Volume 6, Number 1

Paul Emery, Editor

Arthritis affects large numbers of people: more than 7.5 million people in England have the disease. The financial and operational burden on the NHS is substantial. The direct cost is £5.5 billion. Prescription costs are £34 million, and hip and knee replacements are £4–5 million. One in five of the adult population see their GP for arthritis or a related condition.

Graham Hughes MD FRCP Head, The London Lupus Centre, London Bridge Hospital

There are three major connective tissue diseases which are seen in every general practice. These are lupus, Sjögren’s syndrome and Hughes syndrome (the antiphospholipid syndrome).

Karen Douglas MBBS BSc MD MRCP Consultant Rheumatologist; George Kitas MD PhD FRCP Professor of Rheumatology, Dudley Group of Hospitals

A 29-year-old student nurse was admitted with a rapid onset of breathlessness accompanied by central, non-radiating chest pain at rest. She denied any cough, productive sputum, haemoptysis or orthopnoea. She and her husband had joined a gym 18 months previously, and while he became fitter she became dyspnoeic. Her symptoms had accelerated rapidly in the past fortnight. Her weight was stable and she had no risk factors for venous thrombosis.

Zuzana de Jong MD PhD Rheumatologist, Leiden University Medical Centre; Jet Veldhuijzen van Zanten PhD School of Sport and Exercise Sciences, University of Birmingham; George Kitas MD PhD FRCP Professor of Rheumatology, Dudley Group of Hospitals NHS Trust

Rheumatoid arthritis (RA) is a chronic destructive disease, which classically involves small joints of the hands and feet. In long-standing disease, larger joints such as knees, hips, ankles, shoulders and elbows,1 as well as the internal organs (heart, lungs and kidneys) may become involved. Systemic symptoms may be prominently present and subsequently patients complain of lack of energy, tiredness and depressive feelings.

Susie Earl BM (Hons) MRCP Specialist Registrar in Rheumatology, Queen Alexandra Hospital, Portsmouth; Cyrus Cooper MBBS DM FRCP FMedSci Professor of Rheumatology; Nigel Arden MBBS MRCP MSc MD Reader in Rheumatology, University of Southampton

Osteoarthritis (OA) is the most common form of arthritis in Western populations. It is the single most important cause of disability in older adults. OA of the knee, the principal joint affected, is diagnosed in 10% of the UK population older than 55 and results in disabling knee symptoms for 10% of them. Radiographic evidence of knee OA in men and women aged over 65 years is reported in 30% of subjects, around one-third of whom are symptomatic. Furthermore, the rapid aging of Western societies and increasing rates of obesity are likely to significantly increase the health and economic burden of knee osteoarthritis.

Semina Seraj MD Instructor in Medicine; Christopher T Ritchlin MD Associate Professor of Medicine, University of Rochester Medical Center, Rochester, NY, USA

Psoriasis has been the subject of intense interest since it was first described in ancient times. While mild disease is quite common, a significant fraction of patients suffer from moderate-to-severe skin involvement, which can have a profound negative impact on self-image and quality of life (QoL). Of late, a concept of psoriatic disease has been introduced which encompasses all the various tissues and organs that can be involved in patients with psoriasis, including musculoskeletal structures as well as the eyes, gut and the cardiovascular system.