People suffering from arthritis are being urged to lose weight and exercise, instead of being prescribed medication, including paracetamol, to deal with the condition.
New NHS guidance says people who are overweight should be told their pain could be reduced if they shed the pounds.
The National Institute for Health and Care Excellence (Nice) said aerobic exercises, such as walking and strength training, can ease symptoms and improve quality of life.
In the UK, more than 10 million people have arthritis or similar conditions, with knees, hips, and hand joints most affected.
The guidelines also recommend the use of some medicines – non-steroidal anti-inflammatory drugs (NSAIDs) – but not the prescription of paracetamol, glucosamine or strong opioids.
Nice said there is a risk of addiction with strong opioids, while new evidence suggests little or no benefit for some medicines when it comes to quality of life and pain levels.
‘Any weight loss beneficial’
In the guidance, doctors are told to diagnose osteoarthritis – the most common form of arthritis – themselves without further investigation in people aged 45 or over who have activity-related joint pain.
Patients should also have no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes to be diagnosed this way.
The draft guideline says people can be offered tailored exercise programmes, with an explanation that “doing regular and consistent exercise, even though this may initially cause discomfort, will be beneficial for their joints”.
Exercising in the long-term also increases its benefits, the guideline adds.
When it comes to weight loss, people will be told that “any amount of weight loss is likely to be beneficial, but losing 10% of their body weight is likely to be better than 5%”.
People can also be referred for hip or knee replacement if their condition cannot be managed in other ways, and these should not be held off due to age, sex or obesity.
Many people ‘stuck on painkillers’
Dr Paul Chrisp, director for the centre for guidelines at Nice, said beginning the journey can sometimes be uncomfortable for people and they should be supported to help manage their condition.
“Osteoarthritis can cause people discomfort and prevent them from undertaking some of their normal daily activities,” he said.
“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.
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Tracey Loftis, head of policy and public affairs at the charity Versus Arthritis, said: “We’ve seen first-hand the benefits that people with osteoarthritis can get in being able to access appropriate physical activity, especially when in a group setting. Something like exercise can improve a person’s mobility, help manage their pain and reduce feelings of isolation.
“But our own research into the support given to people with osteoarthritis showed that far too many do not have their conditions regularly reviewed by healthcare professionals, and even fewer had the opportunity to access physical activity support.
“The lack of alternatives means that, in many cases, many people are stuck on painkillers that are not helping them to live a life free from pain.”