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In October 2013, the British Society for Rheumatology (BSR) launched a major 12-month campaign called ‘Simple Tasks’ to raise awareness of rheumatic diseases such as arthritis, gout and lupus, which affect up to 16 million people in the UK. These chronic conditions can make even the simplest tasks – such as eating, brushing teeth and driving a car – impossible.

According to Chris Deighton, BSR president, it is crucial that patients are diagnosed and treated as early as possible. “The first weeks following the onset of rheumatic symptoms, which often occur in the prime of life, are known as the ‘window of opportunity’,” he says. “If patients are seen during this critical time – as soon as possible but certainly within the first weeks of experiencing early symptoms – we can help to ease their suffering and avoid long-term complications.”

 

Seeking help

Despite the importance of early diagnosis, surveys reveal that many people with joint problems don’t seek medical help. A survey of 1,000 people who experience aches and pains, commissioned by the Simplyhealth Advisory Research Panel (ShARP), revealed that every year one in five people in the UK has a new onset or recurrence of a musculoskeletal problem, mainly in the back, knee, neck and shoulder, hip and/or legs. Three out of four sufferers don’t ask for professional advice, with more than a third of those who don’t seek help saying the cost of care puts them off.

Paul Hobrough, physiotherapist and ShARP member, says: “Joint discomfort and joint health issues are a huge problem in the UK, with millions of diagnosed sufferers and many others who struggle on in silence. Joints that are stiff or cause discomfort can badly affect quality of life, with many activities we take for granted proving difficult or even impossible, including the health benefits of taking regular exercise.”

In December 2013, Nuffield Health issued a warning to individuals to be more aware of the damage that can be caused if they simply put up with the pain. The charity’s research revealed that one in five respondents made their injury worse through failing to take appropriate advice or action. Forty-five per cent of UK adults are in pain at least once a week, rising to almost three-quarters at least once a month. Of those in pain, more than three quarters say it negatively affects their everyday life. Despite this, 59 per cent don’t seek help from professionals such as GPs or physiotherapists.

“Half of us are living in pain and potentially making ourselves worse because we’re not sure how to seek help or where to seek it from, but there are appropriate and easy-to-access treatments and advice available,” says Liz Adair, director of physiotherapy at Nuffield Health. “Our physiotherapists often see people who have done more harm than good by trying to deal with pain themselves or by not doing anything at all.”

Pain relief

People experiencing joint pain may visit the pharmacy for advice, particularly in relation to pain control. The first-line OTC analgesic is usually paracetamol. This can be taken regularly, even when the pain has subsided. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac can also help. However, the Scottish Intercollegiate Guidelines Network (SIGN) guidance on the management of chronic pain, which focuses on non-specialist settings such as pharmacies, states that anyone who needs to take OTC pain relief regularly for arthritis symptoms should be advised to see their GP.

“Over-the-counter painkillers can be very useful, particularly for acute episodes,” says Dr Gill Jenkins, leading GP on ShARP, “but it isn’t wise to take them for long periods without consulting a GP, particularly if someone has any underlying problems. Hypertension increases with age, as does the incidence of diabetes and heart disease, and it’s important that people with persistent aches and pains discuss their options with a GP, physiotherapist or other healthcare professional.”

According to the SIGN guidance, topical NSAIDs should be considered in the management of chronic pain caused by musculoskeletal conditions, particularly in people who can’t tolerate oral preparations. Topical rubifacients can also be considered if other medicine options have proven ineffective.

Customers may need advice from the pharmacy team on choosing between gels, creams, patches and rubs. Some products warm or cool aching muscles and joints. Salonpas Pain Relief Patches use a transdermal drug delivery system (TDDS) to deliver active ingredients (methyl salicylate, and levomenthol) directly to the site of pain.

The Reckitt Benckiser focus for 2014 is ‘Unite to Conquer Body Pain’, with a campaign promoting the use of Nurofen Express Tablets combined with Nurofen Express Heat Patches for maximum effect. Nurofen Express Heat Patches activate immediately to deliver soothing heat therapy, while Nurofen Express Tablets quickly target pain at the site. Since the patches are non-medicated, they are safe to use with oral Nurofen.

