Volume 7, Number 1

Ash Samanta MD FRCP Consultant Rheumatologist, University Hospital of Leicester NHS Trust; Stan Andrzejewski Rheumatoid arthritis patient; Vicky Andrzejewski Wife of a rheumatoid arthritis patient

In 2006, at the age of 56, Stan Andrzejewski developed acute-onset polyarticular symptoms with pain, swelling and stiffness affecting his hands, wrists, elbows, knees and ankles. Investigations showed a haemoglobin of 9.6 g/dl (13.0–18.0) that was normocytic and normochromic; platelets 738 x 10/l (150–400); plasma viscosity 1.96 CP (1.50–1.72); CRP 205 mg/l (<10); rheumatoid factor negative. A range of other investigations, including routine
biochemistry, autoantibody screen, thyroid function, immunoglobulins, electrophoresis, prostate-specific antigen and anti-neutrophil cytoplasmic antibodies were essentially unremarkable except for intermittent slight elevations of alkaline phosphatase and ALT.

Paul Emery, Editor

It is well documented that the number one priority for patients with arthritis and rheumatic complaints is relief of pain. However, it is becoming increasingly acknowledged that the psychological burden of rheumatic disease can be at least as great as the physical one.

Emma Beatty PhD Independent Medical Writer, Melbourne, Derbyshire

The Joint Account meeting, held in Leamington Spa on 22–23 January 2009, was attended by clinical practitioners and service commissioners responsible for arranging and providing rheumatology services across the Midlands. Its aim was to bring together different perspectives on treatment pathways, with a focus on the patient-centred care that is central to Lord Darzi’s NHS Next Stage Review and the NHS Plan. In particular, it covered the implementation of clinical practice within the practice-based commissioning of services.

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

Neck and upper limb disorders are ubiquitous in the developed world. Because of their frequency and association with disability, they impact substantially in occupational settings. Estimates of the size of the problem depend on case definition and the population studied, but neck and upper limb disorders represent one of the two major categories of work-related illness in Britain today, second only to back pain.

Andrew Vallance-Owen MBA FRCSEd Group Medical Director, Bupa, London

Over the past few years, the role of the private sector within the UK has changed dramatically from being a parallel, even peripheral, part of the healthcare system to having a significant role in both provision and commissioning within the NHS. This role is set to develop further, according to the NHS Next Stage Review Final Report (the Lord Darzi report) published in June 2008.

Elizabeth D Hale BA(Hons) MSc CPsychol Chartered Health Psychologist; Gareth J Treharne BSc(Hons) PhD; George D Kitas MD PhD FRCP Consultant Rheumatologist and Professor of Rheumatology and Musculoskeletal Health, Department of Rheumatology, Dudley Group of Hospitals NHS Trust

‘I was becoming a burden on the family. I was becoming totally dependent on my husband and children. I was having to have outside help which I found extremely difficult to cope with because I’d always been very self-sufficient and able to cope on my own as best I could but my hands by this time were getting so deviated that I was not even able to feed myself and then came, you know, the shoes, the wheelchair, and that was when I tried to attempt suicide …’ (Mrs S)