Arthritis Research UK call for musculoskeletal conditions to be central to future multimorbidity plans

Published by Arthritis Research UK | 20 July 2017

Arthritis Research UK has launched a report exploring why it's essential to consider musculoskeletal health when planning how our health system tackles multimorbidity.

Multimorbidity, which means living with two or more long-term conditions, is becoming increasingly common. Alongside an ageing population, multimorbidity will have a substantial impact on our future health and care services. The NHS’s Five Year Forward View and the General Practice Forward View both recognise that the healthcare system must adapt to meet the growing demands of multimorbidity. It must move away from a focus on single diseases to a system which holistically considers the needs of people with multiple long-term conditions.

Good musculoskeletal health underpins living well and independently with multimorbidity, however, musculoskeletal conditions are too often overlooked. This report sets out why musculoskeletal conditions must be included in future plans to address multimorbidity and makes seven clear recommendations for change.

Musculoskeletal conditions affect around 10 million people across the UK, and are often found in people with other long-term conditions. The report reveals that among people over 45 years with a major long-term condition, more than 30% also have arthritis. By age 65, almost half of people with a heart, lung or mental health problem also have arthritis. Conversely, 80% of people with osteoarthritis have at least one other long-term condition such as hypertension, cardiovascular disease or depression.

Recognising the interaction

It's essential to recognise the interaction between musculoskeletal conditions and other health problems. Any long-term condition is associated with a drop in quality of life, but when arthritis or back pain is part of multimorbidity, the drop is greater. The pain and functional limitations of arthritis make it harder to cope when living with other long-term conditions.

Dr Liam O’Toole, Chief Executive Officer at Arthritis Research UK, 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."

Jack, aged 65 lives with osteoarthritis and multiple other long-term conditions, comments: "It's the arthritis that really affects my quality of life. It makes my other conditions harder to deal with. I’ve got four pages of repeat prescriptions. The trouble is they all get out of sync, so I’m in and out of the GPs ordering repeat prescriptions and picking up stuff from the pharmacy virtually every week.

"It would be great if there was one person put in charge of my conditions and had oversight of my whole treatment plan."

A number of challenges ahead

The report highlights the extent of the challenge ahead. By 2018, it's expected that there will be 2.9 million people in the UK living with multimorbidity, a substantial increase from 1.9 million in 2008. Musculoskeletal conditions will be part of this trend, as their prevalence increases in an ageing population. In 2010, 4.7 million people were living with knee osteoarthritis in the UK, by 2035 this is likely to reach 8.3 million.

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 are 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."

Professor Peter Kay, National Clinical Director of Musculoskeletal Services in NHS England; comments: "We must work across systems to ensure we have the appropriate data collected and available to understand the numbers and requirements of people living with multiple long-term conditions.

"As this report points out, as we build metrics and tools to understand and improve quality of services for people with multiple long-term conditions, it’s critical that we include aspects such as pain and functional limitations, alongside capability to manage."

Dr Justin Varney, Lead for Adult Health, Public Health England, said: "People are living longer, but are also spending more years in poor health. Musculoskeletal conditions are the main cause of disability, ill health and sickness absence in England, and often go hand in hand with mental ill health.

"Action needs to come from a variety of places. Employers can prevent these issues by providing healthy environments, advice and support for staff – our musculoskeletal and mental health toolkits show how they can do this."

Visit Musculoskeletal conditions and multimorbidities for the full report.

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