This month has by and large been more concerned with getting lots of ducks in a row than with shooting them down, so to speak – but shoot them down we will.
There are in any case several things I’d like to highlight from February.
At the beginning of the month I went to Edinburgh for Arthritis Care’s Professional Lecture at the Scottish Parliament, which was very well-organised and thought-provoking. As a UK-wide organisation, it’s important for ARMA to continue to support and provide a forum for MSK organisations operating North of the border - despite the particular pressures, challenges and opportunities which England naturally represents - and our Scotland ARMA network exists to do just that. As well as meeting some of our Scotland-based members, I had the opportunity to meet with the Scottish Paediatric and Adolescent Rheumatology Network, which was very useful in terms of informing the development of our MSK clinical networks project in England.
There are of course many differences between the UK nations, with their independent health systems, but many of the main challenges we face are the same, as they are indeed further afield, and we can do worse than learn from each other.
Much has already been said about the cross-cutting importance of physical exercise to keep people healthy and independent, and I am actively involved in Public Health England’s external stakeholder group, which is laying the foundations for a new Health and Wellbeing Framework aimed at shifting the national debate away from illness and towards health and wellbeing. It’s clearly important that our community has a voice(s) at this table, and that everyone has a chance to input fully as the discussions develop. There are also some very interesting, very broad-based initiatives already happening locally in places like Sheffield (see below).
Similarly, the impact of MSK disorders on people’s ability to remain in or return to work is a long-standing area of concern for us, and ARMA continues to be actively involved in the Fit for Work coalition. The coalition met again last week, soon after the publication of significant new data on the impact of MSK disorders on the labour market by the Office for National Statistics - watch this space! ARMA’s Work Charter also continues to be a very relevant and useful resource in this area.
There will of course be a General Election next year, and we have already begun preparing for it. In particular, work has begun on an ARMA Manifesto which we should be able to finalise and make publicly available within the next few months.
This week I am attending the NHS Innovation Expo, where National Voices will be launching their new guide to care and support planning, based on the input of ARMA and many our (shared) members. If you’re on Twitter you can support this by joining their thunderclap.
All the best,
Guest Blog - Can we please talk about early diagnosis?
By Ailsa Bosworth, CEO of the National Rheumatoid Arthritis Society
In November 2011 the then Minister for Long Term Conditions, Paul Burstow MP, commissioned health officials to conduct a scoping exercise into early diagnosis across the health service to understand the extent of delayed diagnosis and its impact on patients. At around the same time the Coalition Government launched a national dementia awareness campaign to encourage people to spot the early signs of the disease and earmarked £10 million for dementia memory services to improve early diagnosis and treatment of the condition. Since 2012 the Government has also piloted and run a number of ‘be clear on cancer’ campaigns and promoted National HIV testing week amongst other things.
These initiatives deserve rich praise. The links between early diagnosis and cancer are particularly well established and predictions about the unabated impact of dementia on future health and care services are simply frightening. The case of cancer and dementia is demonstrative of proper evidenced-based policy: presented with the facts the Coalition Government has formulated a response to try and maximise health gain and head off a looming crisis.
It is therefore slightly frustrating to see the Government’s focus on the overall importance of early diagnosis and long term conditions slipping slightly. More than two and a half years on from Burstow’s original announcement and the results of the scoping exercise on early diagnosis do not appear to have been released into the public domain. The current Minister for Long Term Conditions, Norman Lamb, a person for whom I have a huge amount of respect, has also not made any further, wider pronouncements since his appointment.
One of the most widely cited statistics about the NHS is that long term conditions account for 70% of expenditure on health and social care in England. Clearly, not every long term condition will respond to early diagnosis, but improving rates of early diagnosis for a particular range of long term conditions could make a sizeable dent into this area of expenditure.
Rheumatoid arthritis (RA) is one example where definitive evidence of the importance of early diagnosis exists. Patients diagnosed and started on appropriate treatment within 12 weeks of symptom onset are much more likely to have a better quality of life – staying in work and making a positive contribution to the economy. Moreover, the Public Accounts Committee estimates that doubling the number of people with RA that are early diagnosed from the current level of 10% to 20%, could result in productivity gains for the economy of £31 million over 5 years.
