August 2017 network news

We're currently reviewing our exercise content across our booklets and website information. We've got lots of exciting ideas and we’re working closely with people with arthritis and other MSK conditions, but we need your help too.

You can view our current exercise content for people with arthritis on our website ‘Exercise and arthritis’ and ‘Exercises to manage pain’.

Over the next few months, we’ll also be reviewing our information on the following:

• surgery
• osteoarthritis
• calcium crystal diseases

and developing new drug content on apremilast, ustekinumab, secukinumab, baricitinib and tofacitinib.

If you can spare a little of your time to help us by providing feedback on draft content, please email content@versusarthritis.org.

A major campaign to change perceptions of arthritis

For the millions of people affected by arthritis, the fact that the true impact of the condition is unseen and misunderstood can make living a full and independent life even more challenging. We also know that treating millions of people with arthritis is placing a burden on our GPs. So at the end of August, Arthritis Research UK is launching an educational campaign, including a TV advert, to show how arthritis affects individuals and wider society. To create the campaign, we worked with people with arthritis to ensure our content is as accurate as possible. We also took advice from GPs and healthcare professionals when making the advert. Our campaign goal is to help society recognise and understand the impact of arthritis, which will hopefully lead to the NHS and GPs being better supported in treating patients.

To find out more, our campaign will be live on our website by 23 August 2017.

Our new policy report explores the link between arthritis and many long-term conditions. With the number of people living with two or more long-term conditions (multimorbidity) growing, it’s important that we understand how people's needs can be met.

Arthritis is often found among people who live with other long-term conditions. For instance, by 65 years of age, almost five out of ten people with a heart, lung or mental health problem also have arthritis.

Over the last two years, Versus Arthritis has examined issues around living well with arthritis and multimorbidity in depth. We held a round table, spoke to people with arthritis and other long-term conditions, healthcare professionals, and researchers, conducted a literature review and analysed surveys. All of this helped us to understand more about the nature and impact of living well with arthritis when combined with other long-term conditions.

Key observations

We reached three key observations:

1. Arthritis is very common and is often present where there are other long-term conditions.
2. Arthritis ruins quality of life. The presence of any long-term condition is associated with a drop in quality of life, but when arthritis or back pain is present as one or more of the long-term conditions, the drop is greater.
3. The pain and functional limitation of arthritis makes it harder to cope when living with multiple long-term conditions. Simple everyday tasks such as grasping small objects, standing or sitting can be more difficult with arthritis.

Jack, who is living with asthma, osteoarthritis, depression, carpal tunnel syndrome, a colostomy bag as the result of surgery for colon cancer, an underactive thyroid, diabetes, cataracts, an enlarged prostate and problems with his gall bladder, feels that "it's the arthritis, the carpal tunnel and the bladder control…they're the things that really affect my quality of life."

Recommendations

The report sets out recommendations for change at a national and local level.

We'd like to see musculoskeletal conditions included as part of system-wide approach to addressing the needs of people with multiple long-term conditions. Changes we'd like to see include:

Nationally:

• Improved metrics and outcome tools.
• Better data collection and appropriate health promotion.
• Collaboration within the charity sector to jointly develop resources, programmes, research, and partnerships.
• Research funders should work with partners to ensure there is a flourishing research agenda for multimorbidity including musculoskeletal conditions.

Locally:

• Improved assessment and segmentation of people with musculoskeletal and multimorbidity conditions in local planning documents.
• Ensure pain and functional limits are a part of care and support planning, with appropriate tools.

Response to the report

Dr Liam O’Toole, Chief Executive Officer at Versus Arthritis, comments: "It’s clear that good musculoskeletal health underpins people’s ability to live well and independently with multiple long-term conditions.

"During our research, people told us that having good musculoskeletal health helps them manage; they can open pill packets, change dressings, travel to doctors’ appointments and stay as active as possible. But the reverse is true if someone with long-term conditions also has arthritis.

"As systems change, it’s vital that the needs of people with arthritis are considered. We must ensure that arthritis – whether it's present by itself or among other long-term conditions – does not limit people’s lives."

Tom Wright CBE, Group Chief Executive, Age UK and Chair of the Richmond Group, said: "People with long-term conditions are the main users of health and social care, accounting for about 70% of hospital bed days and 50% of GP appointments.

"Increasingly as we live longer we're more likely to develop more than one health condition and it's very welcome that Arthritis Research UK is carefully considering how care for people needs to take account of these other health conditions alongside musculoskeletal conditions."

