Rheumatology in practice - 2007

Comment: Making the most of developments
Paul Emery
pp 3-3
Back pain is one of the more common symptoms that presents to primary care. In amongst the numerous patients with mechanical back pain are a small percentage that have inflammatory disease. The average time for a definitive diagnosis for these patients used to be around seven years. The availability of new effective therapies for this group of conditions has meant that there is a move to try to identify patients earlier in the hope of preventing long-term consequences of the disease.
How to diagnose ankylosing spondylitis at an early stage
Denis A Poddubnyy, Joachim Sieper and Martin Rudwaleit
pp 4-7
Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disorder of unknown aetiology that primarily affects the axial skeleton (sacroiliac joints and spine). AS belongs to a group of related diseases termed spondyloarthritides (SpAs), which also comprises conditions such as reactive arthritis and arthritis/spondylitis associated with inflammatory bowel disease or with psoriasis.2 Diagnosis of AS according to the modified New York criteria (see Box 1) requires the presence of unequivocal radiographic sacroiliitis (at least grade 2 bilaterally or grade 3 unilaterally). However, in early AS, radiographic sacroiliitis is often not present yet. To help characterise patients with early AS at the preradiographic state who are most likely to progress to full-blown AS, we have proposed to use the term ‘axial preradiographic spondyloarthritis’.
Setting up an osteoporosis service: a practical guide
Andrew Whallett and Alison Tennant
pp 8-10
Osteoporosis is of overwhelming epidemiological importance. However, some areas in the UK have struggled to establish an osteoporosis service. After a long campaign, we have just opened a dual energy X-ray absorptiometry (DXA) facility, supported by a dedicated osteoporosis clinic, in the rheumatology department at the Dudley Group of Hospitals. This article shows some of the difficulties we had to overcome and gives advice to those who may be embarking on establishing their own local service.
The organisation of integrated care pathways
Susan M Oliver
pp 11-13
Care pathways have experienced a recent revival, having been introduced to healthcare organisations a number of times from the early 1990s onwards with varying degrees of success. So why have integrated care pathways (ICPs) become the focus of attention again, and is there any point in considering them as a serious option in service planning?
What imaging has told us about psoriatic arthritis
Ai Lyn Tan, Laura A Rhodes, Helena Marzo-Ortega and Dennis McGonagle
pp 14-16
The advent of imaging modalities such as MRI and ultrasonography has permitted a better assessment of enthesitis in psoriatic arthritis (PsA). This article puts into perspective how imaging, specifically MRI and ultrasound, has lead to a new understanding of PsA and to a pathology-based classification system. PsA is an inflammatory arthropathy that is generally associated with skin psoriasis. However, the skin and joint diseases do not necessarily present at the same time; indeed each manifestation may be seen separately in first-degree relatives in isolation, which has contributed to the difficulties in establishing the true prevalence of the disease.
Detection and treatment of pain in dementia
Peter Passmore
pp 17-19
Pain is common in older people and has considerable effects on their quality of life. Pain is also common in people with dementia and there is an increasing interest in appropriate pain management in this population. While the reporting of pain in patients with mild-to-moderate dementia can be very similar to that of cognitively unimpaired older people, it is clear that – depending on the severity of the underlying dementia – the detection and management of pain can be suboptimal.

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ISSN 1366-6541 (Print)  ISSN 2052-3130 (Online)