Section 2.11 of the latest NHS Mandate on ‘Enhancing quality of life for people with long term conditions’ already contains a specific objective on ensuring timely diagnosis of dementia. My suggestion is that the Government and NHS England simply extend this objective further to include other long term conditions that can present substantial supporting evidence.
Of course, introducing a commitment in the NHS Mandate will not solve the problems over night, but it is symbolic and it may help to overcome some of the present log-jam and help refocus on the need for a national approach. Persuading each individual CCG of the need to undertake a public awareness campaign around RA (or inflammatory arthritis) would take an unfathomable amount of time and resource which neither we, nor the NHS can afford.
Such is the urgent need for action, given the NHS’s diminishing resources and need to reduce service demand to sustainable levels, I believe the Government could do a lot worse than to announce a Long Term Conditions Challenge to try and set out a clear road-map for action and dedicate a work stream to early diagnosis. I use the terminology of Long Term Conditions Challenge deliberately to separate it from the idea of a National Strategy for Long Term Conditions, which the Government has already moved away from and align it more to the much publicised Dementia Challenge. Later this year the Bone and Joint Decade will also hold an international summit. A public declaration about the importance of early diagnosis by this global alliance would also help to send the right signals to policymakers.
Such a Challenge might involve Government working with stakeholders from the long term conditions sector and, using the best available clinical evidence, start to draw up a list of those conditions that respond most critically to early diagnosis, where there is compelling evidence of delay in presentation to GPs and onward referral. Once agreement is reached, objectives could then be drawn up in relation to pooling resources across Government, industry and the third sector and developing coordinated activity with community pharmacy and GP surgeries, as well as the media.
As momentum towards the next general election builds, NRAS wants to work with our 3rd sector and professional partners in the Arthritis and Musculoskeletal Alliance to try and move the subject of early diagnosis back up the agenda of political parties.
Members' News and
British Back Pain Epidemic Study
A new study shows Britain is risking a back pain epidemic caused by unhealthy habits and sedentary lifestyles. The findings from a study by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain, yet also admit to behaviours that put their backs under unnecessary strain.
The study of 5,000 adults found that almost half of the nation admits to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.
Rhiannon Griffiths, a qualified member of the British Acupuncture Council, comments: “Painkillers often numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain. By stimulating different points of the body, traditional acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.”
The BAcC has launched a dedicated website for the awareness week at www.introducingacupuncture.co.uk
Anonymous survey, wide-ranging data
LUPUS UK is currently finalising a new survey to be sent to all LUPUS UK members (approx. 6,000).
The anonymous survey is a great way to collect facts and figures from lupus patients about how the illness affects them. We will be asking questions on a variety of topics including; diagnosis, symptoms, support, medication and work. The survey will be sent out in the next couple of months, after which the information will be collected and analysed.
This survey is an update on another which was sent to LUPUS UK members in 2009, the findings of which were published in our magazine News & Views.
BIMM's Upcoming Events 2014
Dates for your diary from The British Institute of Musculoskeletal Medicine
25th March - Part 1 Diploma in Musculoskeletal Medicine
22nd April - Part 2 Diploma in Musculoskeletal Medicine
St. Georges Hospital, Tooting, London SW17 0QT
The Diploma in Musculoskeletal Medicine was originally instituted by the British Institute of Musculoskeletal Medicine in 1992 and initially hosted by the Society of Apothecaries of London. It is now run directly by BIMM and is held at St George’s, University of London. It is open to candidates from any statutorily regulated health-care profession who have made a special study of the assessment and non-surgical management of musculoskeletal disorders.
It is the intention of the Examinations Board that this qualification will indicate that a practitioner is able to manage independently patients with common musculoskeletal problems in a primary, intermediate or secondary care setting.
BIMM Spring Symposium – “Brighton Peer Review”
Holiday Inn, Kings Road, Brighton BN1 2JF
The 2014 BIMM Spring Symposium presents an exciting and varied array of musculoskeletal topics ranging from the groundbreaking microbiological research that identified the organism associated with chronic intervertebral disc disease to the use of mindfulness meditation in the management of chronic pain. The knee will be in the spotlight this year with lectures on the role of physiotherapy and acupuncture in the management of conditions associated with this joint followed by a look at the current management guidelines for some of these in primary care. Learning points will be emphasised in a variety of short workshops.
