Volume 7, Number 3

Paul Emery, Editor

NICE technology appraisals have been a source of much criticism, not least in the confusion with implementing biologic therapy. In the case of initiating tumour necrosis factor (TNF) blockade, NICE initially adopted the BSR guidelines, based on the principle that TNF should be reserved for resistant patients. With increasing data of the greater efficacy and good long-term safety of these agents, it became clear that the late use of TNF blockade in patients who have more resistant disease (and less ability to improve) is not the optimal method of using these drugs.

Louise Warburton BSc MBChB DFFP DRCOG MRCGP GPwSI in Rheumatology and Musculoskeletal Disease, Telford and Wrekin Primary Care Trust, Shrophsire; Raashid Luqmani DM FRCP FRCP(E) Consultant Rheumatologist/Senior Lecturer, Nuffield Orthopaedic Centre, Oxford; Sheena Hennell BA(Hons) MSc Nurse Consultant Rheumatology, Arrowe Park Hospital, Wirral

Following the British Society for Rheumatology (BSR) guidance, recently updated, the National institute for Health and Clinical Excellence (NICE) issued guidelines on the management of rheumatoid arthritis (RA) in adults. In this article, members of the NICE guideline group explore the challenges and barriers to implementation of the NICE guidance in primary care and specialist care, from the point of view of rheumatologists and specialist nurses.

Michal Rolinski BA(Oxon) BMBCh(Oxon) F1 Doctor in Rheumatology; Jason Seewoodhary BSc(Hons) MBBCh(Hons) MRCP(UK) Specialist Registrar in Rheumatology, Department of Rheumatology, Stoke Mandeville Hospital, Aylesbury

In this review, we will discuss some of the many neurological manifestations encountered in rheumatological practice.

Edith Villeneuve MD FRCPC Rheumatology Research Fellow; Jackie Nam MBBCh FCP Rheumatology Research Fellow, Unit of Musculoskeletal Diseases, Leeds Teaching Hospitals, Leeds

Musculoskeletal conditions account for around 20% of GP consultations. A sizeable proportion will present with polyarthralgia, but exact numbers are not known. Most of those patients will have osteoarthritis or non-specific arthralgia and, often, can be managed in primary care.

Sarah L Westlake BM(Hons) MRCP Consultant Rheumatologist, Department of Rheumatology, Poole Hospital NHS Foundation Trust; Christopher J Edwards BSc MD FRCP Consultant Rheumatologist and Honorary Senior Lecturer, Department of Rheumatology, Southampton General Hospital

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are found worldwide. There is a marked ethnic and geographical variation in their prevalence and severity, with what appears to be an inverse relationship. In populations with a high prevalence of severe RA, there is often a low prevalence of mild SLE. The underlying cause of these diseases is not fully understood, but is thought to be due to a mixture of genes producing a predisposition, influenced by environmental factors. Disease is expressed when gene–environment interactions reach an individual’s disease threshold.

Simon Bowman PhD FRCP Consultant Rheumatologist, Selly Oak Hospital, Birmingham; John Hamburger FDSRCS Senior Lecturer in Oral Medicine; Andrea Richards FDSRCS Consultant in Oral Medicine, Birmingham Dental Hospital and School; Saaeha Rauz PhD FRCOphth Senior Lecturer in Ophthalmology, University of Birmingham

Sjögren’s syndrome (SS) is a systemic autoimmune disorder characterised by inflammation of the exocrine glands leading to dry eyes and dry mouth. Due to a relative lack of awareness of the condition, it is underdiagnosed and consequently undertreated. There is also a perception that this is a mild condition and that therapy is limited and optional. In this article, we will discuss some of the barriers to diagnosis and treatment and potential strategies to deal with them.