Musculoskeletal (MSK) conditions

Headlines

  • Reducing the prevalence of risk factors such as smoking, physical inactivity and obesity could help to reduce the prevalence of MSK conditions.
  • As deprivation increases, the percentage of people visiting their GP for back pain increases. The East has higher rates of back pain than the West.
  • 69% of people in Wakefield saw their GP because of osteoporosis in the last 12 months. The prevalence increases with age but not with deprivation. 15.67% of 90+ year olds saw their GP because of osteoporosis. The highest rates are mainly in the West of the district.
  • The highest rates of rheumatoid arthritis are mainly in the South East area of the district.. Rates of rheumatoid arthritis increase with age up the 80-84 age group at 2.78% but then drop from the 85-89 age group down to the 90+ age group.

Introduction

Musculoskeletal (MSK) conditions affect bones, joints, muscles and the spine and include musculoskeletal autoimmune conditions. MSK is comprised of over 200 varied conditions which are known to impact quality of life by increased pain, limiting range of motion and impacting the ability to take part in daily life such as attending work.

The Population

Back pain
Back pain is considered any pain felt in the back which can be acute or chronic. Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine, from the neck down to the hips. [i]

The rate of back pain fluctuates with age, the rate increases with age up to the 35-39 age group and then varies increasing and decreasing when looking at different age groups. 1.82% of the population have presented with back pain at their GP in the last 12 months. The East of the district has higher rates of back pain than the West.

Osteoporosis

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over years and is often only diagnosed when a fall or sudden impact causes a bone to break. [ii]

The rate of osteoporosis increases with age, around 15% of people aged 85+ have osteoporosis compared to around 3% of those in their 60s and less than 1% of those in their 40s. The highest rates of osteoporosis are in the West of the district.

Rheumatoid Arthritis

Rheumatoid arthritis is a long-term auto-immune condition that causes pain, swelling and stiffness in the joints. The condition usually affects the hands, feet and wrists.

The rate of rheumatoid arthritis increases with age up to the 80-84 age group where it starts to decrease. Rates of rheumatoid arthritis drop significantly when looking at the 85-89 age group and again at 90+. The highest rates of rheumatoid arthritis are mainly in the South East area of the district.  South Elmsall & South Kirby, Hemsworth and Ackworth, North Elmsall and Upton all have significantly higher rates of rheumatoid arthritis than the district average.

The Challenges

Taking action to improve and maintain the health of bones, joints and muscles can help promote MSK health and help avoid MSK disease. Certain potentially avoidable risk factors are particularly harmful when looking at MSK health. Taking action to raise awareness of the effects of the main risk factors and to reduce the prevalence of these across the population will result in improvements in MSK health.

Smoking
19.3% of adults in Wakefield smoke.[iii]
Smoking has a negative effect on bones and joints and can increase the risk of developing osteoporosis. Smoking reduces the blood supply to bones and negatively affects the production of bone-forming cells. Smoking also decreases the body’s ability to absorb vitamins and minerals that are essential in the maintenance of bone health, including calcium. Smoking also has a negative effect on the healing of fractures and wounds in relation to the forming of cells. [iv] There is also a link between smoking and rheumatoid arthritis. [v]

Physical inactivity and MSK
28.5% of adults in Wakefield are physically inactive. [vi]
Increasing physical activity can reduce the risk of developing an MSK condition. Making lifestyle changes can also substantially reduce the impact of an existing condition at every stage. Keeping active is one of the best things a person can do for their MSK health. Exercise builds muscle and helps strengthen bones and increased muscle strength is also linked to fewer falls. [vii]

Overweight/Obesity and MSK
68.9% of adults in Wakefield are classified as overweight or obese. [viii]
Being overweight or obese is commonly measured by calculating a person’s body mass index (BMI). A BMI of over 25 indicates that a person is overweight and 30 and over indicates obesity. However, BMI is not used to diagnose as people that are very muscular can have a high BMI without much fat. MSK issues are one of the greatest threats to the health of people who are obese and obesity can directly affect a person’s recovery from rheumatoid arthritis. [ix]

The Inequality

As deprivation increases, the rate of back pain increases. The three most deprived deciles have significantly higher rates than the district average.

There is no real trend when looking at deprivation deciles and rates of osteoporosis, rates fluctuate throughout which reaffirms that there is no real correlation between deprivation and osteoporosis.

You can use this interactive dashboard to explore these inequalities.

To read more about each of the risk factors mentioned, click on the following JSNA links;
Smoking in Adults, Smoking in Children, Physical Activity in Adults, Physical Activity in Children, Physical Activity Opportunities and Childhood Obesity

Service Provision

Community Assets

References

[i]
https://www.nhs.uk/conditions/back-pain/
Last accessed 06/11/2019

[ii]
https://www.nhs.uk/conditions/osteoporosis/
Last accessed 06/11/2019

[iii]
https://fingertips.phe.org.uk/search/smoke#page/0/gid/1/pat/6/par/E12000003/ati/102/are/E08000036
Last accessed 06/11/2019

[iv]
https://orthoinfo.aaos.org/en/staying-healthy/smoking-and-musculoskeletal-health/
Last accessed 06/11/2019

[v] https://www.nhs.uk/conditions/rheumatoid-arthritis/causes/
Last accessed 07/11/2019

[vi]
https://fingertips.phe.org.uk/search/inactive#page/0/gid/1/pat/6/par/E12000003/ati/102/are/E08000036Last accessed 06/11/2019

[vii]
https://www.versusarthritis.org/media/2177/physical-activity-msk-health-report.pdf
Last accessed 07/11/2019

[viii]
https://fingertips.phe.org.uk/search/obese#page/0/gid/1/pat/6/par/E12000003/ati/102/are/E08000036
Last accessed 06/11/2019

[ix]
https://www.versusarthritis.org/news/news/overweight-rheumatoid-arthritis-patients-less-likely-to-achieve-remission/
Last accessed 06/11/2019