Sports and Exercise Medicine, the Lower Limb
12th – 14th July
LCOM Boston Place London NW1 6QH
The course is a general introduction to sports medicine. With reference to lower limb injury and overuse syndromes the student will learn about the wider range of diagnostic possibilities encountered in the sports medicine clinic and their management. The hip, knee, ankle and foot will be covered comprehensively in terms of anatomy, function, clinical presentations, medical and surgical management.
Sept Foundation Course
27th – 29th
LCOM Boston Place London NW1 6QH
This module will cover the essentials of history taking and systematic physical examination of the musculoskeletal system. You will be introduced to the neurophysiology of pain and the relevance of the dysfunction model to understanding the modern epidemic of backpain. You will learn how to assess posture, gait and function and develop your manual skills in diagnosis of soft tissue dysfunction. Through understanding of joint mechanics and physiology you will begin to learn the principles of mobilisation and manipulation. Demonstration of diagnostic technique on clinic patients in later modules together with small group sessions will help you integrate this new knowledge and skills into your own practice.
EDS UK Patient Awareness Day
- 16th May
EDS UK are proud to announce our programme for the Ehlers-Danlos Syndrome Patient Awareness Day in conjunction with Professor Aziz.
On Friday the 16th May, Ehlers-Danlos Support UK will host their patient awareness day in London. The day will provide state of the art information to EDS patients about the causes of symptoms and their treatments based on the latest research developments in the field.
Leading experts will be invited to provide lectures that would be easily understood by the patients. Discussion groups will be held and patients will be provided with information about resources that they can access in the future. Medical professionals are most welcome to come and participate in the day.
Download the EDS-Patient-Awareness-Day programme.
To find out more or to book your place please click here.
Chiropractic Awareness Week:
14–18 April 2014
The British Chiropractic Association is running Chiropractic Awareness Week from 14 – 18 April 2014.
The theme is the effects of a sedentary lifestyle on young people and BCA members are being encouraged to get involved across the UK.
The CAW logo is available here - click for full size.
ARMA discount for Rheumatology 2014
ARMA members who book online at www.rheumatology2014.org using the reference code RHEUM2014ARMA can claim a 5% discount off the price of the conference ticket. Please spread the word within your organisations.
This three-day conference, at ACC Liverpool from 29 April – 1 May, has eight streams, including
- paediatric rheumatology
- rheumatology in primary care
- allied health professionals
- worldwide challenges in healthcare delivery.
With cutting-edge educational opportunities, the exhibition gives you a chance to learn about the latest products and services available. The exhibitors range from pharmaceutical companies, patient charities, suppliers and support services.
Delegates have an unrivalled opportunity to network and learn from experts in their fields, with sessions covering the latest advances in diagnosis and treatment of arthritis and musculoskeletal conditions such as osteoarthritis, pain, sports medicine, osteoporosis and vasculitis.
1000 delegates and counting for Rheumatology 2014
Join the 1,000 delegates who have registered for Rheumatology 2014
The British Society for Rheumatology are delighted that so many delegates will join them for Rheumatology 2014’s cutting-edge educational opportunities, specialist sessions and invaluable networking opportunities. The conference offers eight topic streams over three days with leading experts in Sjorgen's syndrome, RA, OA, osteoporosis and fibromyalgia, and there will be a number of ARMA members exhibiting. Places for the conference are still available, please book online.
Rheum-mate wanted: tweet at Rheumatology 2014
Apply now to be a guest tweeter for the British Society for Rheumatology at Rheumatology 2014 and report live from the conference to our 1,200 followers.
Last year BSR trended in Birmingham, can you help them this year in Liverpool? The guest tweeter will be given free registration for the full conference. Applications will close on 31 March.
New Editor of Rheumatology
An anniversary issue of the Rheumatology journal and a podcast are now available to celebrate Professor Robert Moots' time as editor for Rheumatology. The British Society for Rheumatology thanks Professor Moots for all his hard work and the significant contribution he has made to the journal over the past five years.
As Professor Robert Moots steps down as editor of Rheumatology, Professor Jaap van Laar will take up the reigns. Professor van Laar is the head of the department of rheumatology and clinical immunology at the University Medical Centre Utrecht, The Netherlands. He is the journal’s first international editor and has worked all over the world, from Newcastle to the United States.
