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Arthritis News

State of Health reportState of health and care: The NHS Long Term Plan after COVID-19

A new report from IPPR shows the extent to which the coronavirus pandemic has disrupted progress on the NHS Long Term Plan. The report looks at cancer, mental illness, cardiovascular disease and multiple long term conditions, but the findings are equally relevant to MSK services.

The report argues that COVID-19 should not become an excuse for low ambition, and that world-class healthcare must remain the overall goal. To achieve this, the report recommends a package of six ambitious changes designed to do three things:

  • Ensure the pandemic does not cause lasting damage to healthcare services for future generations.
  • Bring in areas – like social care and public health – that are not covered in The NHS Long Term Plan, but which are integral to healthcare.
  • To capture the innovations that occurred during the pandemic.

The six recommendations are:

  1. Ensure a sustainable workforce: a new deal to catalyse recruitment and retention – including a pay rise, a new wellbeing offer, and improved training and progression.
  2. Fund the NHS to deliver and sustain transformation: funding to meet the elective care backlog and rise in mental illness to avoid a trade-off between transformation and the pandemic care backlog.
  3. Empower integration from the bottom up: through system focussed regulation, reformed financial incentives and permissive legislation.
  4. Upgrade the digital NHS: providing internet access as a basic public service, understanding patient preferences and investing in the NHS’s digital infrastructure.
  5. Fund and reform social care: including free personal care for everyone aged 65 and over, improving the quality of social care, better pay for care workers, and immigration rules that do not lead to catastrophic shortages.
  6. Level up the nation’s health: a public health cabinet committee to co-ordinate policy functions across Whitehall, and greater devolution of funding and powers to local government to tackle the primary determinants of health.

Read the full report on

Summary of article published in Rheumatology Advances in Practice on 5 January, 2021

“Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society”

Authors: Elena Nikiphorou, Hannah Jacklin, Ailsa Bosworth, Clare Jacklin, Patrick Kiely


In 2020, NRAS conducted a survey amongst its members and non-members who had RA with a disease duration more than 2 years, who were not on advanced therapies (i.e. biologic/biosimilar or targeted synthetic DMARDs (JAK inhibitors)), with the aim of revealing the everyday impact of living with RA in people not treated with advanced therapies. It aimed to assess in detail a wide range of aspects of quality of life and everyday living using the RA Impact of Disease (RAID) patient reported outcome questionnaire and other measures of the impact RA (on work).


It is widely established that prompt and effective treatment in RA using tight control (treat-to-target) strategies improves disease outcomes. (For more information on tight control, please see our booklet ‘Living Better with RA’ and our website). The aim of tight control is to get disease into remission, or if that is not possible, as low a disease activity state as possible. The 28-joint count Disease Activity Score (DAS28) is used in the UK to determine how well disease is being controlled by current medication, and assess eligibility to move on to advanced therapies, if standard disease modifying drugs are not working well enough (current NICE guideline requires a DAS 28 of greater than 5.1 for a patient to be considered for moving onto advanced therapies).


There were 612 responses from patients having an average age of 59 years. 88% were female and 37.7% had a disease duration of 2–5 years and 27.9% a disease duration of 5–10 years. In the last year, 90% had reported a flare of their RA, with more than 23% reporting six flares. As part of the survey, participants completed the RAID questionnaire which measures 7 domains: pain, functional disability assessment, fatigue, sleep, physical wellbeing, emotional wellbeing and coping. Only 12.4% of participants recorded an ‘acceptable state’ as measured by the scoring system for the RAID questionnaire.  On an individual patient level, a score below 2 is deemed ‘a patient acceptable state’ on a scale of 0-10. More than 50% of participants scored each of the seven domains in the high range (indicating a worse state); 74.3% scored sleep problems and 72% fatigue in the high range.

