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For mild to moderate joint discomfort without red flag features, management should be guided by NICE NG226 (Osteoarthritis in over 16s: diagnosis and management) and may include: Exercise and physiotherapy , which are central to NICE-recommended management

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Importantly, slower progress does not indicate failure or lack of effectiveness

If gallstones are confirmed and symptomatic, treatment options range from conservative management to cholecystectomy (surgical gallbladder removal), depending on symptom severity and complication risk

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Of interest, GHD is present in 40100% of the cases [9], and GH replacement therapy should be started as soon as possible because it can prevent obesity and improve psychomotor development [13]