Question 1

What are musculoskeletal conditions?

Accepted Answer

Musculoskeletal (MSK) conditions are disorders of muscles, bones, joints, tendons, ligaments and cartilage. They range from acute injuries (fractures, sprains) to chronic conditions (low back pain, osteoarthritis, rheumatoid arthritis, osteoporosis). MSK conditions are collectively the leading cause of disability globally, affecting 1.71 billion people and generating more years lived with disability than any other condition group.

Question 2

Why is low back pain the leading cause of disability?

Accepted Answer

Low back pain (LBP) — which affects 619 million people — causes more disability than any other single condition because: it is extremely common (affecting up to 80% of people at some point in their lives); it has a high recurrence rate; it significantly impairs work capacity; and it is poorly managed — often with inappropriate imaging, opioids and surgery rather than evidence-based active rehabilitation.

Question 3

What causes low back pain?

Accepted Answer

In approximately 90% of cases, low back pain is "non-specific" — no structural cause is identifiable by imaging. Disc degeneration, muscle strain, poor posture and psychosocial factors (stress, depression, fear-avoidance beliefs, job dissatisfaction) are important contributors. Specific causes (disc herniation with nerve root compression, vertebral fracture, infection, tumour, inflammatory arthritis) account for approximately 10%. Imaging rarely changes management and should not be routine.

Question 4

What is the best treatment for low back pain?

Accepted Answer

For acute LBP: staying active, avoiding bed rest, reassurance and short-term analgesics if needed. For chronic LBP: the evidence base strongly supports exercise therapy (any type), cognitive behavioural therapy (addressing fear and catastrophising), multidisciplinary pain programmes, and — for selected patients — spinal manipulation. NSAIDs provide modest short-term benefit; opioids are not recommended for chronic LBP. Surgery is rarely indicated and has limited evidence beyond specific structural indications.

Question 5

What is osteoarthritis?

Accepted Answer

Osteoarthritis (OA) — the most common joint disease globally — causes progressive degradation of articular cartilage with subchondral bone changes, causing pain, stiffness and functional limitation. It affects 528 million people, predominantly the knees, hips and hands. Risk factors include: ageing (the most important); obesity (every 5 kg increase in weight raises knee OA risk by 35%); joint injury; and genetics. Exercise, weight loss and pain management are the mainstays; joint replacement is highly effective for end-stage disease.

Question 6

What is rheumatoid arthritis?

Accepted Answer

Rheumatoid arthritis (RA) is a systemic autoimmune condition causing chronic inflammation of synovial joints — predominantly small joints of the hands and feet — leading to pain, swelling, stiffness, joint destruction and systemic complications (cardiovascular disease, lung disease). RA affects approximately 18 million people globally. Early diagnosis and aggressive treatment with DMARDs (starting with methotrexate) prevents joint destruction. Biologic DMARDs (TNF inhibitors, IL-6 inhibitors) and JAK inhibitors have transformed management.

Question 7

What is osteoporosis and who is at risk?

Accepted Answer

Osteoporosis — low bone mass causing fragility fractures from minimal trauma — affects approximately 200 million people globally, predominantly postmenopausal women and older men. Risk factors: female sex, older age, family history, low body weight, smoking, alcohol, immobility, corticosteroid use, and conditions affecting bone metabolism. Prevention: adequate calcium and vitamin D from childhood; weight-bearing exercise; avoidance of smoking and excess alcohol. Treatment: bisphosphonates, denosumab, teriparatide depending on fracture risk.

Question 8

What is a Fracture Liaison Service?

Accepted Answer

A Fracture Liaison Service (FLS) systematically identifies patients who have sustained a fragility fracture — a sentinel event indicating high osteoporosis risk — and ensures they receive bone density assessment, falls risk reduction and anti-osteoporosis treatment to prevent a second fracture. Hip fractures carry 30% 1-year mortality; FLS prevents up to 30% of subsequent fractures. The International Osteoporosis Foundation (IOF) advocates for FLS as an essential orthopaedic and fracture care component.

Question 9

How does obesity drive musculoskeletal conditions?

Accepted Answer

Obesity is a major MSK risk factor: it substantially increases knee OA risk through joint loading; causes low back pain through postural and biomechanical changes; increases the risk of gout (from hyperuricaemia); and slows recovery from MSK injuries. For every 5 kg excess weight, knee OA risk increases by approximately 35%. Weight loss of even 5-10% substantially reduces knee pain and improves function in overweight OA patients.

Question 10

What is gout?

Accepted Answer

Gout is the most common inflammatory arthritis — caused by uric acid crystal deposition in joints, typically the big toe (podagra), ankle or knee, causing exquisitely painful acute attacks. Risk factors: obesity, high-purine diet (meat, seafood, beer), kidney disease and genetic predisposition. Prevalence is rising globally with obesity. Colchicine, NSAIDs or corticosteroids treat acute attacks; allopurinol or febuxostat reduce urate and prevent recurrence. Gout is the most undertreated arthritis globally.

Question 11

How does MSK health relate to ageing?

Accepted Answer

MSK conditions are the dominant driver of disability in older age: osteoarthritis, fragility fractures, sarcopenia (muscle loss), and falls-related injuries collectively determine the functional independence of older adults. Physical activity — even at modest levels — substantially reduces the rate of MSK ageing. The WHO's integrated care for older people (ICOPE) programme includes MSK function assessment and rehabilitation as core components.

Question 12

How does GMJ News cover musculoskeletal health?

Accepted Answer

GMJ News covers WHO Global Report on Musculoskeletal Health, low back pain management evidence, osteoarthritis and RA treatment advances, osteoporosis and fracture prevention, and rehabilitation access in LMICs. MSK conditions are the leading cause of disability in Georgia and directly relevant to PHIG's public health and accreditation priorities.

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