Arthritis and Musculoskeletal Alliance
This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.
  • The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK, and our mission is to transform the quality of life of people with musculoskeletal conditions. We have 40 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Musculoskeletal pain

Musculoskeletal conditions are common – we all know that. But it hadn’t struck me until recently just how common compared to other long term conditions. 17 million people in the UK have an MSK condition. Compare that with the 850,000 with dementia and think about how much we talk about dementia. It’s a similar picture for other conditions: diabetes, 3.5 million people, cardiovascular, 7 million. Only mental health exceeds the prevalence of MSK conditions.

Of course, we are rightly worried about dementia. But perhaps we should all worry a little more about our MSK health. It’s not “just pain” or something that is to be expected as we get older. It affects people of all ages and impacts of every aspect of life: work, friends, family, hobbies, the basics of independent living. We should all be working to maintain our MSK health throughout our lives. We should all be able to expect the right physical and psychological support and treatment if we do have MSK conditions.

Anything which has such major impacts on daily life takes its toll psychologically. ARMA members have been pooling their understanding of the links between MSK conditions and mental health. One recommendation we will be making to NHS England about their ten year plan is that everyone diagnosed with a long term MSK condition should have rapid access to psychological support. A pilot with other long term conditions has shown significant savings to the NHS. Providing access to people with respiratory illness, diabetes or a cardiovascular condition led to a saving of £200,000 for just 500 patients through reduced GP appointments, A&E attendance and hospital admissions. Including people with MSK conditions could double those figures.

As well as engaging with the ten year plan we’ve been making plans for the autumn. ARMA members have been supporting the parkrun ambassadors and we’re looking at what more we can do together. Our annual lecture will be on the 21 November and will have the CEO of parkrun as one of the speakers – look out for details in the next newsletter. Our webinar series begins again – see below for details of how to sign up for the first ones. And look out for more on mental health and MSK.

As you can see, there has been lots happening for ARMA over the summer. It feels very positive – MSK is rightly rising up the agenda. 17 million people need it to rise still further. ARMA will be working with you to make sure it does.

Arthritis Action will be holding a new two-day Self-Management Event on 2-3 May 2018 between 2pm–4.30pm at Blackpool Central Library, Queen Street, FY1 1PX

The aim is to help attendees take control of the symptoms of their arthritis, covering topics such as:

  • The impact of physical therapies
  • How you can best manage your pain
  • The benefits of exercise and a healthy diet
  • Ways to work in partnership with healthcare professionals

This event will be free of charge and refreshments will be provided, and is open to all.

For more information, please contact info@arthritisaction.org.uk or 020 3781 7120 and Arthritis Action will be able to provide you with further details.

Alternatively, please register via this Eventbrite link.

The British Orthopaedic Association (BOA) is pleased to announce the recent publication of four revised commissioning guides with the Royal College of Surgeons of England. These NICE-accredited guides set out best practice care pathways to assist CCGs in designing optimal care for their populations. We are extremely grateful to all those involved in the rigorous development and accreditation processes. The guides, which can be found here, are:

  • Pain Arising from the Hip in Adults
  • Painful Deformed Great Toe in Adults
  • Painful Osteoarthritis of the Knee
  • Treatment of Carpal Tunnel Syndrome

Following the recent BOA and ARMA position statements on the rationing of elective orthopaedic services, we are urging stakeholders to consider these guides and to promote their adoption wherever appropriate with local CCGs. The use of these guides will assist CCGs to deliver high quality care in each of these pathways.

If you have any further questions, please contact policy@boa.ac.uk.

Guest Blog by Neil Betteridge, co-chair, Chronic Pain Policy Coalition (CPPC)

As a former Chair of ARMA, it’s a great pleasure to be invited to write a piece for this month’s newsletter. Indeed, looking back to my seven years on the board, it is quite something to recall that the organisation entered the 21st century still called BLAR: the British League Against Rheumatism.

Apart from the name, much has changed in the world of rheumatic and musculoskeletal diseases since then, most of it for the better in my view. But one of the things about all 200 or so of these conditions that remains a huge challenge is the widespread prevalence of chronic pain. It is for this reason that, whilst CEO of Arthritis Care, I joined the Executive of the Chronic Pain Policy Coalition (CPPC), with whom I still serve, now as Co-Chair (together with Dr Martin Johnson, RCGP lead on chronic pain). ARMA and several of its members are affiliate members of the Coalition, and I strongly believe we should be working in tandem like this, given that around 70% of chronic pain is rooted in this family of disorders.

