Rheumatology in practice - 2009

Comment: NICE: out of step yet racing ahead
Paul Emery
pp 3-3
NICE technology appraisals have been a source of much criticism, not least in the confusion with implementing biologic therapy. In the case of initiating tumour necrosis factor (TNF) blockade, NICE initially adopted the BSR guidelines, based on the principle that TNF should be reserved for resistant patients.
Implementing NICE guidance
Louise Warburton, Raashid Luqmani and Sheena Hennell
pp 4-7
Following the British Society for Rheumatology (BSR) guidance, recently updated, the National institute for Health and Clinical Excellence (NICE) issued guidelines on the management of rheumatoid arthritis (RA) in adults for a summary of the two sets of guidelines). In this article, members of the NICE guideline group explore the challenges and barriers to implementation of the NICE guidance in primary care and specialist care, from the point of view of rheumatologists and specialist nurses.
Sjögren’s syndrome: are we missing the signs?
Simon Bowman, John Hamburger, Andrea Richards and Saaeha Rauz
pp 8-10
Sjögren’s syndrome (SS) is a systemic autoimmune disorder characterised by inflammation of the exocrine glands leading to dry eyes and dry mouth. Due to a relative lack of awareness of the condition, it is underdiagnosed and consequently undertreated.
An approach to polyarthralgia
Edith Villeneuve and Jackie Nam
pp 11-13
Musculoskeletal conditions account for around 20% of GP consultations. A sizeable proportion will present with polyarthralgia, but exact numbers are not known. Most of those patients will have osteoarthritis or non-specific arthralgia and, often, can be managed in primary care.
Rheumatology worldwide
Sarah L Westlake and Christopher J Edwards
pp 14-16
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are found worldwide. There is a marked ethnic and geographical variation in their prevalence and severity, with what appears to be an inverse relationship. In populations with a high prevalence of severe RA, there is often a low prevalence of mild SLE.
Neurological presentations of rheumatic diseases
Michal Rolinski and Jason Seewoodhary
pp 17-19
In this review, we will discuss some of the many neurological manifestations encountered in rheumatological practice.

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