Musculoskeletal conditions Flashcards
1
Q
What is a musculoskeletal (MSK) condition?
A
a condition that can affect any joint, bone or muscle, including rarer autoimmune diseases and back pain
2
Q
How many different types of MSK conditions exist?
A
over 200
3
Q
What proportion of the adult population are affected by MSK conditions?
A
1 in 4
many people are young and of working age
4
Q
How many adults and children are affected by MSK conditions in the UK?
A
9.6 million adults
12,000 children
5
Q
What percentage of GP consultations in England are related to MSK conditions?
A
30%
6
Q
How many working days are lost as a consequence of MSK conditions?
A
8 million
7
Q
List some of the co-morbidities associated with MSK conditions.
A
diabetes
depression
obesity
8
Q
What is the cost to the NHS of treating MSK conditions per year?
A
£4.76 billion
9
Q
According to a survey published in 2014, what proportion of UK employees reported having a physical health condition (PHE, 2019)?
A
1 in 4
10
Q
What proportion of those employees with physical health conditions also reported having a mental health condition (PHE, 2019)?
A
1 in 5
11
Q
What proportion of current UK employees have a long-term health condition (PHE, 2019)?
A
1 in 3
12
Q
What proportion of current employees reported having a mental health condition (PHE, 2019)?
A
1 in 8
13
Q
What proportion of employees reported having musculoskeletal conditions (PHE, 2019)?
A
1 in 10
14
Q
What percentage of employees with a health condition felt their condition affected their work ‘a great deal’ or ‘to some extent’?
A
42%
15
Q
What percentage of employees with mental and physical health comorbidity were affected ‘a great deal’?
A
29%
16
Q
What percentage of employees with a physical health condition only were affected ‘a great deal’?
A
13%
17
Q
What percentage of employees with a mental health condition only were affected ‘a great deal’?
A
15%
18
Q
What is the musculoskeletal health questionnaire (MSK-HQ)?
A
a short questionnaire that allows people with musculoskeletal conditions to report their symptoms and quality of life in a standardised way
19
Q
List the 14 items included in the MSK-HQ.
A
pain/stiffness during the day pain/stiffness during the night walking washing/dressing physical activity levels work/daily routine social activities and hobbies needing help sleep fatigue or low energy emotional wellbeing understanding of your condition and any current treatment confidence in being able to manage your symptoms overall impact
20
Q
How is the MSK-HQ scored?
A
each item scored on a scale from 0 (no impact) to 4 (severe impact)
based on the last 2 weeks
21
Q
Name six types of MSK conditions.
A
arthritis fractures hip conditions knee conditions lower back pain spinal conditions osteoporosis
22
Q
Name two types of arthritis.
A
rheumatoid arthritis (RA) osteoarthritis (OA)
23
Q
What is the prevalence of RA?
A
1.5 (men) and 3.6 (women) per 10,000 population
peak 70 yrs
24
Q
What is the prevalence of OA?
A
1 in 5 adults (18.2%) over 45 yrs have knee OA
1 in 9 have OA hip (10.9%)
25
Name one type of fracture?
hip (extracapsular or intracapsular fracture)
26
What is the prevalence of hip fractures?
76,000/558 per 100,000 each year related to falls and osteoporosis
27
Name two types of hip conditions.
related to OA and hip arthroplasty (surgical reconstruction/replacement)
28
What is the prevalence of hip OA?
1 in 9/10.9% over the age of 45 yrs
| 3.2% report severe hip pain
29
Name two types of knee conditions.
related to OA and knee arthroplasty (surgical reconstruction/replacement)
30
What is the prevalence of knee OA?
1 in 5/18.2%, over the age of 45 yrs
| 6.1% report severe knee pain
31
Name two causes of lower back pain.
herniated (slipped) disc (slipped disc)
| ruptured disc
32
What is the prevalence of back pain?
16. 9% of the population
| 10. 2% report severe back pain
33
Name two types of spinal conditions.
```
cervical spondylosis (CS) herniation
kyphosis (curvature)
```
34
What is the prevalence of CS and pain?
107 in 100,000 (men)
| 64 in 100,000 (women)
35
What is the prevalence of kyphosis?
20-40% in older men and women
36
Name three types of osteoporosis.
hand, wrist, spine
37
What is the prevalence of osteoporosis?
estimated 0.8% of the population
| real figure likely to be higher
38
What is rheumatoid arthritis (RA)?
an inflammatory systemic disease that largely affects synovial joints
typically affects the small joints of the hands and the feet, usually both sides equally and symmetrically
39
Name the six types of synovial joints.