For those unfamiliar with our work, the name is pretty much self-explanatory. The focus is on the needs of people with long term, persistent pain; we operate exclusively in the policy domain; and our structure is that we are an umbrella body bringing together organisations that are stakeholders in chronic pain, be they voluntary sector or ‘patient’ groups, clinicians or other health professional bodies such as physios and occupational therapists.

Work is currently one of the Coalition’s top priorities. With the current interest in this area in England from the Dept. for Work and Pensions and the Dept. of Health, we see this as an opportunity to press for positive changes for people with any form of chronic pain who could be better supported in their efforts to get – or keep – a job suitable to their needs and wishes.

To facilitate views on this, during the recent consultation process on the Green Paper ‘Improving Lives: Work, Health and Disability’, the CPPC organised a roundtable chaired by Lord Luce. Officials from relevant government departments had the opportunity to hear the views of health care professionals and patient representatives from the chronic pain community, and the issues raised informed our formal written response.

The key issues to emerge were: highlighting the importance of work for the everyday lives of those with chronic pain; stressing the importance of empowerment, and of integrated support for people with chronic pain; and encouraging the provision of localised information and other support such as self-management for those living with chronic pain, in order that GPs can direct their patients to these resources in a timely way.

More information on this, and the work of the CPPC overall, is available at   www.policyconnect.org.uk/cppc/.

Going forward, we will shortly be conducting policy work into the ways in which opioids are currently prescribed. If any ARMA members are interested in this topic and would like to engage with our work in this area, please contact our Manager Katherine Perry via katherine.perry@policyconnect.org.uk.

It is free to become an affiliate member of the CPPC so if you wish your organisation to lend its name to the fight against the invisible epidemic that is chronic pain, please join us.

At a recent meeting of the World Federation of Chiropractic in Washington, founder of World Spine Care, Scott Haldeman MD, DC, reported on the latest developments.

The WSC is a collaboration of people working in MSK care, a charity dedicated to improving the lives of those suffering from spine related conditions in communities underserved by health care. Desmond Tutu and Elon Musk have put their names to WSC.

Work goes on in India, Ghana, Botswana and the Dominican Republic. Besides facilitating and funding clinicians’ work in these countries, the WSC also funds college education for future chiropractors from these countries.

The Global Spine Care Initiative has created a model for implementing care in countries without adequate provision. This includes evidence of the burden of MSK conditions, evidence-based guidelines, care pathways, resources and research. It recommends non-surgical, primary spine care. Scott Haldeman implored us all to donate and volunteer to support the WSC initiative.

See Nadine Harrison’s pictures of the World Spine Care Shoshong clinic in Botswana.

 

The Back Pain Show – 19 & 20 May 2017

After a decade, The Back Pain Show has moved from Olympia London to St Andrews Birmingham, to give access to sufferers from the Midlands and the North of England. This iconic, two-day show is a hub for sufferers to meet doctors and therapists who provide treatment and manufacturers who supply both preventative and therapeutic equipment.

There are many causes of back pain including crush fractures of the spine which are usually caused by osteoporosis. These fractures are amazingly painful and take many months to ease. For a small donation to the charity BackCare – www.backcare.org.uk – at-risk visitors to show can have a two minute DEXA scan to determine their bone density. With lifestyle changes they can significantly decrease the risk of this disabling condition. The scanner uses the same amount of radiation found in a banana!

Lectures for both the public and professionals will be given by leading researchers in the field of back pain. Don’t miss this opportunity to book the professional lectures and fulfil CPD requirements. Both public and professionals can register for the event and book any of the talks and lectures, free of charge, at www.thebackpainshow.co.uk.

For manufacturers, this is the once-a-year opportunity to show products to both the general public and professionals. With easy access (compared to the nightmare of London venues) and free parking, you should book your stand now before they are all snapped up as the number of stands is limited.

The show will host the AGM of the BackCare charity on Saturday afternoon. All members are welcome to come and meet the trustees and members of the research, publications and executive committees. Membership will be available at the charity’s stand at the entrance of the show. Come and support our unique charity supporting those with back and neck pain and preventing thousands of people from developing these disabling conditions.

