February 2019 network news

1. What is Spondyloarthritis?

脊椎关节炎（SPA）是影响关节和恩特斯的疾病家族的术语。源头是肌腱和韧带与骨相连的部位。水疗中心主要会影响背部和骨盆，这被称为轴向脊椎关节炎（AX-SPA），或者主要会影响外周关节（外围SPA）。

2. Who is at risk of Ax-SpA?

某些患者组的患者患AX-SPA的风险更高。其中包括具有个人或家族史的患者：

• Psoriasis, or psoriatic nail disease
• Inflammatory Bowel Disease
• Iritis

Patients with a family history of Ax-SpA are also at increased risk.

3. What should make me suspect Ax-SpA?

有一些标志性的症状和体征可以帮助通过机械疼痛与AX-SPA区分炎症性背痛：

• Pain which is insidious in onset
• Pain which eases with exercise, or worsens with rest
• Early morning stiffness of longer than 30 minutes
• 夜间疼痛
• Persistent pain affecting tendon or ligament insertions
• Atraumatic joint swelling, or swelling of a whole digit.

4. I am concerned that a patient may have Ax-SpA. What investigations should I request?

The key features of Ax-SpA are clinical. Investigations such as X-rays and blood tests in patients suffering with Ax-SpA are often normal; you should not, therefore, exclude Ax-SpA based on a normal investigation result.

5.我应该参考谁？

不错的指南表明，如果一个人患有45岁以上的腰痛，持续了3个月，则应考虑到以下4个或以下4个以上的情况：

• Low back pain that started before the age of 35 years
• 由于症状，晚上下半年醒来
• 臀部疼痛
• 随着运动的改善
• Improvement within 48 hours of takingnon-steroidal anti-inflammatory drugs (NSAIDs)
• A first-degree relative with Ax-SpA current or past arthritis, current or past enthesitis, or current or past psoriasis.

If exactly 3 of the additional criteria are present, perform an HLA-B27 test. If the test is positive, consider referral.You can find further details about recognition and referral here.

6.如何管理AX-SPA？

非甾体类抗炎药（NSAIDS）具有良好的耐受性，可有效减轻AX-SPA的疼痛和僵硬。有证据表明，它们可能会降低脊柱融合的可能性（钙化）。

Disease-modifying anti-rheumatic drugs (DMARDs)are not effective in treating spinal pain or reducing damage in spinal disease.

7.其他哪些药物可能会开处方？

Several classes of biologic drugs are effective in treating Ax-SpA; these are used if NSAIDs fail to control symptoms.

8.世界卫生大会t about non-pharmacological management?

All patients with axial disease should be referred to a specialised rheumatology physiotherapy service; holistic care should include advice about appropriate weight loss, exercise and smoking cessation.

AX-SPA中的抑郁和焦虑是常见的，并且与疼痛和疲劳水平增加有关；应有机会筛查患者。

9.我的水疗中心患者患有耀斑。我该如何帮助？

Flares can be managed effectively with increased doses of NSAIDs and analgesia. Gentle stretching, heat or TENS machines can help manage pain.

Increased stiffness is a common component of a flare. Patients should be encouraged that stretching and exercise will not cause damage and can help limit symptoms.

10. I’m keen to improve how I manage SpA. How can I implement change?

How high is the level of awareness about Ax-SpA amongst your colleagues and patients? Could the recent NICE guidelines be discussed at a practice education meeting? Could your practice newsletter include information about the symptoms or signs of Ax-SpA?

识别AX-SPA患者很困难。您能否开发或使用模板来评估背痛患者，其中包括提醒转诊标准？

If you would like to see Danny Murphy's presentation in full you can download the slides here（PowerPoint，2.84 MB）。

您可能已经注意到，新的与关节炎网站发生了一些重大变化。beplay体育怎么下载数字团队一直在努力确保我们从英国旧关节炎研究中转移的所有信息和关节炎护理网站是最新的，并致力于我们的专业受众。新网站的布局发生了变化，但您仍然会在一个地方找到所需的所有信息。如果您在挣扎，英国关节炎研究网站上的搜索功能仍在工作，如果需要，您将指向新网站。

我们有了新外观的主要原因是使我们能够更好地展示我们的集体工作，为所有受众提供有用的资源，并确保您拥有所需的信息。除此之外，通过使所有页面可在不同平台（如平板电脑和手机）上查看，也可以改善网站的功能。在接下来的几个月中，随着我们继续进一步开发该网站的发展。

Through ourpushing frontiers in health research funding call, we aim to fund research that will be directly relevant to people with arthritis and whose outputs lead to a positive change to relevant health services.

One of our grants awarded through this scheme was to Dr Celia Gregson at the University of Bristol. She is using large anonymised clinical datasets to assess hip fracture services, including how care is delivered in emergency departments, on wards, in operating theatres, and during rehabilitation. This is because, despite national guidelines, variation in care is seen across hospitals in the UK due to how health services organise hip fracture care. Findings will inform future commissioning and service planning priorities, provide reports for every hospital in England and Wales, and inform development of a new toolkit, which will be maintained by the国家骨质疏松学会.

看这个空间的更多信息projects we have funded through the scheme.

The Public Health England Fingertips musculoskeletal (MSK) diseases profile tool was updated in December 2018. The update included one new indicator (on MSK and co-morbidity) to the profiles and an update of three existing indicators.Further details of this update can be found here.

MSK conditions are the leading cause of pain and disability in England and account for one of the highest causes of sickness absence and productivity loss.