NRAS Super Hero Run & Roadshow
Calling all super hero fans! Join us in Regent’s Park to take part in a 5/10km race and raise much-needed funds for NRAS.
We have secured places in the run which takes place on Sunday 18th May, and the spirit of this event is about ‘taking part’ not ‘winning’ so walk, jog or run – you choose! This is a great race if you are a massive super hero fan!
Entry is £22 and we ask that you pledge to raise a minimum of £100 in sponsorship. (Minimum age for participants is under 8 and under 16’s will need to run with a parent/guardian. If you are under the age of 18 you will need parental consent).
If running isn’t for you, why not organise your own event in aid of NRAS?
Here are a few ideas:
- Quiz night
- Car boot sale
- Race night
- Clothes Swap
If you are feeling really motivated why not give something up for Lent? 40 days of giving up a treat – be it chocolate, alcohol, coffee or whatever you choose! Say goodbye to that guilty pleasure for NRAS!
If you would like more information on how you can support NRAS please email email@example.com and speak to one of the fundraising team.
NRAS Roadshow Elstree 12th March 2014
Do you want to meet others living with Rheumatoid Arthritis? Do you want to learn about how you can get involved with the work of NRAS? Do you want to make a real difference locally and nationally to the lives of those living with RA? If you answer ‘Yes’ to any of these questions please register to join us at
the Holiday Inn,
on 12th March
The NRAS Roadshow will run from 10am to 4pm (hot buffet lunch and refreshments included) with presentations and workshops on a variety of topics. Carers are welcome to attend. This is a free event to all NRAS members. Reasonable travel expenses will also be reimbursed.
The NRAS Roadshow promises to be informative, interactive, stimulating and fun! Book your place today. For bookings, or if you have any queries, please email firstname.lastname@example.org.
Other venues and dates are available if you are unable to attend this event:
- 2nd April – Engineers’ House, Bristol
- 14th May – Woodland Grange, Leamington Spa
- 25th June – Marriott Hotel, York
ACS’s First Professional Lecture
at Scottish Parliament
Arthritis Care Scotland held their first Professional Lecture at the Scottish Parliament on February 5th. The event was very well attended, with a wide range of professionals, policy makers, and people with arthritis present to hear the presentations and take part in the lively discussion.
Bill Kidd MSP was the Parliamentary sponsor for the event, with Dr Alan Macdonald, President of the Scottish Society of Rheumatology, as chair.
Guest speakers were: Dr Duncan Porter, on the importance of early intervention in rheumatoid arthritis; Dr Martin Perry, on the Scottish Public Health Network’s needs assessment for people with RA, and on the progress to date on the report’s implementation; and Professor Martijn Steultjens, who spoke on the need to tackle the rising tide of musculoskeletal pain, proposing that every GP practice should have an msk specialist, probably an AHP, whose role would include referring people to other services.
Angela Donaldson, Director of Arthritis Care Scotland, provided a patient’s view, and took part in a panel discussion with the speakers, Bill Kidd and Dr Macdonald, answering a wide range of questions from the floor. Judi Rhys, Arthritis Care’s recent appointed CEO, rounded up what was a very successful evening (and hopefully only the first of a series) aimed at focusing the attention of policy makers and parliamentarians on the impact of arthritis and new ways of meeting the challenge of MSK conditions.
PSALV, Psoriasis Scotland Activities
- PSALV, Psoriasis Scotland has been lobbying for the inclusion of quality indicators for psoriasis and PsA in the Healthcare Improvement Scotland (HIS) 2014/15 Local Delivery Plan and has just received confirmation that the proposal has been accepted onto the HIS work programme.
In 2008, the charity e-petitioned the Scottish Parliament for NHS Clinical Guidelines for Skin and Joint Psoriasis and subsequently, was invited to join the working group as patient representatives. SIGN NHS Clinical Guideline 121 for Psoriasis/PsA in Scotland was published in October 2010 www.sign.ac.uk/
- PSALV, Psoriasis Scotland helped to initiate a Cross Party Group for Psoriasis/PsA, attended by MSPs from across the political spectrum. The CPG has been running for several years, now. The next AGM will be held on Wed 19 March 2014 at 6pm. If you wish to attend, please contact Mary.Blackford@scottish.parliament.uk
- PSALV, Psoriasis Scotland attended “The Arthritis Care Scotland Professional Lecture: 3 R’s: Recognise, Respond, Relieve” at the Scottish Parliament, 5 February 2014.
