This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Arthritis News

Many NHS staff who would normally answer calls from patients are redeployed to the fight against coronavirus (covid-19). Patient charities continue to experience high volumes of calls from concerned people with musculoskeletal conditions. Patient charities are responding with specific information and guidance, including virtual Q&A and risk calculators.

Here’s a roundup of some of the online help people can refer to:

Fibromyalgia: www.fmauk.org/coronavirus

Hypermobility Syndromes Association (HMSA): https://www.hypermobility.org/news/covid19-resources

National Axial Spondyloarthritis Society (NASS): https://www.nras.org.uk/coronavirus, https://nass.co.uk/news/coronavirus-advice-for-people-on-biologic-therapy/

National Rheumatoid Arthritis Society (NRAS):  https://www.nras.org.uk/coronavirus

Scleroderma & Raynaud’s UK (SRUK): https://www.sruk.co.uk/about-us/news/novel-coronavirus-covid-19-advice-our-community/

Versus Arthritis: https://www.versusarthritis.org/news/2020/march/coronavirus-covid-19-what-is-it-and-where-to-go-for-information/

Last updated 25/6/20

ARMA is working to support our members to share information and respond effectively to the coronavirus outbreak. Patient organisations are working to ensure people have the advice they need related to their condition or medication. Our professional members are working to ensure healthcare professionals have access to the information they need about the virus and also how to continue to provide healthcare support in the current situation.

ARMA is signposting the most relevant information we can find and will update this page as new information becomes available. It includes information for professionals, patients, parents and guidance for Wales and Scotland.

General advice about social distancing including groups who may be more at risk. (Updated 31/5/20)

https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing

Information for professionals

NHSE Speciality guides including:

Medicine:

  • Management of rheumatology patients which includes more information about levels of risk for different groups (v. 2 posted 14 April)

Surgery:

  • Management of trauma and orthopaedic patients (v. 2 posted 14 April)
  • Management of patients requiring spinal surgery (v. 2 posted 15 April)
  • perioperative care of people with fragility fractures

Musculoskeletal:

  • Urgent and emergency musculoskeletal conditions in children (under 16) requiring onward referral
  • Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral – to help primary or community care practitioners recognise serious pathology which requires emergency or urgent referral to secondary care in patients who present with new or worsening musculoskeletal (MSK) symptoms.
  • Management of patients with musculoskeletal and rheumatic conditions on corticosteroids

These can all be found here:
https://www.england.nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/

Other orthopaedics

Operating framework for urgent and planned services within hospitals (14 May)

https://www.england.nhs.uk/coronavirus/publication/operating-framework-for-urgent-and-planned-services-within-hospitals/

Re-starting non-urgent trauma and orthopaedic care guidance from British Orthopaedic Association

https://www.boa.ac.uk/resources/boa-guidance-for-restart—summary—final-pdf.html

Other rheumatology

NICE COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders.

https://www.nice.org.uk/guidance/ng167

Management of patients with musculoskeletal and rheumatic conditions who: are on corticosteroids; require initiation of oral/IV corticosteroids; require a corticosteroid injection (16/6/20)

https://www.rheumatology.org.uk/Portals/0/Documents/COVID-19/MSK_rheumatology_corticosteroid_guidance.pdf

Information to help healthcare professionals manage osteoporosis patients taking denosumab (Prolia) 

https://theros.org.uk/healthcare-professionals/denosumab-prolia-treatment-and-the-covid-19-pandemic

Shielding (England)

Guidance and updates for GPs: Highest clinical risk patients (23 June) Includes text of letter being sent to those who are shielding.

https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/

Identifying high risk patients who should be shielding – There is information on the BSR website about how this will be done in relation to rheumatology including a template of the letter patients will receive.

https://www.rheumatology.org.uk/News-Policy/Details/Action-needed-coronavirus-identifying-high-risk-patients

COVID-19 – ‘shielding’ guidance for children and young people

https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people

Information in the NHS website for patients about shielding. (Updated 22/6/20)

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Community MSK services

Prioritisation within community services guidance – which services should stop, continue or change their provision, including podiatry, rehab, therapy and MSK services. Covers both children and young people services and adult and older people services. Includes a link to the new hospital discharge service requirements to free up beds and will be a priority for some of the services listed above.