Difficulties at work were measured using a selection of questions taken from the Work Productivity and Activity Impairment (WPAI) questionnaire. A need to change working hours was reported by 70%. The survey results showed increasing difficulties with daily physical activities. Reduced emotional and physical well-being in the past week were all strongly linked to levels of pain reported as well as number of flares and ability to cope. The total RAID score strongly predicted the number of flares people reported.

Key outcomes from this study

  • In established RA, patients who are not on advanced therapies, indicate high levels of suffering as reported by the RAID.
  • The RAID ‘acceptable state’ is very uncommon.
  • High levels of pain, physical disability, sleep difficulties and fatigue are key symptoms experienced.

To read the full paper, go to the news section of the NRAS website.

Versus Arthritis has teamed up with Sport England to help distribute £250,000 grants from their ‘Tackling Inequalities’ fund on behalf of the Richmond Group of Charities. The purpose of the fund is to reduce the negative impact of coronavirus and the widening of the inequalities in sport and physical activity through increasing availability of exercise opportunities in local communities.

The funding will be targeted to help support people with long-term health conditions, Black, Asian minority ethnic groups and lower socio-economic groups.

In addition to the Tackling Inequalities fund, Versus Arthritis has secured funding to open the fund UK wide and will be running the Let’s Move Together fund. This fund will be available to support people with arthritis and musculoskeletal conditions to get active.

This funding will enable community groups working with these audiences to continue to exist and engage with their communities, with a view to keeping them active during both the lockdown and early recovery stages.

This is a targeted fund that’s been designed to deal with the ‘here and now’ issues caused as a result of coronavirus and aims to support community organisations working with priority audiences so they have a future to plan for.

As well as supporting specific activities to increase availability of exercise opportunities in local communities, this fund will also support organisations and groups facing financial hardship due to the COVID-19 crisis, with a view of enabling delivery of sport and physical activity work in the future.

The types of activity that might be funded could include:

  • Funding for community groups to find new ways of keeping active during this time
  • Offering advice and training support
  • Increasing resilience, capacity and capability of delivery bodies.

More details on the fund can be accessed on the Inspiring active communities page on the Versus Arthritis website.

To support the review and award of funding applications Versus Arthritis is creating an independent panel of external experts. VA is looking for people with expertise and interest in tackling inequalities with a passion for making a difference to the availability of exercise opportunities in local communities. If you think this sounds like you, please fill out the application form to apply. [Microsoft Office form]

NHS National Clinical Specialist Advisor in personalised care (MSK)

The NHS is seeking a National Clinical Specialist Advisor in personalised care (MSK). It’s an excellent opportunity to help provide clinical leadership within personalised care and help drive the newly launched NHS #BestMSKhealth strategy. 

For details and to apply see the job page on the NHS website.

The College of Podiatry has been renamed as the Royal College of Podiatry (RCPod) after being granted permission to use the title by Her Majesty The Queen.

The RCPod is the professional body for podiatry and represents 10,000 members in the United Kingdom and internationally. With its members, the RCPod campaigns to raise awareness that good lower-limb health is essential, and that podiatry is a key element of preventative medicine in the wider health economy. Permission to use the royal title is granted by The Queen, who acts on advice provided to her by her ministers. Use of the royal title or any personal title is granted sparingly. It was noted that the College’s long history, proud heritage and its embodiment of high standards contributed towards the decision.

Chief Executive of the Royal College of Podiatry Steve Jamieson said: “I am proud that Her Majesty The Queen has granted the College royal status in its 75th year. It is the hard work of our members and their consistent dedication to the profession that is the driving force behind this achievement. I look forward to the future as part of a Royal College, whilst continuing to focus on raising the profile of podiatry and championing its unique impact on patient care.”

Chair of the Royal College of Podiatry Matthew Fitzpatrick said: “I am thrilled by today’s news and delighted for our members who are now represented by a Royal College. The professional standards associated with holding a royal title will enable the RCPod to gain a greater voice representing its members and their patients in all areas of the ealth and social care agenda.”

