SOP Bulletin No. 141

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08 March 2010

THE FOLLOWING RMA SOPS ARE TO TAKE EFFECT ON 10 MARCH, 2010

• There have been some significant changes made to this SOP.
• The name has been changed to the more conventional term – osteoarthritis.
• The definition has been changed to explicitly require (1) clinical manifestations (pain, impaired function and stiffness) AND (2) radiology, other imaging or arthroscopic evidence of articular cartilage loss or osteophytes.
• The “trauma to the affected joint” definition has been changed to make it clear that there must be a discrete traumatic event involving the application of a damaging force to or through the joint.
• In the BOP SOP the time symptoms and signs must last in that trauma definition has changed from ten to seven days (the same as the RH SOP).
• The previous factor for disordered joint mechanics in a hip, knee or ankle joint has been split into three parts:

(i) a disordered joint mechanics factor that applies to any joint, but with a more restrictive definition of disordered joint mechanics.

(ii) a separate factor for necrosis of subchondral bone – in any joint.

(iii) a separate factor, for lower limb joints only, for leg amputation or asymmetric gait.

• The previous vibration factor, that was restricted to particular upper limb joints, no — w covers all upper limb joints.
• The previous lower limb joint factor for lifting loads has been expanded, with a new sub-factor for carrying loads and a further sub-factor for having increased bone mineral density (as defined).
• The previous obesity factor has been extended to:
• now include any lower limb or hand joint (including foot joints and carpo-metacarpal joints in the hand - previously not covered); and
• c — over being overweight (BMI ≥ 25), or having a waist to hip circumference ratio of > 1.0 for men or > 0.9 for women.
• The — re are new factors (RH and BOP) for:
• having chondromalacia patellae (for patello-femoral joint OA only);
• performing repetitive or forceful activities as specified (for upper limb joints only).
• loss of pain sensation or proprioception (sense of position and movement) in the affected joint;
• having Paget's disease of bone of the affected joint; and
• having acromegaly.

• The previously separate SOPs for acute sinusitis and chronic sinusitis have been combined.
• The has been some reorganising and rewording of factors, but all the previous causal mechanisms have been retained.
• The only new (RH only) factor is for having gastro-oesophageal reflux disease.

• T — his SOP has been extensively updated.
• There are modified definitions of suicide and attempted suicide.
• The old stressor factors have been replaced by the standard stressor factors found in the psychiatric SOPs.
• The range of precursor psychiatric conditions has been expanded.
• There are new factors concerning: bullying; childhood abuse; prior attempted suicide or self-injury; severe disability from illness or injury; epilepsy; chronic pain; academic failure; anticipated transfer to a nursing home; and medications.

• This SOP has been updated to comply with the Legislative Instruments Act.
• The old UV damage ratio factor has been replaced by the standard sunlight exposure factor.
• There is a new factor, for melanoma of the eye only, for welding or using a UV tanning device.
• There is a new RH only factor, for SCC of the conjunctiva only, for having specific types of human papilloma virus infection of the conjunctiva.

• This SOP has been updated to comply with the Legislative Instruments Act.
• There are no material changes.

• The 2004 MN of the small intestine SOPs were the subject of an appeal to the Specialist Medical Review Council (SMRC).  The SMRC has directed the RMA to amend the RH SOP to include four new factors. 
• The four new factors concern: fried, barbequed, salt-cured or smoked foods; Helicobacter pylori infection (for carcinoma of the first part of the duodenum only); alcohol from beer and spirits; and, obesity in males.
• Although the amended SOP has been issued in March 2010, t — he SMRC decision took effect on the date the decision appeared in the Gazette, which was 19 August 2009.  So the amended SOP is (retrospectively) effective from that date.