肌肉骨骼疾病的概况旨在将单个平台上的数据汇总在一起，以使高价值的肌肉骨骼服务调试。数据以用户友好的格式提供，以帮助地方政府和卫生服务：

• understand the health needs of their populations
• see how many people are accessing services in their areas
• find out the cost and outcomes of services.

Whilst people enjoy, and get great benefits from, physiotherapy, it is often reported to us that they may not continue their exercises after group sessions are finished.

Our Services Coordinator for the East Midlands has been working with the physiotherapy team at Clay Cross Hospital in North Derbyshire to devise a model of delivering our modular self-management course alongside weekly physiotherapy sessions.

The sessions have been well received by both healthcare professionals and the participants and include topics on:

• Diet
• Relaxation
• Managing pain
• Living with arthritis

Our local Coordinator saw a need to support people to remain in contact with each other during and after completing their physiotherapy sessions, and organised regular informal meet ups with current and past session attendees to encourage networking and maintain motivation.

In January 2018 our volunteer-led Chesterfield Versus Arthritis community group was formed - affectionately called Clicky Knees and Creaky Hips. With support from the League of Friends, equipment was purchased for the group, allowing them to continue with their exercise programme.

This group of 20 + people now meets regularly to socialise and continue their physiotherapy exercises. Every person attending Clay Cross physiotherapy is also signposted to the group. The volunteer group leaders learn the exercise routines at the Clay Cross education group – some ongoing support is offered by the physiotherapy team in the form of information sheets and the occasional visit. Our volunteers show new people how the exercises are completed, provide information sheets and generally encourage everyone to continue exercising.

Following the success of the community group, we are now working with physiotherapists in the neighbouring Erewash CCG and several more across England (17 as of January 2019), delivering self-management information and supporting people to develop groups that offer longer term support for people with all types of arthritis.

There are similar peer support groups across the UK and a full list can be found here.

If you would like more information please contact Debbie Holden atd.holden@versusarthritis.org.

On 7 January 2019, NHS England published theirLong Term Plan, which sets out a vision for the health service in England over the next five years.

长期计划认识到英格兰关节炎和肌肉骨骼状况的越来越多，它们对身心健康服务的影响及其与肥胖的联系。

Three key elements of the plan which will impact people with arthritis are:

Ensuring joint replacement surgery within effective timescales

The majority of hip and knee replacements carried out in the NHS are for people withosteoarthritis. Delays in access tohip和knee replacements对于那些需要他们会导致恶化in health and worse overall outcomes, ultimately costing the health and care system more.

目标可以在持有医疗保健提供者的情况下发挥重要作用，以便在适合患者的时间范围内提供护理。这就是为什么在转介治疗后的18周内保留患者接受选修手术（包括髋关节和膝盖置换）的权利如此重要的原因。

Whilst the Long Term Plan did not give a commitment to the 18-week target, it did include a measure to re-introduce fines for hospitals and Clinical Commissioning Groups (CCGs) who do not deliver surgery within 52 weeks, which will improve accountability in the short-term.

Supporting the mental health of people with arthritis and other long-term conditions

心理健康是长期计划的关键优先事项，我们很高兴看到扩大改善长期条件患者的心理疗法（IAPT）服务的承诺。

Arthritis and musculoskeletal conditions can have a huge impact on a person’smental health, with depression and anxiety being more common for those in persistent pain. IAPT services aim to provide better treatment for people with anxiety and depression at an earlier stage.

理疗

我们很高兴看到对扩大英格兰初级保健网络中工作的物理治疗师数量的承诺。这将帮助更多患有肌肉骨骼状况的人访问与没有GP转介的更好结果（例如恢复运动和功能）相关的服务。

Besides the areas we have highlighted here, the Long Term Plan includes a commitment to improving research in the NHS, with the aim that a million people will register to participate in health research by 2023/4. It also included commitments to more investment in primary and community care such as GP appointments and continued expansion of personalised care so that people can better manage their own health.

The Long Term Plan provides a starting point for improving health and care services for people with arthritis. The new commitments are important steps towards improving quality of life for people with arthritis and supporting them to live independently for longer.

但是，在实施长期计划以实践其承诺方面需要大量工作。

beplay体育怎么下载与关节炎致力于与NHS England和其他伴侣合作，以确保未来十年对1780万关节炎和相关状况的1,780万人取得真正的进步。

尽管我们认识到长期计划有很多解释，但GP在线和国王基金会还提供有趣的观点。

Providing good musculoskeletal care for patients is about having the skills and confidence to make a positive diagnosis and explain what is happening to the patient. This ensures that when the patient leaves the consultation they feel empowered to self-manage.

Our Core Skills in Musculoskeletal Care workshops focus on the practical skills required in a 10-minute GP consultation. They are split into three sections: spine, lower limb and upper limb. The trainer will go through an example examination demonstration and explanation including a management plan, and small groups will be encouraged to practise this, with the aim of increasing confidence in helping patients self-manage.

See the workshops in action here.

整个2019年，整个英国都将在整个英国举办一系列研讨会。

MSK冠军与关节炎beplay体育怎么下载

We’re delighted to announce that we’re now open for applications for the second round of the MSK Champions programme; a prestigious leadership development opportunity. Together with international business schoolAshridge Executive Education, we have created a bespoke leadership initiative, which will support you to become a Champion of musculoskeletal care. You’ll join a galvanized community of role models and ambassadors who champion change and work together to improve musculoskeletal care across the whole of the UK.

Are you passionate about leading change in MSK care?

If so, applications for the second cohort are now live and the programme will start in June 2019.

Have a look at thewebsitefor more information or emailchampions@versusarthritis.org.