Chapter 14 Musculoskeletal conditions NATIONAL DEPARTMENT OF HEALTH

Chapter 14: Musculoskeletal conditions NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME PRIMARY HEALTHCARE GUIDELINES 2018 1

EVIDENCE Please access the National Essential Medicines List Committee (NEMLC) report for detailed evidence (including rationale, references and costings) informing decision-making on medicine addition, amendments and deletions: http: //www. health. gov. za/index. php/standard-treatment-guidelines-andessential-medicines-list/category/285 -phc DISCLAIMER This slide set is an implementation tool and should be used alongside the most recently published STG available on the EML Clinical Guide Application. This information does not supersede or replace the STG itself. 2

Rheumatoid arthritis DESCRIPTION • • A chronic inflammatory systemic condition. May affect many organs, but the musculoskeletal system is predominantly affected with several joints becoming painful and swollen. Four ‘S factors’ are useful to screen for early joint disease. By James Heilman, MD - Own work, CC BY-SA 3. 0, https: //commons. wikimedia. org/w/index. php? cu rid=11110471 CHANGES REASON • Prednisone ADDED for acute symptom control while awaiting rheumatology assessment if NSAIDs contra-indicated. Pragmatic recommendation to minimise pain while awaiting assessment/ definitive management at higher level of care. 3

Rheumatoid arthritis PREVENT By James Heilman, MD - Own work, CC BY-SA 3. 0, https: //commons. wikimedia. org/w/index. php? curid=11110471 CHANGES • Proton pump inhibitors ADDED REASON Reduce risk of ulceration in rheumatoid arthritis patients on NSAIDs with a high risk of peptic ulceration. 4

Gout DESCRIPTION • • • A metabolic disease in which uric acid crystals are deposited in joints and other tissues. Characterised by recurrent attacks of an acute arthritis that often affects one joint which is very painful, tender, swollen, red and hot to the touch. The inflammation may extend beyond the joint. CHANGES REASON • Prednisone ADDED Prednisone recommended if NSAIDS are contraindicated, e. g. peptic ulceration, warfarin therapy and renal dysfunction, or heart failure. 5

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