1. CHAPTER 14: MUSCULOSKELETAL CONDITIONS
11/20/2018
NATIONAL DEPARTMENT OF HEALTH
AFFORDABLE MEDICINES
ESSENTIAL MEDICINES PROGRAMME
DISCLAIMER
This slide set is an implementation tool and should be used alongside the published STG. This information does not supersede or replace the STG itself.
PRIMARY HEALTHCARE 2014
Updates to the 2008 PHC STG & EML

2. DERMATOMYOSITIS STG for Dermatomyositis was not added to the chapter.
Rationale: Not considered as a common condition that requires to be covered by the essential medicines concept in South Africa.
2014
PRIMARY HEALTHCARE 2014 IMPLEMENTATION SLIDES: MUSCULOSKELETAL CONDITIONS

3. Level of evidence: II RCT
GOUT, ACUTE
Ibuprofen, oral: retained
Naproxen, oral: not added
Although naproxen is not associated with long-term cardiovascular adverse events, etc. this is an acute setting.
A single NSAID was considered pragmatic for primary level of care.
Level of evidence: III Expert opinion
Prednisone, oral: dose not amended
Lancet article investigated prednisolone 35 mg daily for 5 days for the treatment of gout.
As the dose of prednisolone is equivalent to prednisone, prednisone, oral was retained in the STG as 40 mg daily for 5 days, for the treatment of acute gout where NSAIDS are contraindicated, e.g. peptic ulceration, warfarin therapy and renal dysfunction.
Level of evidence: II RCT
Ref 1
PRIMARY HEALTHCARE 2014 IMPLEMENTATION SLIDES: MUSCULOSKELETAL CONDITIONS

4. Level of evidence: III Expert opinion
GOUT, CHRONIC
Colchicine 0.5mg tablets: not added
Colchicine had been deleted in the previous edition (2008) and no new evidence was available to support its inclusion in the PHC EML.
Level of evidence: III Expert opinion
PRIMARY HEALTHCARE 2014 IMPLEMENTATION SLIDES: MUSCULOSKELETAL CONDITIONS

5. Level of evidence: III Guidelines
14.3 ARTHRITIS, SEPTIC
Urgent referral criterion for children: amended
2008: All children with hot, swollen, joints, very painful on movement with restricted movements administered a single dose of ceftriaxone, prior to referral.
2014: Nurse to determine whether a child is septic using the IMCI Guidelines for “POSSIBLE SERIOUS BACTERIAL INFECTION” .
Recommendation: Text was amended as follows:
Rationale: Prevent over treatment with a broad spectrum antibiotic of children who may not have septicaemia. In addition, subsequent cultures would be negative impeding further management at secondary level.
Level of evidence: III Guidelines
-Children with suspected septic arthritis should be assessed for evidence of septicaemia and septicaemic shock which should be treated accordingly.
-Infants up to the age of 2 months who fulfil the IMCI criteria for “POSSIBLE SERIOUS BACTERIAL INFECTION” should receive a first dose of Ceftriaxone along with other IMCI urgent care while arranging transfer.
• Ceftriaxone, IM, 80 mg/kg/dose immediately as a single dose.
Ref 2
PRIMARY HEALTHCARE 2014 IMPLEMENTATION SLIDES: MUSCULOSKELETAL CONDITIONS

6. 14.5 OSTEOARTHROSIS Paracetamol, oral: dose amended
Dose was amended for consistency throughout the PHC STGs, 2014:
“Paracetamol, oral, 1 g, 6 hourly”.
PRIMARY HEALTHCARE 2014 IMPLEMENTATION SLIDES: MUSCULOSKELETAL CONDITIONS

7. Slide
Ref #
Reference
GOUT, ACUTE 3 1
PREDNISONE
Janssens HJ, Janssen M, van de Lisdonk EH, van Riel PL, van Weel C. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet May31;371(9627):
SAMF, 2012 edition.
14.3 ARTHRITIS, SEPTIC 5 2
National Department of Health. Integrated Management of Childhood Illness Guidelines, 2014.
PRIMARY HEALTHCARE 2014 IMPLEMENTATION SLIDES: MUSCULOSKELETAL CONDITIONS