The Richmond Group, as a leading coalition of health and care charities, are collaborating to better understand and respond to the reality that many of our beneficiaries struggle with the impact of more than one condition on their lives.

For more information please see our report Musculoskeletal conditions and multimorbidity (PDF, 8.2 MB) or contact the policy team at policy@versusarthritis.org.

Jack, 65, from Lincolnshire, has no fewer than 11 long-term conditions. As well as managing asthma, osteoarthritis, depression, carpal tunnel syndrome, a colostomy bag as a result of surgery for colon cancer, an underactive thyroid, diabetes, cataracts, an enlarged prostate and problems with his gall bladder, Jack has recently been diagnosed with cervical myelopathy (problems in his spine caused by osteoarthritis).

Jack’s health conditions have had a big impact on his life. He's given up many of his passions because of the functional change that multimorbidity, including arthritis, has brought to his life. One difficult change was his decision to stop breeding dogs and training horses, hobbies that were very important to him: "I used to do lots of active things that are now just impossible".

Instead, he's picked up new hobbies, fuelled by his love of knowledge and lifelong learning. "I'm nearly 70 chronologically, but mentally I'm 40". Jack's an avid reader, which he compliments with French lessons and classes at his local adult education centre. He's also active in his local branch of the University of the Third Age, taking a keen interest in their genealogy group.

Managing medications

However, managing multimorbidity impacts on all areas of Jack’s life. The plethora of medications Jack needs to take require careful management to minimise repeat trips to the pharmacy. Along with a time-consuming daily exercise regime, this means Jack’s life has lost its spontaneity. "I’ve got four pages of repeat prescriptions, of about 13 different medications, plus non-pharmacological items to help manage blood sugars and my colostomy.

"The trouble is they all get out of sync, so I'm in and out of the GPs ordering repeat prescriptions and picking stuff up from the pharmacy virtually every week."

Jack finds the need to attend multiple clinics for his different long-term conditions particularly stressful and exhausting. Recently, Jack had a clinical consultation in Sheffield (he drove himself the 2-hour journey there, although he sees a day where he'll no longer be able to drive), which required a follow up by x-ray. It was only when Jack highlighted the difficulties of returning for another appointment that arrangements were made for him to have the x-ray on the same day.

But too often such join up doesn’t occur, and after so many separate appointments, Jack is ‘wiped out’ which can mean him missing out on the activities he loves.

Jack's ask for the system

Jack's already given up a great deal because of living with multimorbidity, including his beloved wolfhounds. But he believes that the lack of coordination from the health system, which currently means he has to make further compromises, could be avoided. His asks for the system are simple:

1. That healthcare professionals communicate with each other and ensure important details are noted down clearly.
2. That he could have a single touchpoint in the system, someone with an overview of all his conditions, that he could go to for help and advice.

You can download our latest policy report, Musculoskeletal conditions and multimorbidity (PDF, 8.2MB), to find out how we're helping people like Jack.

Once patients finish NHS-provided exercise therapy for arthritis, it is up them to maintain a healthy and physically active lifestyle.

Despite the clear benefits of exercise on health and wellbeing, research shows that many patients are unable to be as physically active as they should be. We are funding research, led by Kirsty Bell at Glasgow Caledonian University, which aims to assess the activity levels of patients with inflammatory joint diseases, identify the main barriers to physical activity and exercise, and explore the links between physical activity, health and wellbeing in these patients.

Identifying barriers to exercise in patients with arthritis should help healthcare professionals and patients develop strategies to overcome them. This study is currently in the recruitment phase and you can read more about the study on our research pages.

You have acid in your tissues’ – David Butler, Pain Physiotherapist and Lecturer.

This phrase has stayed with me since and shaped my clinical practice. This highlights the need for tissues to receive nourishment, move and be used. In much the same way that we can’t expect plants to survive without care and attention, our bodies need certain things to thrive- this includes exercise.

In an age where people are living longer, with higher levels of diabetes, cardiovascular disease and obesity, it’s essential for the public health that we, as musculoskeletal clinicians, do all we can to reduce the impact of ageing and illness. Research has looked at amount, type and intensity of exercise in helping manage conditions such as Rheumatoid Arthritis and Osteoarthritis.

A key question is, which are more important- particular types of exercise or engagement of individuals? In fact, both are important.

Tailoring exercise regimes to individuals is crucial but it is also vital they choose exercise that they enjoy and will sustain as they embark on a journey using exercise to improve musculoskeletal health. We, as clinicians have the power to encourage, empower and support. Using the UK Chief Medical Officer’s Guidelines will help encourage, empower and support healthy and active lifestyles.