```
hinge (elbow)
saddle (carpometacarpal joint)
planar (acromioclavicular joint)
pivot (atlantoaxial joint)
condyloid (metacarpophalangeal joint)
ball and socket (hip joint)
```
40
List the components of assessment for a patient with suspected RA.
medical history
physical examination (REMS)
blood tests
X-ray
41
What is the regional examination of the musculoskeletal system (REMS)?
the more detailed examination that should be carried out once an abnormality has been detected either through the history or through the screening examination (GALS)
42
What are the four main principles of the REMS?
look, feel, move, function
| specialist clinicians may also use special tests
43
How do you complete a 'look' assessment?
look for skin changes, scars, muscle bulk, and swellings in and around the joint
deformity in terms of alignment and posture of the joint
always compare sides
44
How do you complete a 'feel' assessment?
feel for skin temperature across the joint line and other relevant sites
assess swellings for fluctuates and mobility
assess vascular and neurological status
assess for synovitis using the triad of warmth, swelling, and tenderness (suggests inflammatory arthritis)
45
How do you complete a 'move' assessment?
assess the full range of joint movement actively and passively
a difference between active and passive movement indicates a problem with nerve, tendon, or muscle function
these tests can help detect a loss of movement or a degree of extra movement (hypermobility)
46
How do you complete a 'function' assessment?
complete a functional assessment of the affected joint to demonstrate whether limited joint movement causes any difficulty with daily activities
47
Why are blood tests carried out for adults with suspected RA who are found to have synovitis on clinical examination?
to detect rheumatoid factor (RF) (autoantibody)
48
When might further blood tests be considered?
for patients with suspected RA who test negative for RF
| involves measuring anti-CCP antibodies in adults
49
Why is an X-ray carried out for adults with suspected RA?
to detect changes related to RA in the hands and feet (e.g. bone erosion, bone displacement)
50
What are the next steps after RA has been diagnosed or ruled out?
the patient is monitored and given further guidance
| e.g. X-rays to detect further erosion, further RF or anti-CCP if not already used in the diagnosis
51
What is the Health Assessment Questionnaire (HAQ)?
an additional tool to ascertain the impact of RA on the individual
complements the MSQ-HQ
52
What is osteoarthritis (OA)?
a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life
the most common form of arthritis, and one of the leading causes of pain and disability worldwide
the most commonly affected peripheral joints are the knees, hips, and small hand joints
characterised pathologically by localised loss of cartilage, remodelling of adjacent bone, and associated inflammation
53
What is the underlying cause of OA?
OA includes a slow but efficient repair process that often compensates for an initial trauma, resulting in a structurally altered but symptom-free joint
in some people, due to overwhelming trauma or compromised repair, the process cannot compensate, resulting in symptomatic OA ('joint failure')
54
Why does the diagnosis of OA differ from RA?
OA is not an autoimmune disease
| blood tests are currently ineffective unless combined with a physical examination
55
What are the components of a diagnosis of OA without investigations?
person is aged over 45 yrs
exposed to activity-related joint pain
morning joint-related stiffness or morning stiffness that lasts no longer than 30 mins
forms part of a holistic assessment
56
What might a holistic assessment look like for a person with OA?
```
social
health beliefs, including concerns, expectations, and current knowledge of OA
occupational
mood
quality of sleep
support network
other musculoskeletal pain
attitudes to exercise
influence of comorbidity
pain assessment
```
57
What are atypical presentations of OA?
e.g. history of trauma, prolonged morning joint-related stiffness, rapid worsening of symptoms, the presence of a hot swollen joint
may indicate alternative or additional diagnosis
important differential diagnoses include gout, other inflammatory arthritides (e.g. RA), septic arthritis, and malignancy (bone pain)
58
What is the difference between OA and RA in terms of onset?
OA - pain tends to develop gradually and intermittently over several months or years when bone rubs against bone
RA - an inflammatory condition where the immune system attacks joint tissues causing pain and stiffness that worsen over time
59
What is the difference between OA and RA in terms of location?
OA - common in the hip, knee, lower back, neck, feet, and finger joints
RA - can appear in any joint, most commonly the hands, wrists, and feet
60
What is the difference between OA and RA in terms of the type of stiffness?
