Rheumatology in practice - 2009

Comment: Europe takes the rheumatism lead
Paul Emery
pp 3-3
The interest in rheumatic diseases in Europe is expanding at a rapid rate. The recent EULAR Congress in Copenhagen was visited by more than 13,500 participants, making it one of the largest rheumatology meetings ever.

Should rheumatoid arthritis form part of CVD algorithms?
Hoda Mirjafari and Ian N Bruce
pp 4-6
Symptomatic cardiovascular disease (CVD) events occur when atherosclerosis progresses to flow-limiting disease, resulting in ischaemia, or when a thrombus forms on an existing plaque as a result of rupture. In the general population, there is great emphasis on identifying asymptomatic patients with high CVD risk for more intense interventions to reduce future events and mortality.

The treatment and care of hot, swollen joints
Israa Al-Shakarchi and Gerald Coakley
pp 7-9
The presentation of one or more hot swollen joints is a common medical emergency. Although the differential diagnosis is wide, bacterial septic arthritis should always be suspected due its potential for significant morbidity, and a mortality rate of up to 11%. One of the difficulties in diagnosing septic arthritis is that patients often present to clinicians inexperienced in the management of musculoskeletal disease.

The window of opportunity for treatment in early RA
Tina Ding, Louise Warburton, Kate Gadsby and Chris Deighton
pp 10-12
Increasing evidence shows that substantial irreversible damage occurs early in rheumatoid arthritis (RA), with 75% of joint erosions occurring in the first two years, and at least 25% of patients already have erosions at disease diagnosis. There is increasing evidence that a narrow window of opportunity to slow down, or potentially halt, the joint damage caused may exist in the early stages of RA.

A dilemma in treating Wegener’s granulomatosis
Tina Ding and Marian Regan
pp 13-14
A 38-year-old Caucasian man was diagnosed with Wegener’s granulomatosis in 1996 with joint, renal, and ear, nose and throat (ENT) involvement. He was treated with 12 pulses of intravenous cyclophosphamide (6 g in total) and intravenous methylprednisolone. He achieved clinical remission in terms of renal and ENT diseases though serologically he was persistently positive for circulating anti-neutrophil cytoplasmic antibody.

Autoimmune disease and the role of the obstetrician
Kate Bramham and Catherine Nelson-Piercy
pp 15-19
Autoimmune disease is not uncommon in women of childbearing age, presenting as multisystem disease that can be challenging to manage, before, during and after pregnancy. Here, we review common conditions affecting pregnant women and discuss prenatal, antenatal and postnatal treatment and diagnosis.

2009, Volume 7 Number 1

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