Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: NICE NG226 — Osteoarthritis in over 16s: diagnosis and ma… 2022 · sources last checked 2026-08-20

Reference tool — not medical advice. Thresholds, targets, and first-line agents differ by guideline body and change over time — switch the lens to compare. Clinician judgement, dosing/monitoring, contraindications, and live coverage always required. Runs entirely in your browser — no data is collected.

Osteoarthritis selector

Choose the guideline lens (OARSI / ACR / NICE / ESCEO), the joint, comorbidities and stage — get the plan: exercise + weight + education for everyone, topical NSAID first-line (knee/hand), comorbidity-gated oral NSAIDs, and honest handling of the contested options (glucosamine, hyaluronic acid) where ESCEO diverges.

Guideline lens

Jointchoose one

Comorbidities (gate oral NSAIDs)

Features

Stagechoose one

Core treatment (all patients)

Exercise + weight management (if overweight) + education/self-management — strong across every guideline

First pharmacologic step

Topical NSAID (knee/hand) — safest first pharmacologic option

Notes

  • • OARSI/ACR/NICE recommend AGAINST glucosamine/chondroitin (no benefit over placebo) and are skeptical of hyaluronic acid; ESCEO (a separate lens) is more supportive. Acetaminophen, capsaicin and hyaluronic acid are low-value/contested options.
  • • Beyond conventional therapy: a naturopathic/dietary lens raises glucosamine/omega-3 (evidence weak per the mainstream), and a manual-therapy/osteopathic lens raises manual therapy/massage as an ADJUNCT to exercise — neither should override the exercise + weight-management + topical-NSAID-first core.

Suggested drug classesPer OARSI 2019.

Select the joint and any comorbidities to begin.

Switch the lens to see the key divergence: OARSI/ACR/NICE recommend AGAINST glucosamine/hyaluronic acid; ESCEO supports them.

Guidelines

References

  1. [1]Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019;27:1578. link
  2. [2]Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol 2020;72:220. link
  3. [3]NICE NG226 — Osteoarthritis in over 16s: diagnosis and management, 2022 (topical-first; PPI with any oral NSAID; do-not-offer glucosamine/hyaluronic acid). link
  4. [4]Bruyère O, et al. ESCEO stepwise algorithm for knee OA, 2019 (supports crystalline glucosamine sulfate). Choosing Wisely Canada / PEER (CFP 2020) advise against glucosamine/chondroitin. link