NHS England has launched a new programme with the aim of sustaining the delivery of evidence-informed, personalised, high-quality integrated healthcare of value to all. This new initiative, part of the Pathways for Better Health Programme, significantly increases the resource to support MSK service delivery.

The programme covers the breadth of MSK including orthopaedics, rheumatology and pain, spanning primary secondary and community services. You can watch the launch event here.

The programme has ten workstreams, each led by a relevant clinical specialist:

  • Diagnostics
  • Orthopaedics
  • Rheumatology
  • Primary and Community MSK Provision
  • Spinal Services
  • Falls, Fragility Fractures and Osteoporosis
  • Data, Validation and Coding
  • Communications and Developing MSK Networks
  • Supporting those with Long Term MSK Conditions
  • Outpatients

There is the intention to ensure that the programme is coproduced involving the range of stakeholders including people with lived experience and patient organisations. The aim is to support local system leads to deliver MSK services in line with the programme, rather than to mandate a specific service model.

BestMSKHealthThe primary and community workstream, led by Chris Mercer, will be vital to the success of the programme overall. The other workstreams all depend on effective support in primary and community services. Having all the pieces of work in one programme will enable co-ordination. At the launch event Chris talked about the potential for the new White Paper to start breaking down some of the boundaries in the NHS and the need for MSK leadership across all levels of the system.

Summing up, Andrew Bennett, National Clinical Director for MSK, encouraged everyone to engage with the programme as it develops. The work has only just begun. This will not be a top-down initiative. It will be based on collaboration and coproduction.

Look out for updates in future ARMA newsletters and on twitter using #BestMSKHealth.

The coronavirus pandemic has changed the delivery of healthcare services, creating challenges for healthcare professionals and people living with musculoskeletal conditions. Patients are increasingly required to monitor their own disease activity and report on their condition during remote or virtual consultations.

To address this, the Centre for Epidemiology Versus Arthritis has been working on the REmote MOnitoring of Rheumatoid Arthritis (REMORA) study. REMORA is a smartphone app study that encourages people with rheumatoid arthritis (RA) to monitor and record their daily symptoms. It then connects this data directly into the patient’s electronic health records and makes it accessible to their clinician.

In the early stages of the study, we recognised the importance of training people with RA how to self-examine for tender and swollen joints, as these are key to tracking disease activity. During the regular Patient and Public Involvement and Engagement (PPIE) meetings, the PPIE group identified that the existing online resources did not meet their needs in explaining how to perform joint self-examination.

The PPIE group were clear that they wanted to develop their own video, addressing the questions and difficulties patients meet when self-examining for tender and swollen joints. The process of development and production took a few months from the initial preparation, to filming, and final editing. At all stages, our first priority was ensuring the safety of everyone involved. Most of the work around the video was coordinated remotely. For the actual filming on campus, we followed all COVID-19 safety measures and rules regarding social distancing and masks.

A number of useful materials were created to support patients while they are self-examining their joints. For example, we created a manikin (human-like model) and a table that allows people to keep track the tender and swollen joints as they go along with the video. We have also written answers to frequently asked questions.

The video on how to self-examine tender and swollen joints was released on February 3, 2021. We were delighted to see how well received it was from both patients and clinicians, receiving over 1,000 views during the first week since its launch!

We would encourage everyone with RA and their clinicians to watch and signpost others to the video. We are really keen to hear feedback from both patients and healthcare professionals through our online survey. This is really important to inform the development of a future version, incorporating feedback and (we hope) to be filmed without the need for masks.

Latest information about the REMORA study and more insights to the development of the video here.

Follow the Centre for Epidemiology Versus Arthritis:

remora-shark man uni logo

The 2021 Backcare Awareness Week will run from 4-8 October.
The theme for this year’s campaign is Back Pain working from home.

BackCare is due to release display packs and more information soon.
Check this page on the BackCare website for updates.