https://www.england.nhs.uk/coronavirus/publication/covid-19-prioritisation-within-community-health-services-with-annex_19-march-2020/

The Stanford Hall consensus statement for post-COVID-19 rehabilitation

https://bjsm.bmj.com/content/early/2020/05/31/bjsports-2020-102596.full

Guidance from the CSP on implementing remote consultations

https://www.csp.org.uk/publications/covid-19-guide-rapid-implementation-remote-consultations

Paediatrics

COVID-19 – talking to children and families about returning to school: guiding principles

https://www.rcpch.ac.uk/resources/covid-19-talking-children-families-about-returning-school-guiding-principles

Other

Information about NICE rapid guidelines on the active management of COVID-19 infection. NICE are also reviewing guidance on ibuprofen and other non-steroidal anti-inflammatory drugs in relation to impact on covid-19 illness.

https://www.nice.org.uk/covid-19

Guidance on infection prevention and control for COVID-19

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

Guidance on Vitamin D supplements for people getting out less due to shielding, isolating or lockdown.

https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

 

Information for patients

A risk calculator for rheumatology patients to assess their risk and whether you should be isolating or shielding.
https://www.versusarthritis.org/rheumatology-patients-and-covid-19-learn-more-about-the-risk-levels/

FAQs for patients on resuming surgical services
https://www.boa.ac.uk/resources/coronavirus-boa-faqs-for-patients.html

Many patient organisations have helplines and web-based information.

Arthritis Action: https://www.arthritisaction.org.uk/covid-19-advice/

Fibromyalgia UK: http://www.fmauk.org/coronavirus

Hypermobility Syndromes Association: https://www.hypermobility.org/news/covid19-resources

Lupus UK: https://www.lupusuk.org.uk/coronavirus/

National Axial Spondyloarthritis Society (NASS): https://nass.co.uk/managing-my-as/covid19-coronavirus/

National Rheumatoid Arthritis Society (NRAS): https://www.nras.org.uk/coronavirus (info page);
and Here For You, a new service that allows you to arrange a callback with someone with RA who understands you: https://www.nras.org.uk/here-for-you

Psoriasis Association: https://www.psoriasis-association.org.uk/psoriasis-and-treatments/covid-19-information

Royal Osteoporosis Society: https://theros.org.uk/information-and-support/coronavirus-and-osteoporosis

Scleroderma & Raynaud’s UK (SRUK): https://www.sruk.co.uk/about-us/news/novel-coronavirus-covid-19-advice-our-community/

Versus Arthritis: https://www.versusarthritis.org/news/2020/march/coronavirus-covid-19-what-is-it-and-where-to-go-for-information/

 

Information for patients and parents of children and young people

From SPARN (Scottish Paediatric and Adolescent Rheumatology Network)

https://www.sparn.scot.nhs.uk/

CCCA Kids with Arthritis incorporating JIA Matters facebook group

https://www.facebook.com/CCAAorguk/

Great Ormond Street Hospital advice for parents of vulnerable children and young people – useful practical advice on shielding for a child. 

https://www.gosh.nhs.uk/news/coronavirus-covid-19-information-hub/coronavirus-covid-19-and-vulnerable-children

Resources for young people – specifically about shielding and social distancing and developed with input of children/young people.

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/covid-19-guidance-on-protecting-people-most-likely-to-get-unwell-from-coronavirus-shielding-young-peoples-version

Information for Wales

Guidance for professionals (nothing MSK specific)

https://gov.wales/health-professionals-coronavirus

COVID-19 High risk shielded patient list identification methodology (note different methodology for rheumatology from England and guidance below contains more up to date list)

https://nwis.nhs.wales/coronavirus/coronavirus-content/coronavirus-documents/covid-19-high-risk-shielded-patient-list-identification-methodology/

Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from coronavirus (COVID-19). (updated 1 June).

https://gov.wales/guidance-on-shielding-and-protecting-people-defined-on-medical-grounds-as-extremely-vulnerable-from-coronavirus-covid-19-html

https://gov.wales/get-coronavirus-support-extremely-vulnerable-person – contact your local authority

https://www.wlga.wales/welsh-local-authority-links

Shielding guidance in Wales did not change from 22 June:

https://gov.wales/statement-deputy-chief-medical-officer-wales-dr-chris-jones-coronavirus-shielding

Information for Scotland

Guidance for healthcare professionals

https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/

Shielding advice

https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19/coronavirus-covid-19-shielding

Mr Jones is 72 today. A few years ago, he would have celebrated with friends in the pub, but now the pain in his back makes is hard to go out and he gets tired quickly. So, he’s at home watching TV while his wife cooks a meal. He spends a lot of time watching TV and his back seems to be getting worse, but his GP says there is nothing she can do for him but being more active will help. That’s easy for her to say, he thinks, it’s not her back that’s in agony every time she stands up.