OA - mild morning stiffness is common and often goes away after a few minutes of activity; the same type of stiffness may occur during the day after resting the joint for about an hour
RA - morning stiffness does not begin to improve for an hour or longer; occasionally, prolonged joint stiffness in the morning is the first symptom
61
Why is it impossible to determine the severity of OA using an X-ray?
there is often a poor link between changes visible on an X-ray and symptoms of OA
minimal changes can be associated with a lot of pain, or modest structural changes to joints can occur with minimal accompanying symptoms
62
Why is it important that adults with RA and OA have ongoing access to a multidisciplinary team?
to provide the opportunity for periodic assessments of the effect of the disease on their lives (e.g. pain, fatigue, daily activities, mobility, work and social activities, quality of life, mood, sexual relationships) and help to manage the condition
63
List some of the non-pharmacological treatments for RA.
occupational therapy and physiotherapy
hand exercise programmes
psychological interventions
diet and complementary therapies
64
What are the aims of physiotherapy for adults with RA?
to improve general fitness and encourage regular exercise
to learn exercises to enhance joint flexibility and muscle strength, and manage other functional impairments
to learn about the short-term pain relief provided by methods such as transcutaneous electrical nerve stimulators (TENS) and wax baths
65
When should adults with RA have access to a specialist occupational therapy service?
if they have difficulties with daily activities or problems with hand function
66
When should adults with RA have access to a tailored strengthening and stretching hand exercise programme for pain and dysfunction of the hands or wrists?
they are not on a drug regimen for RA or they have been on a stable drug regimen for RA for at least 3 months
67
What care is available for adults with RA and foot problems?
all adults should have access to a podiatrist for assessment and periodic review of their foot health needs
functional insoles and therapeutic footwear should be available if indicated
68
Why is it important to offer psychological interventions for adults with RA?
to help individuals adjust to living with their condition
| e.g. relaxation, stress management, cognitive coping skills
69
What type of diet may be advised for adults with RA?
```
Mediterranean diet (more bread, fruit, vegetables and fish; less meat; replace butter and cheese with products based on vegetable and plant oils).
no strong evidence
```
70
What is the aim of treating adults with active RA?
to achieve a target of remission or low disease activity if remission cannot be achieved (treat-to-target) measuring C-reactive protein (CRP) and disease activity monthly in specialist care is recommended until the target of remission or low disease activity is achieved
71
What is the first-line pharmacological treatment for adults newly diagnosed with active RA?
conventional disease-modifying anti-rheumatic drugs (DMARDs)
this could be monotherapy using oral methotrexate, leflunomide, or sulfasalazine within 3 months of the onset of persistent symptoms
alternatively, hydroxychloroquine can be considered as an alternative to oral methotrexate, leflunomide, or sulfasalazine for mild disease
72
What is bridge therapy?
the use of steroids as a temporary treatment for individuals diagnosed with RA who are in pain
can be given after commencing first-line treatment to relieve symptoms
e.g. glucocorticoids (oral, intramuscular, intraarticular)
73
What is the second-line pharmacological treatment for adults newly diagnosed with active RA?
additional conventional DMARDs can be given alongside the medication that was initially prescribed if the treatment target (remission or low disease activity) has not been achieved despite dose escalation
74
What is the third-line pharmacological treatment for adults newly diagnosed with active RA?
short-term treatment with glucocorticoids to manage flares in adults with recent-onset or established disease to rapidly decrease inflammation
long-term treatment with glucocorticoids is only considered when the long-term complications of glucocorticoid therapy have been fully discussed, and all other treatment options (including biological and targeted synthetic DMARDs) have been offered
75
List some of the non-pharmacological treatments for OA.
exercise and manual therapy
weight loss
electrotherapy (TENS)
aids and devices
76
How can health professionals offer exercise and manual therapy for adults with OA?
advise exercising as a core treatment irrespective of age, comorbidity, pain severity or disability
exercise should include local muscle strengthening, general aerobic fitness, and splinting as required
manipulation and stretching should be considered adjuncts to core treatments, particularly for hip OA
77
What aids and devices may be offered for adults with OA?
```
advise on appropriate footwear (including shock-absorbing properties) as part of core treatments for adults with lower limb OA
assistive devices (e.g. walking sticks, tap turners) should be considered adjuncts to core treatments for specific problems with ADLs
```
78
What is the first-line pharmacological treatment for adults with OA?
paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclo-oxygenase 2 (COX-2) inhibitors, or opioids
79
What is an alternative first-line treatment for adults with OA?
topical capsaicin should be considered as an adjunct to core treatments for knee or hand OA
rubefacients should not be offered as it causes erythema
80
What is the second-line pharmacological treatment for adults with OA?
topical NSAIDs should be substituted for an oral COX-2 inhibitor (ibuprofen or naproxen)
a proton pump inhibitor (PPI) should be prescribed to reduce NSAID-induced GI adverse events
81
What is the third-line pharmacological treatment for adults with OA?
consider the addition of opioid analgesics
82
What is the fourth-line pharmacological treatment for adults with OA?
consider intraarticular corticosteroid injections should as an adjunct to core treatments for the relief of moderate to severe pain
