Exercise should be viewed as a principal treatment for osteoarthritis and recommended in preference to some analgesic drugs, NICE has said in new draft guidance.

In draft osteoarthritis guidelines that were published on April 29 and are currently the subject of a public consultation, NICE states that OA patients should be informed that “regular and consistent exercise” benefits joints, as does losing weight if appropriate.

The guidance states that patients can be offered tailored therapeutic exercise such as muscle strengthening, and that this may be combined with an education programme or other behaviour change approaches.

NICE says that topical NSAIDs may be offered in certain circumstances , and that some patinets may benefit from oral NSAIDs “if topical medicines are ineffective or unsuitable”.

It also says that paracetamol and glucosamine should not be offered routinely, advising clinicians: “If discussed, explain that there is no strong evidence of benefit for five paracetamol or glucosamine, and the risks of strong opioids may outweigh 6 the benefits.”

Paul Chrisp, director for the centre for guidelines at NICE said: “Osteoarthritis can cause people discomfort and prevent them from undertaking some of their normal daily activities.

However, there is evidence which shows muscle strengthening and aerobic exercise can have an impact on not just managing the condition, but also providing people with an improved quality of life.

“Beginning that journey can be uncomfortable for some people at first, and they should be supported and provided with enough information to help them to manage their condition over a long period of time.

“Whilst topical and sometimes oral NSAIDs remain an important treatment option for osteoarthritis, we have taken the decision to not recommend some painkillers, such as paracetamol and some opioids for osteoarthritis.

“This is because new evidence has shown there was little or no benefit to people’s quality of life, pain or psychological distress and particularly in the case of strong opioids, there was evidence that they can cause harm in the longer term, including possible addiction.”