- PSALV, Psoriasis Scotland contacted the Cabinet Secretary and the Minister for Public Health, February 2014, to ask the Scottish Government to support IFPA and psoriasis associations worldwide in their campaign to put psoriasis and psoriatic arthritis on the agenda of the World Health Organization. During the 133rd meeting of the WHO Executive Board in 2013, a resolution on psoriasis/PsA and World Psoriasis Day, which is held each year on 29 October, was proposed and discussed, leading to unanimous adoption by the WHO Executive Board.
In May 2014, the resolution will be put to the vote to all Member States at the World Health Assembly. This resolution is important as it will send a powerful, global message that psoriasis/PsA are serious non-communicable diseases (NCDs) that need greater public awareness of inflammatory nature, psychosocial impacts and shared risk factors with other, more deadly NCDs.
Birmingham ARMA Awareness Day
On Thursday 6th of February, Birmingham ARMA group held an awareness day by putting up a stand in the main Atrium of the Queen Elizabeth Hospital Birmingham. The purpose was to raise awareness and to talk to patients visiting the Rheumatoid Arthritis and Osteoporosis Clinics.
We provided lots of information leaflets covering many of the issues confronting patients who suffer with these diseases, including where and how to get help from the various support groups.
It was a very successful day and we will be staging the event again in April. Birmingham ARMA group will also hold a meeting at the Queen Elizabeth Hospital in March, date to be advised.
We must thank Rheumatology Nurse, Carol Green, who not only linked the event with her clinic but stayed with us on the stand all day talking to patients.
Many thanks also must go to Hazel Cole and Jane Westwood who worked with me to set this up, and attended the stand all day giving advice and helping patients with enquiries.
MoveMore Plan for Sheffield
The recently completed MoveMore plan is a 5 year strategy for physical activity and a recipe for culture change, working towards an active and 'activated' city. It will be fully achieved by engaging the population in it's delivery.
In the attached pdf plan, the “one page visual summary” (p8) is helpful, and the introduction guides you through the key aspects. There was extensive consultation on this project, and the document captures the current best evidence nationally and internationally.
Sickness Absence in the Labour Market
New research published February 2014
on the impact of MSK disorders on work
A new report by the Office for National Statistics highlights the enormous impact of MSK disorders on work, and by extension the UK economy. ONS's Labour Force Survey, which was also featured in the BBC Business News section, found that musculoskeletal conditions accounted for more prolonged absences than any other ailment.
Acupuncture Awareness Week 2014 03 March 2014
NRAS Roadshow, North London 12 March 2014
Clinical Network Meeting 18 March 2014
Policy Leads Meeting, Arthritis Care 20 March 2014
Acupuncture Research Symposium, King's College London 29 March 2014
CEO Meeting, Arthritis Care 01 April 2014
NRAS Roadshow, Bristol 02 April 2014
BIMM Spring Symposium 12 April 2014
Chiropractic Awareness Week 14-18 April 2014
PMR-GCA Scotland AGM, Dundee 17 April 2014
ARMA Board Meeting 24 April 2014
Naidex National, NEC Birmingham 29 April-1 May
BSR Conference - Rheumatology 2014, ASC Liverpool 29 April 2014
ARMA session at BSR Conference, ACC Liverpool 30 April 2014
NRAS Roadshow, Leamington Spa 14 May 2014
EDS UK Patient Awareness Day 16 May 2014
Policy Leads and Gold Partner Stakeholders meeting 07 May 2014
Policy Leads Meeting, Arthritis Care 17 June 2014
2014 Love Your Bones conference, The Mountbatten Centre 25 June 2014
NRAS Roadshow, York 25 June 2014
Commissioning Show, Excel London 25 June 2014
CEO Meeting, Chartered Society of Physiotherapy 08 July 2014
ARMA Board Meeting 18 July 2014
CEO Meeting, British Orthopaedic Association 07 October 2014
2014 World Network Conference 12 October 2014
ARMA Board Meeting 17 October 2014
BSR Autumn Conference 27 November 2014
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