Topical Reviews
Reports on the Rheumatic Diseases Series 5
These reports are intended to provide authoritative overviews of current areas of clinical interest and research in rheumatic diseases. They are aimed primarily at rheumatologists in training and general physicians.
WARNING: THESE PUBLICATIONS ARE INTENDED FOR MEDICAL PRACTITIONERS. SOME OF THEIR CONTENTS MAY BE DISTURBING TO READERS WITH ARTHRITIS OR THEIR CARERS.
Sports-Related Musculoskeletal Disorders
June 2008 No 14
Musculoskeletal problems will affect everyone who exercises or plays sport at some time. Acute problems requiring medical intervention will usually be managed in the community, or in Accident & Emergency or orthopaedic departments. Chronic musculoskeletal complaints will, however, present to a variety of professionals, including rheumatologists.
Glucocorticoids in Rheumatic Diseases
October 2007 No 13
Glucocorticoids (GCs) (also called corticosteroids, or, more loosely, 'steroids') were first used in 1948 with dramatic results. Patients with inflammatory arthritis found their symptoms melted away, but physicians used high, long-term doses and serious adverse effects were encountered. For 30 years there were no clear guidelines for the use of GCs.
Immunisation of Immunosuppressed Patients with Rheumatic Diseases
June 2007 No 12
Patients with inflammatory rheumatological diseases have increased morbidity and mortality from infection. In rheumatoid arthritis (RA), deaths from infection (usually chest infection) are 2–5 times more common than would be predicted by age and sex.
Rheumatological Manifestations of Malignant Haematological Conditions
February 2007 No 11
Many of the rheumatic diseases may be complicated by malignancy. The association of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and Sjögren's syndrome with lymphoproliferative disease has received much attention. The cause of these malignancies seems to be at least partly related to the pathological process of autoimmunity itself.
Work-Related Disorders of the Upper Limb
October 2006 No 10
Work-related musculoskeletal disorders (WMSDs) are an important source of occupational morbidity. Estimates of the size of the problem depend on case definition and the source of the statistics, but by most measures they represent one of the two major categories of work-related illness in Britain today (the other being mental illness).
Qualitative Research: Its Relevance and Use in Musculoskeletal Medicine
June 2006 No 9
Qualitative research aims to understand people's experiences and interpretations of life events, and as such these approaches are particularly useful in studying the way people live with and adapt to musculoskeletal conditions.
Rheumatic Diseases: Serological Aids to Early Diagnosis
February 2006 No 8
Laboratory methods to detect particular autoantibodies have provided the clinician with valuable tools to assist in diagnosis and, to some extent, prognosis of patients with autoimmune rheumatic diseases. Serology is of particular value in the early stage of disease when clinical expression is often incomplete.
Malignancy and the Rheumatic Diseases
October 2005 No 7
There are many links between malignancy and musculoskeletal conditions. Both primary and secondary tumours may occur in bones and the soft tissues. Musculoskeletal symptoms may occur as part of a paraneoplastic syndrome.
Systemic Amyloidosis in the Rheumatic Diseases
June 2005 No 6
The amyloidoses are a group of diseases characterised by the pathological accumulations of a range of insoluble proteins in the extracellular matrix of tissues and organs. There are several different forms of amyloid protein, which are associated with a number of distinct underlying causes, including autoimmune disease, infections and malignancies.
Heritable Collagen Disorders
February 2005 No 5
Although the first clinical description of articular hypermobility is attributed to Hippocrates, who in the 4th century BC described the Scythians as a race having such 'flabbiness and atony' that they were unable to use their weapons, the condition has only attracted rheumatological interest in the last four decades.
An Update on Gout
October 2004 No 4
In 1848, Sir Alfred Garrod linked gout with hyperuricaemia. Articular crystal deposition and its association with arthritis was established by McCarty and Hollander in 1961 when they identified monosodium urate (MSU) crystals in the synovial fluid (SF) of patients with acute gout.
Surgery for Arthritis: Total Hip and Knee Joint Replacement
June 2004 No 3
Surgery and a total replacement joint is the final stage of treatment for many patients with arthritis after other approaches such as drug therapy and physical therapy have been exhausted.
Idiopathic Inflammatory Myopathies
February 2004 No 2
The idiopathic inflammatory myopathies (IIM), or myositis, are rare disorders with a combined incidence difficult to determine but probably in the region of 15 per million population. Diagnosis is important since there is significant morbidity and mortality in the absence of treatment, but it may be difficult because of the insidious onset of the characteristic muscle weakness.
Low Back Pain
September 2003 No 1
Low back pain is not only the most common musculoskeletal complaint, but arguably is also the most common human illness with the exception of the common cold. The anatomy, biomechanics and aetiology of back pain are complex, and unsurprisingly the pathophysiology in many cases is still poorly understood.
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