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Br J Gen Pract. 2008 September 1; 58(554): 649.
PMCID: PMC2529208


Christian David Mallen, Lecturer in General Practice
Arthritis Research Campaign National Primary Care Centre Primary Care Sciences Keele University Keele, Staffordshire, ST5 5BG. E-mail:
George Peat, Senior Lecturer in Clinical Epidemiology and Physiotherapist
Keele University, Primary Care Musculoskeletal Research Centre
Mark Porcheret, Research Fellow and GP

We read with interest the recent ‘Top tips in 2 minutes: Osteoarthritis of the knee’, which was published in the May issue of the BJGP.1 Although written in an engaging style it is baffling that such an article should appear just 2 months after the published NICE osteoarthritis guidelines and yet contain no reference to them.

While certain pieces of advice contained in the article are consistent with the NICE osteoarthritis guidelines (notably ‘don't leave surgery too late’), it also substantially diverges in many places:

  • Core treatment is information and advice about the condition; weight loss; exercise (both aerobic and strengthening have been shown to be effective — there is no basis for the emphasis on ‘non-impact’).
  • Glucosamine is not recommended for use within the NHS. While 1500 mg glucosamine sulphate has demonstrated a small benefit over placebo for knee osteoarthritis guidelines, this product does nor currently have an EU licence.
  • Topical NSAIDs are recommended.
  • Neither viscosupplementation not debridement are recommended (‘when symptoms worse than X-ray’ is relatively meaningless).
  • X-rays not recommended to confirm a clinical diagnosis of knee osteoarthritis guidelines; indicated only in the presence of giving way/locking.
  • MRI not currently recommended for diagnosis, even in early osteoarthritis guidelines.

We would encourage readers of BJGP seeking Top Tips in 2 minutes on this subject should consult the NICE osteoarthritis guidelines 2-page summary and the accompanying version for members of the public.


Top Tips in 2 Minutes for the May issue was compiled in January 2008, a month before the NICE guidelines were published. A correction was published in the June issue with reference to the latest NICE guidance. DOI: 10.3399/bjgp08X302907.


1. Bastable R, Rann S, Barker V. Top tips in 2 minutes: osteoarthritis in the knee. Br J Gen Pract. 2008;58(550):376–377. [PMC free article] [PubMed]
2. National Institute for Health and Clinical Excellence. Osteoarthritis, the care and management of osteoarthritis in adults. NICE; 2008.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners