What are Musculoskeletal Disorders?
‘Musculoskeletal conditions’ is a broad term, encompassing around 200 different conditions affecting the muscles, joints and skeleton. Around 10 million adults, and around 12,000 children, have a musculoskeletal condition in England today.
Musculoskeletal conditions are a major area of NHS expenditure, comprising a separate ‘programme budget’ which – in 2009-10 – consumed £4.76 billion (over £13 million a day). This represents a greater spend than on neurological conditions, diabetes, and infectious diseases, and is an equivalent level of expenditure to that on respiratory conditions. Expenditure on musculoskeletal conditions has risen rapidly in recent years and it is now the fourth highest area of NHS programme budget spend.
The management of musculoskeletal conditions cuts across public health, NHS and social care. Examples of conditions where this is clearly the case include back pain and rheumatoid arthritis.
We provide a number of helpful and informative resources on this site; a good place to start is the document provided by Versus Arthritis called “Understanding Arthritis,” which is a useful snapshot of the most widespread forms of musculoskeletal diseases.
Chronic Musculoskeletal Pain
Chronic musculoskeletal pain (CMP) is generally classed as a musculoskeletal pain condition that has no identifiable underlying, serious or specific disorder and has not resolved in less than 3 to 6 months.
Connective Tissue Disease
Connective tissue diseases (CTD) are a group of conditions characterised by multi-organ inflammation and autoimmunity. They are generally considered to be uncommon, but are lifelong conditions with significant impact on a person’s health and daily life.
When acutely active, Connective Tissue Diseases can be life threatening and may require immediate access to specialist services to prevent multi-system damage.
Symptoms vary depending on the disease, but many share the common symptoms of joint aches and pains, fatigue, muscle pain and weakness, rashes, skin changes and inflammatory changes in different organ systems. All of these conditions can affect children. The term does not encompass inherited conditions such as Marfan’s disease or the Ehlers-Danlos group of inherited conditions of connective tissue.
Juvenile Idiopathic Arthritis
About 12,000 children in the UK under the age of 16 have a form of arthritis. Most kinds of childhood arthritis come under the general heading of juvenile idiopathic arthritis (JIA). JIA involves inflammation, pain and swelling in one or more joints for at least six weeks. It is often referred to as juvenile arthritis. The causes are unknown. The outlook for most children with JIA is good. Although some children will develop joint damage, the majority get better and grow up to lead ordinary lives.
The most common forms of Juvenile Idiopathic Arthritis:
1 – Oligoarticular JIA
Oligoarticular JIA is the most common kind of childhood arthritis and affects four or fewer joints in the body. Symptoms are swollen, painful joints, particularly the knees and/or ankles. Eye problems are quite common and specialist eye checks are needed.
2 – Polyarticular JIA
Polyarticular JIA is another kind of juvenile arthritis, one that affects more than five joints. It usually starts before seven years of age, but can appear later in childhood. As well as pain and stiffness in joints other symptoms include tiredness and eye inflammation.
3 – Systemic Onset JIA
Systemic onset JIA is a type of arthritis that begins with systemic symptoms such as fever, rashes, lethargy and enlarged glands. Early signs are often mistaken for an infection. Other symptoms include joint and muscle pain, skin rash and tiredness. The most common age for the condition to start is before five years.
Osteoarthritis (OA) is the most common form of arthritis and refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. Knee, hip and hands are the joints most frequently affected.
The causes of osteoarthritis are complex and include physical, environmental and genome factors. This interaction contributes to articular cartilage damage which impacts differently in various joints.
Osteoporosis is a condition characterised by reduced bone mass density and deterioration of bone tissue which results in increased bone fragility and susceptibility to fracture. The strongest single risk factor for osteoporotic fracture is falling and not osteoporosis, and the incidence of bone fracture is increased as bones become weak due to hormonal changes.