 

ARMA is working with Public Health England and Business In The Community to develop a new toolkit for employers in the workplace, which launches in Spring/Summer 2017. Musculoskeletal conditions are an important consideration for businesses as they are a leading cause of pain and disability in the UK, affecting many employees.

The toolkit draws together information for employers to support staff in the prevention, early identification, management and adaptation for people affected by musculoskeletal conditions. The musculoskeletal toolkit is a simple step-by-step guide dealing with back, neck, muscle and joint pain at work. It will help employers access the best free resources that are available for their organisation and employees.

At the Health and Wellbeing at Work conference in the NEC on 7-8 March 2017, presentations and flyers will raise awareness and anticipation of the MSK toolkit pre-launch to employers and hundreds of delegates.

nice-backpain-quoteNICE’s updated guideline on low back pain and sciatica recommends exercise in all its forms – for example stretching, strengthening, aerobics or yoga – as the first step in managing the condition.

The guideline also recommends encouraging people to continue with normal activities as far as possible. However the guideline says massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone.

The updated guideline has been expanded to include people with sciatica, a painful condition typically caused by irritation or compression of the nerves which run from the lower back, through the legs and down to the feet.

Click here to read more from the NICE website.

by Professor Michael Hurley, Clinical Director,
Musculoskeletal Programme, Health Innovation Network South London

Along with many others in the musculoskeletal community, I get a tired of hearing about other long term conditions which continuously feature in the headlines – both in national media and NHS policy. Poor old ‘common’ joint pain is neither sexy nor headline-grabbing, but we all know how much it impairs the quality of life – none more so than the people who suffer it.

In the musculoskeletal programme of the Health Innovation Network (South London’s Academic Health Science Network http://www.hin-southlondon.org/clinical-areas/musculoskeletal) we have been focusing on improving community management of osteoarthritis, or chronic joint pain, for the past couple of years. We have three main projects: the ESCAPE-pain programme, education and training and a new ‘Osteoarthritis Advisor’ role.

ESCAPE-pain stands for Enabling Self-Management and Coping with Arthritic Pain using Exercise (www.escape-pain.org | @escape_pain). It is a group-based, 6-week rehabilitation programme that combines exercise and education. It has now been implemented at 25 sites in England, both in clinical physiotherapy departments, and in leisure centres. Participants learn how to manage chronic joint pain using exercise and coping techniques, and we have seen just how powerful the learning and interactions of the group are in changing health beliefs and increasing physical activity. Don’t just take our word for it; look at what some of the 2000 participants who have undertaken the programme say: https://player.vimeo.com/video/151535343. We also have substantial evidence that it will save the health system money – a lot of money. We are currently finalising an app that will allow many more people to access and benefit from the programme.

vimeo-participantsEarly on, we recognised how important it was to improve the training and education of the whole workforce in primary care. So we delivered a short training programme (devised by the Arthritis Research UK and Royal College of General Practitioners) to more than 200 GPs across 10 South London boroughs. They reported improved confidence in their ability to manage people with OA and less inappropriate referrals. Because it used a “train the trainer” approach, where participants who attend the programme can easily be trained to deliver it, we now have 7 GPs who are keen to continue to run these courses and educate their colleagues.

We also realised that leaving it to poor struggling GPs is not an option. People with benign joint pain get stuck in the bottleneck of primary care; because there’s insufficient manpower to deliver effective care, people receive little useful advice or adequate support, and consequently suffer unnecessarily for many years. So we are training other allied health professionals, health trainers and other disciplines to give more people better advice. In particular, we have also been delighted to observe how the provision of care NICE guidelines – simple advice and education delivered by an “Osteoarthritis Advisor” rather than a GP – can help reduce people’s joint pain, body weight and improve physical activity levels. This approach has huge potential for allied health professionals to elevate the burden on overstretched GPs, simplify over-complicated care pathways and deliver effective evidence-based care to large numbers of people.

HIN-logo-transparentOur projects show consistent improvements in pain, in function, wellbeing, and quality of life, and reduce health and social care costs. We are really excited about working with the health and social care systems across South London to scale-up and develop these projects so that many more people can lead better lives.

