Volume 5, Number 1

Paul Emery, Editor

This is a critical period for the interaction between primary and secondary care, particularly so for specialties such as rheumatology. The pace of change in the NHS, the culture of targets and the redistribution of funding have made these uncomfortable times. Rheumatology, in particular, is going through a revolution, both in its therapeutic possibilities and in payers’ assessment of it as a primary/secondary care interface specialty.

Marwan Bukhari MBBS MSc FRCP PhD Consultant Rheumatologist, Royal Lancaster Infirmary

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in rheumatology practice. They are, however, associated with an increased risk of gastrointestinal (GI) perforations, ulcers and bleeds as well as other GI symptoms, such as dyspepsia. There is currently a debate on whether or not selective COX-2 inhibitors (coxibs) offer any added benefit over standard NSAIDs.

Andrei Calin MD FRCP Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases, Bath

One of the sadder aspects of dealing with ankylosing spondylitis is that, even now, there are often years between initial symptoms developing and a diagnosis being made that allows the patient to be referred to a rheumatologist.

Philip Helliwell DM PhD FRCP Senior Lecturer in Rheumatology, University of Leeds

In the last five years there has been an explosion in the number of articles on psoriatic arthritis (PsA). A Medline search shows that fewer than ten papers per year were published from 1966 to the mid-1980s, from which point this rose to between 70 and 80 papers per year, until the millennium when 200 were published. That is still less than 10% of the number of papers on rheumatoid arthritis (RA), where a smaller increase has been observed.

Louise Warburton MBChB DRCOG DFFP MRCGP GP, Telford and Wrekin Primary Care Trust; GPwSI in musculoskeletal medicine

To be diagnosed with rheumatoid arthritis (RA) was once a life sentence of disability. With gold injections and steroids being the mainstays of treatment, most patients would have had crippling joint disease and only a small minority would have been able to continue working in their jobs.

Cosimo De Bari MD PhD MRC Clinician Scientist, Clinical Senior Lecturer and Consultant in Rheumatology, King’s College, London

In recent years, stem cell research has generated great interest. In rheumatology, haematopoietic stem cell (HSC) transplantation has become a clinically feasible therapy for patients with severe autoimmune diseases. This technique attempts to reset the deregulated immune system and restore a proper immune homeostasis.

Jackie Nam MBBCh FCP(SA) Cert Rheum(SA) Clinical Research Fellow in Rheumatology; Richard Wakefield BM MD MRCP Senior Lecturer and Honorary Consultant in Rheumatology, Chapel Allerton Hospital, Leeds

Imaging is playing an increasingly important role in the diagnosis and management of patients with rheumatic conditions. Conventional radiography has been the cornerstone of imaging for many years but advances in technology have pushed imaging techniques such as ultrasonography, MRI and CT to the fore. The focus of this article is on the current role of ultrasonography in rheumatology.