The National Institute for Health and Clinical Excellence has issued new guidelines relating to the treatment and management of osteoarthritis and irritable bowel syndrome.

NICE and the National Collaborating Centre for Acute Care have developed new national standards for the care and treatment of osteoarthritis, the most common form of arthritis that affects nearly 8.5 million in the UK and cost the economy a whopping £3.2 billion in lost production alone back in 1999/2000.

The recommendations are heavily focused on the holistic assessment of patients and underscore the importance of promoting certain lifestyle changes to help improve quality of life alongside medical intervention.

“This is the first national guideline to provide evidence-based recommendations on how the lives of people with osteoarthritis can be improved, whether their symptoms are mild or severe,” commented Andrew Dillon, Chief Executive, and Executive Lead for this guidance. “Up until now, treatment for the condition may have varied but now for the first time, clear advice is provided to the NHS and individuals, no matter where they live in England and Wales.”

Amongst the lifestyle-type recommendations are exercise as a “core treatment” for all patients and advice on weight loss where relevant. On the treatment side, it is advised that doctors consider prescribing a topical non-steroidal anti-inflammatory for patients with osteoarthritis in the hand or knee, and that these should be given precedence over oral NSAIDs, COX-2 inhibitors or opioid-based painkillers.

But the guidelines state that if paracetamol or topical NSAIDs are insufficient for pain relief, then a standard NSAID or COX-2 inhibitor should be considered with a proton pump inhibitor to help counter any gastrointestinal side effects. This, according to a press release from Pfizer, which manufactures the COX-2 inhibitor Celebrex, is the first communication from NICE to address the use of this class of drugs in osteoarthritis since 2001.

It is also recommended that healthcare professionals dish out both verbal and written information to all patients to help them better understand the condition and dispel certain myths, such as that it is untreatable. As the Royal College of Physicians, which published the guidelines, notes, a recent study found that over half of people with severe and disabling knee pain had not visited their GP in the past 12 months, as people’s perception of osteoarthritis is that it is a part of normal ageing and that nothing can be done, so it is hoped that the new guidance will help prompt more patients to seek treatment for their condition.

Susan Oliver, nurse consultant in rheumatology and Guideline Development
Group member, described the guidelines as good news for people with osteoarthritis. “For the first time, patients can be reassured that they will be offered core symptom-relieving therapies to help them take control of their condition. If these do not work, patients can be confident that they can return to their GP and continue to explore other treatment options, until they find a treatment that is right for them,” she stressed.

First guidelines for IBS diagnosis
Meanwhile, the Institute also issued guidance for the diagnosis, care and treatment of people with irritable bowel syndrome, a disorder characterised by abdominal discomfort, bloating and changes in bowel habit which affects up to one in 10 people at some time in their lives.

This marks the first time healthcare professionals have been given a “clear set of symptoms” necessary for diagnosis of the condition, as before diagnosis was often dependent on a process of elimination of other illnesses, which involved patients undergoing many unnecessary investigative procedures at an unnecessary expense to the National Health Service. According to the Institute, the reduction in the number of tests to diagnose the condition envisaged from the successful implementation of these recommendations could garner annual savings of £6.7 million.

In terms of drug therapies, it is recommended that IBS patients should be prescribed antispasmodics where necessary, and taught how to adjust their doses of laxative or antimotility agent, preferably loperamide, according to the clinical response. It also says that healthcare professionals should consider tricyclic antidepressants for pain relief as a second-line resort.

Self-management key
Again, the guidelines also stress the importance of helping patients to self manage their condition, and recommend that doctors provide information on general lifestyle, physical activity, diet - in particular fibre intake, and symptom-targeted medication.

Welcoming the guidelines, Marion Saunders, patient representative and Guideline Development Group Member, said: “IBS has a massive impact on the quality of life of the individual and symptom recurrences can be severe enough to stop them going to work, taking public transport, and participating in leisure activities,” and she added that “there is currently a lot of misinformation about what treatments really help”.

And Joe Blanchard Smith, patient representative, The Gut Trust, and Guideline
Development Group member, commented: “Whilst there is no magic cure for this condition, if patients get a positive diagnosis, they will feel reassured that they can actively start managing the symptoms and improve their quality of life.”