Inflammatory arthritis conditions cause inflammation in the joints and symptoms can include severe pain, stiffness, fatigue, deformity and reduced joint function. Joints and organs can be affected, and severe inflammatory arthritis can significantly shorten life expectancy.
Inflammatory arthritis includes some of the most severe, painful and disabling musculoskeletal conditions, some of which start in children or young adulthood. Conditions include psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis and juvenile idiopathic arthritis. It is not known what causes a person to develop inflammatory arthritis. Various factors may be relevant, including the environment, infection, trauma and a person’s genetic make-up.
Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. PsA can be considered as a disease within a disease, the appearance of inflammatory arthritis (IA) on a background of pre-existing or future development of psoriasis. Usually arthritis post-dates, often by several years, the onset of psoriasis.
Rheumatoid arthritis (RA) is a chronic, progressive and disabling disease where the immune system attacks the synovial lining to the joints and other organs. If left untreated, the joint can lose its shape and alignment, cause bone erosion and ultimately lead to destruction of the joint and permanent disability. It typically affects the small joints of the hands and the feet, and usually both sides equally in a symmetrical distribution, though any synovial joint can be affected. In patients with established and aggressive disease, most joints will be affected over time. RA is also a systemic disease, which means it can affect internal organs of the body such as the heart, eyes and lungs.
It is not known what causes a person to develop inflammatory arthritis. Various factors may be relevant, including the environment, infection, trauma and a person’s genetic make-up.
The lack of disease-specific diagnostic features means diagnosis of RA is usually based on the assessment of a rheumatologist using relevant physical examination, classification criteria, blood tests and imaging and the patient’s own self-reported history – because there is no single diagnostic test for Rheumatoid Arthritis, a clinical diagnosis by a skilled specialist is required.
The triggers for Rheumatoid Arthritis are not well understood. There is evidence to suggest that abnormalities in components of the immune system lead to the body developing abnormal immune and inflammatory reactions, particularly in joints, these changes may precede the onset of RA by many years.
The risk factors commonly associated with Rheumatoid Arthritis are:-
- Female gender: partly due to the female hormonal environment during pregnancy, breastfeeding, use of the oral contraceptive pill and menopause;
- Genetics: with two genes in particular having been identified – the HLA-DRB1 gene and the protein tyrosine phosphatase non-receptor 22 (PTPN22) gene, with varying degrees of correlation;
- Diet: high caffeine, low antioxidants and high red meat consumption may be possible contributory risk factors;
- Ethnicity: with lower prevalence in people of Chinese, Pakistani or first and second generation African Caribbean origin compared to European Caucasians and Native American populations;
- Following a viral infection: exposure to certain infections may be an elevating risk factor, with the Epstein-Barr virus highlighted as one possible candidate;
- Smoking is a well-established environmental risk factor associated with increased risk of developing RA.
Soft Tissue Rheumatism
Soft tissue rheumatism (STR) describes conditions affecting tissue surrounding a joint, such as ligaments and tendons, and includes conditions such as tendonitis, bursitis, fasciitis and fibromyalgia.
STR forms a broad spectrum of health problems, most of them poorly defined according to diagnostic criteria and case definitions.
Musculoskeletal Services Framework
The Musculoskeletal Services Framework demonstrates a new model of service to deliver better care, closer to home for the estimated 10 million people in the UK with bone and joint conditions. The Musculoskeletal Services Framework (‘MSF’) provides the NHS with new guidance to help improve services for people suffering from conditions such as arthritis,back pain and fractures. The Framework sets out how the NHS can use a wider range of health professionals including physiotherapists, nurses and pharmacists in addition to GPs and hospital consultants. By using more staff to treat patients – rather than just the traditional GP-consultant axis – patients will receive faster treatment, in a more convenient setting such as closer to home rather than in hospital. The framework is crucial to delivering the 18 week pathway from GP referral as orthopaedic waiting times present currently one of the greatest challenges to meeting the target.
- Musculoskeletal Services Framework [pdf 2.36MB]