People with arthritis are being told that exercise and losing weight are a better therapy than painkillers such as paracetamol.
Pain can be reduced if overweight people shed the pounds, according to new NHS guidance from the UK's National Institute for Health and Care Excellence (Nice).
It advises that aerobic exercise and strength training can ease symptoms and improve quality of life.
Starting exercise programmes may initially make the pain worse, but this should settle down, the guidance suggests.
Nice also gives recommendations on the use of medicines, such as offering non-steroidal anti-inflammatory drugs (NSAIDs) but not offering paracetamol, glucosamine or strong opioids.
It said there was a risk of addiction with strong opioids, while new evidence suggests little or no benefit from some medicines when it comes to quality of life and pain levels.
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.
Tailored exercise programmes should be offered, 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 guidance says.
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%.”
Patients can also be referred for hip or knee replacement if their condition cannot be managed in other ways, and referrals should not be held off due to age, sex or obesity.
Dr Paul Chrisp, director of 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.”
In the UK, more than 10 million people have arthritis or other similar conditions that affect the joints.
The most affected areas are the knees, hips and small hand joints.
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.
“While we welcome the draft Nice guidelines, healthcare professionals need further resources and support to better understand their role in promoting treatment like physical activity for people with osteoarthritis.
“There is clearly a need for people with arthritis to be given a bigger voice so that their health needs are not ignored.”
Indoor cricket in a nutshell
Indoor Cricket World Cup - Sept 16-20, Insportz, Dubai
16 Indoor cricket matches are 16 overs per side
8 There are eight players per team
9 There have been nine Indoor Cricket World Cups for men. Australia have won every one.
5 Five runs are deducted from the score when a wickets falls
4 Batsmen bat in pairs, facing four overs per partnership
Scoring In indoor cricket, runs are scored by way of both physical and bonus runs. Physical runs are scored by both batsmen completing a run from one crease to the other. Bonus runs are scored when the ball hits a net in different zones, but only when at least one physical run is score.
Zones
A Front net, behind the striker and wicketkeeper: 0 runs
B Side nets, between the striker and halfway down the pitch: 1 run
C Side nets between halfway and the bowlers end: 2 runs
D Back net: 4 runs on the bounce, 6 runs on the full
KILLING OF QASSEM SULEIMANI
Europe’s rearming plan
- Suspend strict budget rules to allow member countries to step up defence spending
- Create new "instrument" providing €150 billion of loans to member countries for defence investment
- Use the existing EU budget to direct more funds towards defence-related investment
- Engage the bloc's European Investment Bank to drop limits on lending to defence firms
- Create a savings and investments union to help companies access capital
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
