Rheumatology in practice - 2007


Comment: Advancing across all fronts
Paul Emery
pp 3-3
While most readers are aware of the revolution that has occurred in the management of autoimmune inflammatory diseases, the changes that have occurred in surgical techniques have not been given the same publicity. Yet advances in orthopaedic techniques have moved at an accelerated pace over the last few years.Ramakrishnan Venkatesh and Jake Timothy’s article provides an overview of this area. At first they highlight the survival rates of major prosthetic joint replacements, well over 90% of which are now long term.
The latest techniques in orthopaedic surgery
Ramakrishnan Venkatesh and Jake Timothy
pp 4-6
The Seventies and Eighties saw major advances in joint replacement surgery and trauma fixation, and techniques were developed that made outcomes more predictable. Over the last decade, advances in engineering and material science and increasing expectations towards faster rehabilitation and improving long-term outcomes have been the driving forces in orthopaedic and trauma surgery.
Musculoskeletal pain - diagnosis and management
Jon H Raphael abd Sandeep Kapur
pp 7-9
Among chronic musculoskeletal causes of pain, those arising from the spine or diffusely from the muscles are the commonest. In most of these cases, serious medical or structural causes can be excluded but understanding the mechanisms and management remains challenging. For such chronic spinal pains, imaging fails to define validated sources for the symptoms. However, recent studies have shed an optimistic light on some therapies; their optimal realisation can be assisted by attention to spinal diagnostics. In the case of diffuse musculoskeletal pains, there are still no proven highly effective treatments: optimal management is based upon a multidisciplinary approach, using a biopsychosocial model to target available therapies and avoid inappropriate medicalisation.
Developing the provision of rheumatology services
Lorena Tonarelli
pp 10-13
Although there is widespread agreement on the need to improve patients’ access to rheumatology services, there is no consensus on which changes should be made to achieve this and there is much concern over the usefulness of relocating specialist medicine in general – and rheumatology in particular – into primary care. Some specialists think that this should, and could, be avoided through a reorganisation of secondary care services. This was the topic under discussion at the recent meeting of the multiprofessional West Midlands Rheumatology Forum, chaired by Dr Rainer Klocke, Chair of the Forum’s steering committee and Consultant Rheumatologist at Dudley Group Hospitals NHS Trust, West Midlands. The meeting offered an in-depth assessment of how the delivery of rheumatology care within the NHS has recently evolved, and explored ways of ensuring that patients receive a better service and that the highest level of care is provided efficiently and close to home.
Why early referral is essential
Mark Quinn
pp 14-16
Rheumatoid arthritis (RA) is characterised by its chronic progressive, destructive and debilitating nature. However, historically, therapeutic intervention used to be delayed due to concern over the toxicity of disease-modifying antirheumatic drugs (DMARDs) and the assumption that RA was generally a benign condition. The advent of the first early RA cohort studies altered the rheumatologists’ perception of RA and revealed its true damaging nature. As a result of these data and improved knowledge of therapeutics, the concepts of early assessment and intervention were conceived.
New therapies in lupus
Christopher Holroyd and Christopher Edwards
pp 17-19
After many years of using corticosteroids and traditional immunosuppressive treatments, there has been an explosion in drug development in the area of systemic lupus erythematosus (SLE). Understanding is also increasing as to the best use of traditional lupus therapies and the promise of therapies targeted to individual patients. Matching the therapy to the organ involved and the likely prognosis will be an increasing theme in the future. Because lupus can present in many ways, studies of new therapies are far more complicated than in single organ diseases. In turn, this has led to a concentration of research on easily and rigidly defined features of lupus.

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