For more information contact us at the musculoskeletal clinical area at HIN South London.

phe-logoFrom the Public Health Matters blog, Public Health England
, 11 January 2016 — Health and Wellbeing

Life expectancy in England has risen by more than five years in the past two decades, yet for many people, a longer life will involve more years spent in ill-health.

Earlier this year, The Global Burden of Disease project – an international study ranking the diseases and risk factors that cause death and disability – highlighted the toll that musculoskeletal conditions are taking on people’s health.

2000px-Lumbar_region_in_human_skeleton.svgMusculoskeletal conditions are disorders of the bones, joints, muscles and spine. They can cause pain, stiffness or a loss of mobility and dexterity that can make it difficult to carry out everyday activities.

Low back and neck pain is now the leading cause of disability in England for both men and women combined. Falls, which are often a result of poor musculoskeletal health, also remain in the top ten causes of disability adjusted life years – a combination of the number of years of life lost to disease and the number of years lived with disability as a result of disease.

 

The wider effects

Each year 20% of people in the UK see a doctor about a musculoskeletal problem, and the NHS in England spends £5bn each year treating these conditions.

As well as causing pain and disability, musculoskeletal conditions can affect people’s physical health more generally. For example, people with osteoarthritis have an increased risk of cardiovascular disease, and falls among older adults increase the likelihood of early mortality.

Although many musculoskeletal conditions become more common as we age, they are not limited to older adults. A report published by Arthritis Research UK in 2014 highlighted that, in the past year, one in six adults aged over 25 had reported back pain lasting more than three months. Obesity, physical inactivity and injury are all major risk factors for back pain.

Mental health conditions can also increase the likelihood of developing some musculoskeletal disorders. For example, people with depression are at greater risk of developing back pain. Here lies a vicious cycle, as musculoskeletal conditions can also have a significant impact on mental health. Living with a painful condition can lead to anxiety and depression, and depression is four times more common among people in persistent pain compared with those without pain.

People with musculoskeletal conditions are also less likely to be employed than people in good health, and are more likely to retire early.

DALY

Musculoskeletal health: making a difference

Steps can be taken to improve musculoskeletal health at every stage of life, and tackling a number of risk factors could result in the dramatic improvement in the musculoskeletal health of the public.

Bones, joints and muscles begin to develop before birth, and continue to develop throughout childhood. Women who have a good diet and are physically active have babies that go on to have stronger bones throughout life. Conversely, childhood obesity can put pressure on vulnerable joints, increasing the risk of MSK conditions.

Regular physical activity and exercise at every stage of life can reduce the risk of many musculoskeletal conditions, including arthritis, back pain, neck pain, falls and fractures. Indeed, many of the NICE guidelines on physical activity to prevent disease or improve health are directly relevant to musculoskeletal health. A healthy balanced diet is also important for good bone health, to prevent osteoporosis and falls in later life.

There is also a lot that can be done in the workplace to reduce any threats to musculoskeletal health, including adapting physical environments and work practices, as well as early interventions to identify and address problems.

It’s important to note that, for the three leading musculoskeletal conditions that cause the most DALYs in England, there are evidence-based interventions that work (see table).

msk-interventions

Evidence-based interventions for the musculoskeletal conditions that cause the most DALYs in England, including low back and neck pain, falls and osteoarthritis.

 

At Public Health England, we’re working to reduce the impact of musculoskeletal conditions in a number of different ways:

Data and surveillance resources

The Arthritis Research UK report puts a clear emphasis on the need to urgently improve the extent and quality of clinical data on musculoskeletal health. More work is needed fill these gaps, but two useful weapons in our data arsenal are currently available:

The PHE Global Burden of Disease Compare tool helps local authorities to see the burden of musculoskeletal conditions on their local populations, while the Public Health Outcomes Framework enables us to see which risk indicators for musculoskeletal disorders are high in each local authority area.

 

Programmes for patients and professionals

Moving from evidence into action, PHE is working with partners on a number of prevention programmes and resources for people across all stages of life, as well as initiatives to help commissioners procure services to help prevent musculoskeletal ill-health.

For example, the Every Body Active Every Day framework sets out our vision of everybody being physically active, every day. It details clear steps for local authorities and partner organisations to promote change and encourage active lifestyles.

