Rheumatology in practice - 2007

Comment: Reflecting a fast-moving world
Paul Emery
pp 3-3
In this issue of Rheumatology in practice we address a number of the areas that are currently of contention in the field. Andrew Bamji, President of the British Society for Rheumatology (BSR), summarises the role of the BSR in a time of great change. From his experience of medical politics, Andrew makes some telling points and illustrates how important it is to have an active professional body in this area. One of the BSR’s greatest achievements was to set up a biologics register (the BSRBR), an undertaking initiated at the time of Gabriel Panayi’s presidency. Although this has been a rich source of data and has been the envy of other countries, it is now under threat from recent government initiatives. In their article, Kimme Hyrich and Deborah Symmons highlight the virtues of such registers.
Should anti-TNF treatment be used for early AS?
Alexander Bennett, Laura Coates and Helena Marzo-Ortega
pp 4-6
Ankylosing spondylitis (AS) is a chronic progressive inflammatory disorder that affects the axial skeleton and peripheral joints and is considered the prototype of the spondyloarthropathies (SpAs). It is common, with a prevalence of up to 1.4%, and typically affects young patients in the second and third decades of life. Its aetiology is unknown, but it has a complex pathogenesis and susceptibility has been shown to be largely genetically determined.4 The leading clinical symptom of AS is inflammatory back pain, while the involvement of the sacroiliac joints (SIJs) is the hallmark of the disease.
Highlights from EULAR 2007

pp 7-7
Gender disparity in treatment for rheumatoid arthritis (RA) At the 2007 annual congress of the European League Against Rheumatism (EULAR), data from a study at the Karolinska Institute, Sweden, showed that women receive anti-tumour necrosis factor drugs at a higher perceived level of disease activity and when reporting more severe pain than men. Lead researcher Ronald van Vollenhoven commented, ‘Our study does not show a gender bias as such, but does indicate that physicians to some extent “discount” the subjective measures of disease activity’.
The role of the rheumatology nurse specialist
Jackie Hill
pp 8-10
Nurses have long been considered essential members of the rheumatology team, but it was not until the 1980s that the role of specialist nurse began to evolve.1,2 It was at this time that many of the drug treatments and management of inflammatory rheumatic diseases became increasingly complex, and it was realised that with specialist training, nurses could provide specialist services in the multidisciplinary team. Several of the early publications on these extended roles came from Leeds, where nurses undertaking clinical drug trials began holding nurse-led clinics alongside their rheumatologist. These clinics were established because patients who had completed their drug trials were requesting referral back into the nursing clinic for further advice and support.
Drug resgistries in rheumatology
Kimme Hyrich and Deborah Symmons
pp 11-12
A registry involves the systematic follow-up of a population defined by a common factor – for example, a disease or exposure to a particular therapy – to study specific outcomes. The study design is known as a longitudinal observational study. In rheumatology, patient registries have provided us with valuable information on the ‘real-world’ outcomes (that is, those outside clinical trials) among patients living with rheumatic diseases. These registries have focused on two main issues: the ‘natural’ history of the disease and, more recently, the safety and effectiveness of new therapies.
The British Society for Rheumatology: where next?
Andrew Bamji
pp 13-14
Paul Emery began his editorial for the summer 2007 issue, ‘This is a critical period for the interaction between primary and secondary care,’ and he is right. The last ten years of this Labour government have produced more funding for the NHS than ever before, and yet there has been increasing disillusionment, even despair, among doctors on both sides of the fence that has been erected to separate hospitals from the community.
Turning the spotlight onto juvenile idiopathic arthritis
Hayley Farles and Helen Foster
pp 15-18
The last few decades have seen huge changes in the management of juvenile idiopathic arthritis (JIA). For most children with JIA – with prompt referral to specialist teams and access to appropriate care – remission without functional limitation is an expected outcome.

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