Development Group.

As well as emphasising the need for surgery referral where joint pain has a ‘substantial impact’ on quality of life, NICE has set out a groundbreaking package for the holistic assessment and active management of osteoarthritis.

'It's robust, far-sighted, and innovative, a genuine first. Until now, people with OA have had a Cinderella service, and have often felt sidelined by the system. OA has never even featured in the government’s pay-for-performance targets for GPs, making those who live with it feel short-changed. Now millions with OA can demand the treatment to which they are entitled, and which NICE says will boost their ability to live life fully', said Betteridge.

The new standard recommends a whole-person prescription which may include: exercise, weight management, pain relieving gels and medications, as appropriate, and provision by health professionals of myth-busting information to help people understand their osteoarthritis and the control of its symptoms.

'It recommends the holistic and can-do approach that Arthritis Care has always promoted. The package means that people should never again be told that "nothing can be done", that "osteoarthritis is a natural part of getting old", and something you "just have to put up with," said Betteridge, whose organisation pioneered arthritis self-management courses in the UK, and provides information, free helplines, and training.

'These guidelines are a giant leap in the right direction. But they mean little if not supported by the range of services needed in GP’s surgeries, hospitals and the wider community. The real challenge is to ensure that NHS commissioners provide doctors, nurses, and all allied health professionals with resources to put these patient-centred recommendations into action', he said.

'If properly implemented, the NICE guidelines can become a framework for the 'smart' healthcare of the future – partnerships in which health professionals and patients team up to provide active management and effective coping strategies for people with long term conditions like osteoarthritis. With an ageing population, the way forward must be a future not of “patients” but of “people living successfully with arthritis within the family, community and workplace”’, added Betteridge.