This is a common story in the UK, where musculoskeletal conditions such as chronic back pain are the biggest cause of years lived with disability. Social prescribing has enormous potential to help people like Mr Jones. Here are three things it has to offer:

  • You are not alone – one of the single most effective things that will help is peer support. To know that others are in the same situation can reduce the feelings of isolation and provide a source of hints and tips for coping form those who know what they are talking about. A link worker can sign post to the local groups, national helplines and sources of peer support run by our members.
  • Keep active – Mr Jones’ GP is right. Even when moving hurts, it can often be the best thing for conditions such as arthritis or back pain. Some people will benefit from a specialist programme such as Good Boost or Escape Pain. Others just need to find a local gym or activity group that is welcoming and encouraging. ARMA has two webinars explaining how fitness and activity providers can help people with MSK conditions be more active. The first of these would also help link workers understand pain and activity so they can better help people in this position.
  • Stay connected – Many people lose their social connections when an MSK condition makes keeping in touch more difficult. This can lead to isolation, loneliness and anxiety or depression – all of which make pain feel worse. A link worker supporting someone who has become lonely or isolated needs to ask about problems with pain or mobility. Not everyone will mention this without being asked. A link worker who understands how MSK can impact on the ability to stay engaged can help a person reconnect.

So, on Social Prescribing Day 2020, I would encourage everyone to “think MSK” and find out how social prescribing and community support can make a difference.

Resources to help:

Webinars on activity and fitness: arma.uk.net/physical-activity-msk

Patient organisations offering helplines, information, groups and support:

Arthritis Action
Arthritis Action offers members healthy eating advice, clinical appointments, exercise tips and pain management techniques.

Ehlers Danlos Support UK
Ehlers Danlos Support UK run the only helpline in the UK specifically to help anybody touched by EDS and at a local level, our network of volunteers run local support groups and regional facebook pages to help families, friends and patients.

Fibromyalgia Action UK
Fibromyalgia Action UK offers national helplines on fibromyalgia and benefits issues, an online support forum that is available 24/7 and a UK wide system of support groups.

Hypermobility Syndrome Association
Hypermobility Syndrome Association provides a helpline for support and advice, local support groups, and locally run Facebook groups for peer support.

National Axial Spondyloarthritis Society
NASS provides support and advice on exercising, medication and living with axial SpA (AS) including local groups and an online community forum.

National Rheumatoid Arthritis Society
NRAS provides a freephone helpline, NRAS local groups around the UK, and an online community.

Scleroderma and Raynaud’s UK
SRUK provides a helpline, local support contacts, support groups and an online forum.

UK Gout Society
UK Gout Society provides basic information to people living with gout, their families, friends and carers.

Versus Arthritis
Versus Arthritis provides a helpline, 24/7 arthritis virtual assistant, online community and local groups.

We know that musculoskeletal conditions are much more prevalent in deprived areas so the publication of this report is very relevant to addressing the social determinants of MSK health. It has been produced by the Institute of Health Equity and commissioned by the Health Foundation to mark 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review).

The report highlights that:

  • people can expect to spend more of their lives in poor health
  • improvements to life expectancy have stalled, and declined for the poorest 10% of women
  • the health gap has grown between wealthy and deprived areas
  • place matters – living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly five years less.

The purpose of the report is to show what can be done, in a spirit of social justice, to take action on the social determinants of health to reduce these avoidable health inequalities. It makes a series of recommendations for improvement around five themes:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create and develop healthy and sustainable places and communities

You can read and download the full report, Health Equity in England: The Marmot Review 10 Years On, or executive summary from the Health Foundation website.

You can read a response from Sue Brown on medium.com.

