I would strongly argue that this is misleading, because there is a choice of primary or intermediate care options, namely viscosupplementation and prolotherapy, which are poorly promoted to our colleagues.
Links for prolotherapy in particular, which is extremely cost-effective, can be found at www.bimm.org.uk or by Googling 'prolotherapy'. GP would be doing patients a favour by including an article on it.
Dr Peter Skew, GPSI in musculoskeletal medicine, past president and current honorary treasurer of the British Institute of Musculoskeletal Medicine
Editor's note: Thank you for the feedback. We take on board your comments and will look to commission an article on these therapies for the new year.