Chapter 10: Musculoskeletal and joint disease | Right Decisions

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Polypharmacy guidance: realistic prescribing
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Chapter 10: Musculoskeletal and joint disease

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

NSAIDs

CAUTION: Gastro-intestinal ADRs (Risk factors: age>75, GI ulcer, antithrombotics, steroids, SSRIs, high alcohol use)
- If NSAIDs are essential: Consider gastro-protection with a PPI in those with GI risk factors
CAUTION: Cardiovascular ADRs (Risk factors: CVD risk>20%, previous CVD events, heart failure)
CAUTION: Renal ADRs (Risk factors: age>65, on ACEI, ARBs and/or diuretics, CKD or heart failure
- If NSAIDs are essential: Monitor eGFR; advise patient to stop during intercurrent illness

Skeletal muscle relaxants

Rarely indicated long term (except for spasticity)

CAUTION: Anticholinergic ADRs

DMARDs

Assess effectiveness and discuss any need for changes with secondary care specialist

Ensure patient adherence to dosing/monitoring regimen

Adherence/Patient centeredness

CAUTION: Methotrexate overdosing. Avoid preparations with different strengths