Our Falls prevention booklet explains how older people at risk of falls can reduce their risk and stay active. We have also developed a Falls and Fragility Fraction Population Healthcare Programme to help local authority public health teams gather and disseminate information about their local FFF system. The programme also supports local FFF initiatives, assesses and tracks performance and enables local partners to learn from best practice.

 

Partnerships and public engagement

Improving musculoskeletal health requires commitment from many different stakeholders, and will benefit patients, the health care system and other groups such as employers. We’re working with several partners to find joined-up ways of improving musculoskeletal health across the life course, such as our Workplace Wellbeing Charter to help employers provide workplace environments that support and encourage a healthy workforce.

We’re also working with Arthritis Research UK to make sure that improving the musculoskeletal health of the population is on the agenda of both the public health community and local and national government. Bedfordshire Clinical Commissioning Group is a great example of how some parts of the NHS are already using an integrated approach to improving MSK services. Last year it commissioned one single provider for its entire MSK programme with responsibility for delivering a service that joins up with other elements of the care pathway and focuses on outcomes for patients.

 

Reducing the burden of disease

As health care professionals, we must work together to promote good musculoskeletal health as a way to address multi-morbidity and protect mental health and wellbeing. At PHE, we are committed to working with partners and academics to identify health interventions that really work, supported by world-class knowledge and data, and to improve the capability and capacity of the NHS and the wider public health workforce to identify and treat MSK conditions, and implement effective and efficient prevention programmes.

The Global Burden of Disease study highlighted the fact that, as a nation, we must do better to reduce the burden of chronic diseases. Tackling musculoskeletal conditions and their wider impacts on health and wellbeing is a crucial step.

mediaplanet-bones-and-jointsARMA is pleased to once again support Mediaplanet on the 2015 Bones and Joints campaign to raise awareness of bone and joint health, from everyday strains to critical musculoskeletal diseases.

The campaign, launching today, features leading editorial from industry experts and insights on what is being done to provide better quality of life for patients with bone and joint problems. First-hand accounts from patients living with osteoporosis can be found on the dedicated campaign site, alongside pieces by Craig Revel Horwood and Greg Retter, Clinical Director at The Royal Ballet, on what we can learn from dancers about bone and joint health.

Mr Tim Wilton, President of the BOA, is leading the campaign with the foreword in the print supplement, with Professor Edward Davis of The Royal Orthopaedic Hospital explaining the different possibilities for patients undergoing surgery. You can pick up a copy of Bones and Joints in The Guardian today, or view it online at www.healthawareness.co.uk/bones-and-joints.

Please share on social media and retweet the tweets!

ADWoolf-x200_nlby Professor Anthony Woolf, Chair of ARMA and Chair of the Bone and Joint Decade: A Global Alliance for Musculoskeletal Health

Musculoskeletal conditions continue to be the greatest cause of disability in the UK according to the Global Burden of Disease study [click for summary], accounting for 30%. Low back pain is the greatest specific cause of disability and osteoarthritis is increasing with ageing of the population and increasing obesity. We, the MSK community, have always known the impact these problems have on people and society but now policy makers cannot escape from the facts and have to come up with policies to prevent and manage them more effectively.

The drivers for political action are not just numbers of years lived with disability due to MSK conditions but the economic impact this has due to loss of work and independence. People are living longer and need to be able to work into older ages and maintain their independence. But with ageing physical function declines and people collect long-term conditions like children collected postage stamps. Society cannot afford to look after them. 

It needs to be recognised that musculoskeletal health is essential to general health and well-being and more invested in maintaining it. Promoting physical activity and ideal body weight is important but the gain for musculoskeletal health needs to be more transparent – people think it the main danger from obesity is diabetes but the risk of OA is just as great. We need other solutions to offer the policy makers to reduce the future burden. We know a lot of the “whats”, like early diagnosis of inflammatory arthritis, but we need more examples of the “how” to demonstrate how it can be achieved in a cost-effective way.

We also have to work as an MSK community as no individual person or group can deal with the spectrum of MSK conditions and deliver the integrated care many need. The burden of disease data along with the current political context gives us a great opportunity to present ourselves as a community with solutions to offer – at last policy makers are asking for this and we have to meet the need.

Findings of the Global Burden of Disease Study 2010, from the Lancet.
More about the Bone and Joint Decade, including recent posts.