Volume 6, Number 3

Chris Deighton BMedSc MD FRCP Consultant Rheumatologist, Derbyshire Royal Infirmary; Chairman of the British Society for Rheumatology Clinical Affairs Committee; Kimme Hyrich MD PhD FRCPC Senior Lecturer in Rheumatic Disease Epidemiology, University of Manchester; Consultant Rheumatologist, Manchester Royal Infirmary

The 2001 British Society for Rheumatology (BSR) guidelines accepted by the National Institute for Health and Clinical Excellence (NICE) ensured that rheumatoid arthritis (RA) patients had some access to anti-tumour necrosis factor (anti-TNF) drugs, but resulted in restrictions that are far greater than in other countries. To increase eligibility for patients, evidence needs to be produced to shift current NICE guidelines in a manner that increases access to drugs, but in a cost-effective fashion acceptable to NICE. How can this be achieved?

Jason Seewoodhary BSc(Hons) MBBCh(Hons) MRCP ST2 in Core Medical Training; Andrew Keat MBBS MD FRCP Consultant Physician and Rheumatologist, Northwick Park Hospital, Harrow

Infection plays a role in many forms of inflammatory arthritis. In some, that role is well established; in others, it is probable; while in yet others, in which mechanisms are poorly understood, microbial involvement in pathogenesis is distinctly possible. With the increasing use of potent immunosuppressive treatment and implant joint surgery, complications of existing joint disease by secondary infection and prosthetic joint infection are increasing threats.

Paul Emery, Editor

Soft tissue disorders, particularly of the upper limb, affect up to 80% of adults during their lifetime, with a point prevalence of up to 40%. In the first article of this issue, Helena Robinson and Karen Walker-Bone document the various afflictions, stressing their clinical diagnosis and principles of treatment.

Karen Douglas BSc MBChB MRCP MD Consultant Rheumatologist, Dudley Group of Hospitals

In recent months, you may have noticed your colleagues had disappeared to enjoy a few sunny summer days in Paris. Indeed, you may even be lucky to have been one of 14,000 in attendance yourself. I am not referring to Fashion Week, but the European League Against Rheumatism (EULAR) 2008 conference and I have been set the task of summarising it. What could be easier than reporting back on four days that cover 1,546 posters and 279 oral presentations, not to mention the 15 ongoing simultaneous scientific sessions each day, and 28 satellite symposia? Please do not think that I can provide anything more than a personal taster of this rather well rounded but seriously expanding conference.

Brian Hazleman MA MB FRCP Consultant in Rheumatology, Addenbrooke’s Hospital, Cambridge

Aspiration and injection techniques are easily learnt and some knowledge of the easiest routes for each joint is of value to all doctors. Both diagnostic and therapeutic joint aspiration are often necessary in emergencies. Confidence is gained by studying diagrams, watching others and, finally, by using the techniques.

Helena Robinson MBBS BSc MRCP Specialist Registrar in Rheumatology, Brighton and Sussex University Hospitals NHS Trust, Brighton; Karen Walker-Bone BM FRCP PhD Senior Lecturer (Honorary Consultant) in Rheumatology, Brighton and Sussex Medical School, Haywards Heath

Soft tissue disorders of the upper limb are a common, heterogeneous group of clinical disorders that affect a considerable proportion of the population at any point in time. They have wide-ranging impacts on work and leisure activities and contribute to a significant burden of disability and substantial healthcare utilisation. The lack of consensus about clinical case definitions has resulted in marked variation in estimates of prevalence and impact and, furthermore, has hindered the development of high-quality randomised, controlled trials of interventions.