Professional advice

In January 2014, research published in the Annals of the Rheumatic Diseases revealed that only a third of people with gout are receiving urate-lowering therapies, which are the most effective treatments. “As well as changing their lifestyle, people with gout need to go on the drugs that will control their condition, such as allopurinol and febuxostat, which reduce urate levels in the body,” says Professor Alan Silman, medical director of Arthritis Research UK. “However, too many patients are on a standard dose of urate-lowering drugs instead of a dose that is matched to their particular needs – and this needs to change.”

SIGN guidance recommends that people using analgesics to manage chronic pain should be reviewed at least annually, or more frequently if medication is being changed or the pain and/or underlying medical conditions alter. This is an area for which pharmacists are ideally placed, as they have regular contact with people taking prescription medicines.

A recent Pharmacy Research UK project explored how arthritis medicine usage impacts on young people’s self image and engagement with their peers, as well as how pharmacies deliver services to young people with arthritis. This research revealed that pharmacists need to promote their services and expertise to young arthritis sufferers.

“In juvenile arthritis, the therapies can be complex and team-working with other professionals is needed to provide the best care for young people,” says Dr Janet McDonagh, senior lecturer in paediatric and adolescent rheumatology at the University of Birmingham and co-lead of the study. “Pharmacists were not generally recognised as a part of the care team by young people and parents. There are opportunities to get more involved, and some innovative UK practice is now being seen, but pharmacists will need to demonstrate their value.”

Alternative suggestions

Some people find that dietary supplements can help to ease joint pain and inflammation. With such a wide range available from pharmacies, customers may need help to choose the most appropriate product for their needs.

Another study recently published in the Annals of the Rheumatic Diseases underlined the potential benefits of using glucosamine and chondroitin compared to traditional treatment options for osteoarthritis. The results revealed that patients taking these supplements experienced a reduction in cartilage volume loss over a two year period. This beneficial effect was seen regardless of whether the patients were also receiving more conventional treatment with analgesics or NSAIDs.

The effectiveness of glucosamine and chondroitin in arthritis is controversial. According to SIGN, taking glucosamine and chondroitin supplements may nourish cartilage damaged by osteoarthritis. But the products shouldn’t be taken by people who are allergic to shellfish, those with diabetes or patients taking warfarin.

The Vitabiotics Jointace range includes chondroitin and glucosamine tablets and patches. Other popular dietary supplements include rosehip (found in GOPO Joint Health and Vitabiotics Jointace Rose Hip and MSM) and New Zealand green-lipped mussels (eg, Regenovex). Omega-3, which is found in fish oils (eg, Seven Seas Pulse Original Omega-3), plays a role in reducing stiffness and joint pain.

A combination of analgesics, manual therapies (eg, physiotherapy) and coping strategies can help to manage joint pain. SIGN guidance recommends that healthcare professionals signpost patients to self-help resources, identified and recommended by local pain services. Gentle exercise is particularly useful in osteoarthritis and lower back pain, but should be recommended only by a doctor or physiotherapist, who can suggest suitable exercises.

In overweight or obese patients, losing weight will reduce the strain on joints, particularly load-bearing ones such as the hips and knees. “Watching our weight and getting plenty of exercise are essential for optimum musculoskeletal health,” says Mr Hobrough. “But there is increasing evidence that good nutrition is also a major weapon against the ravages of age-related wear and tear.”

A positive attitude is also essential. Independent research commissioned by Lloydspharmacy found that 41 per cent of people living with persistent pain listen to music to help alleviate their symptoms. Music had the biggest impact for younger people, with two thirds of those aged 16-24 claiming it helped with their pain management.

“There are lots of different ways of managing pain, not only with medicines but also with lifestyle changes such as moderate exercise and relaxation,” says Andrew Mawhinney, Lloydspharmacy pharmacist and pain expert. “After speaking to many people who are living with pain, we were interested to learn just how many found music beneficial.”