Volume 5, Number 3

Paul Emery, Editor

While most readers are aware of the revolution that has occurred in the management of autoimmune inflammatory diseases, the changes that have occurred in surgical techniques have not been given the same publicity. Yet advances in orthopaedic techniques have moved at an accelerated pace over the last few years.

Mark Quinn MBChB MRCP Consultant Rheumatologist, York Hospitals; Honorary Senior Lecturer, Hull York Medical School

Rheumatoid arthritis (RA) is characterised by its chronic progressive, destructive and debilitating nature. However, historically, therapeutic intervention used to be delayed due to concern over the toxicity of disease-modifying antirheumatic drugs (DMARDs) and the assumption that RA was generally a benign condition. The advent of the first early RA cohort studies altered the rheumatologists' perception of RA and revealed its true damaging nature.

Christopher Holroyd BM MRCP Specialist Registrar in Rheumatology; Christopher Edwards BSc FRCP MD Consultant Rheumatologist and Honorary Senior Lecurer, Department of Rheumatology, Southampton General Hospital

After many years of using corticosteroids and traditional immunosuppressive treatments, there has been an explosion in drug development in the area of systemic lupus erythematosus (SLE). Understanding is also increasing as to the best use of traditional lupus therapies and the promise of therapies targeted to individual patients. Matching the therapy to the organ involved and the likely prognosis will be an increasing theme in the future.

Jon H Raphael MSc FRCA MD Consultant in Pain Management; Sandeep Kapur MBBS MD FRCA Consultant in Pain Management, Birmingham City University

Among chronic musculoskeletal causes of pain, those arising from the spine or diffusely from the muscles are the commonest. In most of these cases, serious medical or structural causes can be excluded but understanding the mechanisms and management remains challenging.

Ramakrishnan Venkatesh MS Orth DNB Orth FRCS(G) FRCS Tr & Orth Consultant Orthopaedic Surgeon; Jake Timothy MBBS(Lon) FRCS(Eng) FRCS(SN) Consultant Neurosurgeon, Leeds Teaching Hospitals

The Seventies and Eighties saw major advances in joint replacement surgery and trauma fixation, and techniques were developed that made outcomes more predictable. Over the last decade, advances in engineering and material science and increasing expectations towards faster rehabilitation and improving long-term outcomes have been the driving forces in orthopaedic and trauma surgery.

Lorena Tonarelli MSc BSc(Hons) Independent Medical Writer, Henley-on-Thames

Although there is widespread agreement on the need to improve patients’ access to rheumatology services, there is no consensus on which changes should be made to achieve this and there is much concern over the usefulness of relocating specialist medicine in general – and rheumatology in particular – into primary care. Some specialists think that this should, and could, be avoided through a reorganisation of secondary care services.