Volume 7, Number 2

Hoda Mirjafari MRCP Clinical Research Fellow, arc Epidemiology Unit; Ian N Bruce MD FRCP Reader in Rheumatology, University of Manchester

Symptomatic cardiovascular disease (CVD) events occur when atherosclerosis progresses to flow-limiting disease, resulting in ischaemia, or when a thrombus forms on an existing plaque as a result of rupture. In the general population, there is great emphasis on identifying asymptomatic patients with high CVD risk for more intense interventions to reduce future events and mortality. The National Institute for Health and Clinical Excellence (NICE) in the UK has advocated the use of the Framingham Heart Study Risk Score in primary CVD prevention.

Kate Bramham MRCP Clinical Research Fellow, Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust; Catherine Nelson-Piercy FRCP FRCOG Consultant Obstetric Physician, St Thomas’ Hospital, London

Autoimmune disease is not uncommon in women of childbearing age, presenting as multi-system disease that can be challenging to manage, before, during and after pregnancy. Here, we review common conditions affecting pregnant women and discuss prenatal, antenatal and postnatal treatment and diagnosis.

Paul Emery, Editor

The interest in rheumatic diseases in Europe is expanding at a rapid rate. The recent EULAR Congress in Copenhagen was visited by more than 13,500 participants, making it one of the largest rheumatology meetings ever.

Israa Al-Shakarchi MBBCh MRCP BSc(Hons) ST3 Rheumatology; Gerald Coakley FRCP PhD Consultant Rheumatologist, Queen Elizabeth Hospital, Woolwich

The presentation of one or more hot swollen joints is a common medical emergency. Although the differential diagnosis is wide, bacterial septic arthritis should always be suspected due its potential for significant morbidity, and a mortality rate of up to 11%. One of the difficulties in diagnosing septic arthritis is that patients often present to clinicians inexperienced in the management of musculoskeletal disease. This can lead to a delay in prompt diagnosis and treatment, which are essential in order to prevent irreversible joint damage and dysfunction. This article will focus primarily on the diagnosis and management of septic arthritis. Hot swollen joints may be caused by other conditions, including crystal arthritis, reactive arthritis or a monoarticular presentation of a polyarthritis.

Tina Ding MB BChir MSc MRCP Consultant Rheumatologist, Department of Rheumatology, Royal Derby Hospital; Louise Warburton MBChB DRCOG DFFP MRCGP GP, Shawbirch Medical Practice, Telford; GPwSI in Musculoskeletal Medicine, Telford and Wrekin Primary Care Trust; Kate Gadsby RGN BSc(Hons) Rheumatology Nurse Specialist/Lead Clinical Educator, Derby City Hospital; Chris Deighton BMedSc MD FRCP Consultant Rheumatologist, Department of Rheumatology, Royal Derby Hospital

Increasing evidence shows that substantial irreversible damage occurs early in rheumatoid arthritis (RA), with 75% of joint erosions occurring in the first two years, and at least 25% of patients already have erosions at disease diagnosis. There is increasing evidence that a narrow window of opportunity to slow down, or potentially halt, the joint damage caused may exist in the early stages of RA.

Tina Ding MB BChir MSc MRCP Consultant Rheumatologist; Marian Regan MB FRCP Consultant Rheumatologist, Department of Rheumatology, Royal Derby Hospital

A 38-year-old Caucasian man was diagnosed with Wegener’s granulomatosis in 1996 with joint, renal, and ear, nose and throat (ENT) involvement. He was treated with 12 pulses of intravenous cyclophosphamide (6 g in total) and intravenous methylprednisolone. He achieved clinical remission in terms of renal and ENT diseases though serologically he was persistently positive for circulating anti-neutrophil cytoplasmic antibody. He was maintained on azathioprine but was never able to reduce oral prednisolone dose below 2.5 mg daily, due to flare of joint synovitis on withdrawal.