Volume 5, Number 4

Denis A Poddubnyy MD Rheumatology Research Fellow; Joachim Sieper MD Professor of Rheumatology; Martin Rudwaleit MD Consultant in Rheumatology, Rheumatology, Department of Medicine, Campus Benjamin Franklin, Berlin, Germany

Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disorder of unknown aetiology that primarily affects the axial skeleton (sacroiliac joints and spine). AS belongs to a group of related diseases termed spondyloarthritides (SpAs), which also comprises conditions such as reactive arthritis and arthritis/spondylitis associated with inflammatory bowel disease or with psoriasis. Diagnosis of AS according to the modified New York criteria (see Box 1) requires the presence of unequivocal radiographic sacroiliitis (at least grade 2 bilaterally or grade 3 unilaterally).

Paul Emery, Editor

Back pain is one of the more common symptoms that presents to primary care. In amongst the numerous patients with mechanical back pain are a small percentage that have inflammatory disease. The average time for a definitive diagnosis for these patients used to be around seven years. The availability of new effective therapies for this group of conditions has meant that there is a move to try to identify patients earlier in the hope of preventing long-term consequences of the disease.

Susan M Oliver RN MSc Nurse Consultant, Chair of the Royal College of Nursing Rheumatology Forum

Care pathways have experienced a recent revival, having been introduced to healthcare organisations a number of times from the early 1990s onwards with varying degrees of success. So why have integrated care pathways (ICPs) become the focus of attention again, and is there any point in considering them as a serious option in service planning?

Andrew Whallett FRCP Honorary Senior Lecturer, Division of Immunity and Infection, University of Birmingham; Consultant Rheumatologist, Russells Hall Hospital, Dudley; Alison Tennant MRPharmS MPH Specialist in Pharmaceutical Public Health, Dudley Primary Care Trust

Osteoporosis is of overwhelming epidemiological importance. However, some areas in the UK have struggled to establish an osteoporosis service. After a long campaign, we have just opened a dual energy X-ray absorptiometry (DXA) facility, supported by a dedicated osteoporosis clinic, in the rheumatology department at the Dudley Group of Hospitals. This article shows some of the difficulties we had to overcome and gives advice to those who may be embarking on establishing their own local service.

Peter Passmore BSc MD FRCP (Lond, Glasg) FRCPI Reader in Geriatric Medicine, Queen’s University Belfast, Consultant in Elderly Care, Belfast Trust

Pain is common in older people and has considerable effects on their quality of life. Pain is also common in people with dementia and there is an increasing interest in appropriate pain management in this population. While the reporting of pain in patients with mild-to-moderate dementia can be very similar to that of cognitively unimpaired older people, it is clear that – depending on the severity of the underlying dementia – the detection and management of pain can be suboptimal.

Ai Lyn Tan MRCP MD Clinical Lecturer in Rheumatology, University of Leeds and Chapel Allerton Hospital; Laura A Rhodes PhD Research Fellow, Academic Unit of Medical Physics, University of Leeds; Helena Marzo-Ortega MRCP Consultant Rheumatologist, University of Leeds and Chapel Allerton Hospital; Dennis McGonagle FRCPI PhD Professor of Regenerative Medicine and Consultant Rheumatologist, University of Leeds and Chapel Allerton Hospital and National University of Ireland, Galway

The advent of imaging modalities such as MRI and ultrasonography has permitted a better assessment of enthesitis in psoriatic arthritis (PsA). This article puts into perspective how imaging, specifically MRI and ultrasound, has lead to a new understanding of PsA and to a pathology-based classification system.