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Restarting support for people with arthritis

The term 'arthritis' incorporates a number of conditions that can cause patients to suffer with pain, swelling. During the COVID-19 pandemic, a lot of treatments help people manage arthritis symptoms have been significantly reduced or stopped altogether.  

However, earlier this summer, with the steady reduction in the number of new coronavirus cases, the majority of BCHC’s musculoskeletal (MSK) clinicians (physiotherapists, orthopaedic practitioners and psychologists) returned from redeployment to ‘restart’ their services, offering help to those patients with long-term pain.

Elderly man with arthritis - hands

This article aims to highlight the challenges and opportunities of managing arthritis for both patients and clinicians in light of this ‘new normal’.

Novel coronavirus (COVID-19) is a new strain of virus for which there is no vaccine. It has spread rapidly worldwide. In the beginning, knowledge of this new virus was very limited and treatment difficult, resulting in significant numbers of people with severe symptoms and a high incidence of mortality.

The effect on the health system was profound, with a significant number of elective surgical procedures cancelled in order to create increased capacity as part of national emergency NHS planning.  At first, there were concerns that steroids, commonly administered by injection to treat arthritic joint pain, might increase the risk of mortality in patients with influenza and delay viral clearance 1. The decision was therefore taken to cease routine steroid injections.

As knowledge of the virus has improved, guidance has been updated to allow for the restart of elective care however, surgery for arthritis has been nationally set at priority 4, with a target timescale of over three months to surgery 2. Corticosteroid injections have been recognised as an important and effective treatment for some MSK conditions, including arthritis, and whilst the risk from steroid has not changed, injections for arthritic pain are recommencing in certain circumstances. The emphasis in the management of arthritic pain however, remains on quality self-management strategies 1. One such strategy is participation in the national ESCAPE-pain3 programme for arthritic hip and knee pain. Previously offering this education and exercise class face-to-face, our MSK service has been able to deliver it virtually during the pandemic, using material developed for remote access and with great patient outcomes.

From early March until the first week of August, 80 per cent of the MSK team was redeployed to other services as part of the Trust’s emergency response to the pandemic. As a result, the MSK service was reduced to a skeleton offering. Having now begun recovery, we are rapidly ratcheting up care capacity to respond to patient demand. Doing so in a COVID-secure manner, using a virtual-first approach of video and telephone consultations.

Across the country, this virtual approach has been welcomed by patients who are now able to gain access to advice and treatment for their arthritic pain. Our clinicians can discuss treatment options with patients (including steroid injections and referral for surgery), giving sensible, evidence-based advice to help manage their symptoms and reduce suffering. Acknowledging that the situation is different from before, there is now help available for patients suffering arthritis-related symptoms which can make a real difference to their function and quality of life.

Damien KIMBER and Richard HUSSELBEE,
Consultant Physiotherapists, BCHC MSK Service


References

1.     NHS England & Improvement.  16 June 2020 - management of patients with musculoskeletal and rheumatic conditions who are on corticosteroids, require initiation of oral/IV corticosteroids or require a corticosteroid injection.

2.     Federation of Speciality Surgical Associations.  24 July 2020 - clinical guide to surgical prioritisation during coronavirus pandemic.

3.     ESCAPE Pain, 2020 - enabling self-management and coping.