Versus Arthritis is campaigning to ensure that everyone who needs a joint replacement gets timely access to treatment. Hundreds of thousands of joint replacement operations take place each year. More than 90% of people who have hip and knee replacements have osteoarthritis.

At the end of February, Versus Arthritis released figures revealing that, in one year alone, almost 30,000 people with arthritis in England waited more than the guaranteed 18-weeks to start treatment. This has been featured in the Telegraph, with more coverage to follow.

Not only are people with arthritis already facing an agonising wait for surgery but now, a review of NHS waiting times in England, also puts our existing 18-week right to treatment at risk. The VA campaign is calling on the government to protect our NHS right to treatment within 18 weeks, and ask for a plan to reduce waiting times and improve access for those who need joint replacements.

We know people with arthritis are facing long waits for joint replacements all over the UK. Waiting times are measured differently in each UK nation, but most recent data suggests that all four health systems are struggling to meet their respective targets. This is the first step in building our UK-wide campaign, and Versus Arthritis has started in England because the NHS review of joint replacement waiting times is a live policy issue.VA will be doing further work to campaign for change across all nations, and everyone across the UK is urged to back this campaign.

Sign and share the petition today

  • Wherever you live in the UK, please add your name to the petition today and share it with your friends, family and networks on social media. Thousands of signatures are needed to make sure the government listens to our calls.
  • For everyone in England, there’s also an option to share the petition with your MP. So please make sure you say “yes” to this step too.
  • If you live outside of England, please encourage anyone who has had a joint replacement, or is waiting for surgery, to share their story with us.

 

Spread the word with our resources

Please share the message far and wide with your professional and personal networks. VA has created a number of different resources that you can use:

Campaign PDF provides a summary of the campaign.

Downloadable petition for those who want to print copies and take our petition out to communities.

Video of Rob’s story, highlighting the agonising wait faced by people with arthritis. 

 

Accessing Advanced Therapies (biologics, biosimilars, oral JAK inhibitors)

For some time, NRAS has been concerned that some Clinical Commissioning Groups (CCGs) have been artificially restricting access to advanced therapies (biologics, biosimilars/JAK inhibitors) and undertook a Freedom of Information request to all CCGs about this. Following discussions with NHS England on behalf of RA patients about this practice, which was felt to be unethical, NRAS is delighted to share with you news of the attached recently published statement from the NHS Regional Medicines Optimisation Committee.

This statement about the sequential use of biologics has clarified that restricting access to NICE approved medicines is counter to the provisions of the NHS Constitution and that ‘clinical assessment of the appropriateness of treatments should be the overriding factor rather than the implementation of policies for cost-saving reasons’. NRAS urges you to print the statement and share it with colleagues in rheumatology who may not yet be aware of this important clarification on advanced therapy pathways. If the CCGs you deal with are not adhering to this NHS England guidance, NRAS would like to know and would urge you to email samuel@nras.org.uk with details of which CCGs’ practices brings them into opposition to the NHS constitution.

 

The final version of the GP Contract which sets out requirements and funding for the new Primary Care Networks was published in February. Some significant changes were made in response to consultation, including one relevant to the delivery of “additional roles” which, amongst other things, will help fund the roll out of First Contact Practitioners. The two main changes are an expansion of the roles and an increase in the funding from 70% to 100% of salary. Many of the new roles are also important for MSK health.

Initially the additional roles covered by the reimbursement scheme were clinical pharmacists, social prescribing link workers, physician associates, physiotherapists and community paramedics. To this list has now been added pharmacy technicians, health and wellbeing coaches, care co-ordinators, occupational therapists, dietitians, podiatrists and community paramedics. Mental health practitioner roles – including Improving Access to Psychological Therapy (IAPT) practitioners – will also be included in the Scheme from April 2021. It is up to each PCN to decide the distribution of roles required.

Funding for the scheme has been increased, both to increase the number of additional staff by 6,000 and to increase the reimbursement from 70% of salary costs to 100%.

The Institute of Osteopathy has recently published additional reports, including the impact of Multidisciplinary management of low back pain and sciatica in primary care. This impact report provides an overview of the Plymouth Community Back Pain Service which has delivered a sustainable primary care service with measurable outcomes run by a multidisciplinary team including GPs, osteopaths, cognitive behavioural therapists and physiotherapists.

To see all recent publications, visit the iO Research and Reports page.