Symposium articles

Education the key to improving outcomes in gout

22 May 2019Paid-up subscribers

The most common presentation of gout is a flare, characterised by acute onset of one, or occasionally more, hot, red, swollen joints which are very painful and tender. Less common is insidious onset of chronic usage related joint pain, especially in joints already affected by osteoarthritis. Subcutaneous tophi can also be the presentation, particulary in older people. In typical cases, clinical assessment alone is sufficient for diagnosis. Gout is also associated with comorbidities such as nephrolithiasis, chronic kidney disease, metabolic syndrome and heart disease, and increased mortality.

Optimising the management of systemic lupus erythematosus

22 May 2019Paid-up subscribers

Systemic lupus erythematosus (SLE) is a multisystem, autoimmune disease. SLE mainly affects women and causes fatigue, rashes (often associated with photosensitivity), hair loss and inflammatory arthritis. However, it can also affect men in whom it is often more severe with a greater likelihood of renal involvement and a greater degree of organ damage. According to the British Society for Rheumatology guideline, the diagnosis of SLE requires a combination of clinical features and the presence of at least one relevant immunological abnormality.

Diagnosis and treatment of Sjögren’s syndrome

20 Dec 2018Registered users

Primary Sjögren’s syndrome is a chronic systemic immune-mediated condition of unknown aetiology characterised by focal lymphocytic infiltration of exocrine (mainly salivary and lacrimal) glands. It affects 0.1-4.6% of the European population and 90% of cases are female. Although it usually presents in the fifth or sixth decade, it can be seen in younger people who tend to present with systemic disease and are less likely to have classical sicca symptoms. Patients should be referred to a rheumatologist to confirm diagnosis, and this may involve scintigraphy/sialography and/or labial gland biopsy.

Managing low back pain in primary care

20 Dec 2018Registered users

Chronic low back pain is a common problem. Lifetime adult prevalence rates vary from 50 to 80%, and around a quarter of adults say they have experienced back pain during the past month. One in 40 report disabling back or neck pain. Each year around 7% of patients consult their GP with back pain. In 65-70% of primary care patients with low back pain there is no known pathoanatomical cause. Their pain is described as nonspecific and is postulated to arise from muscle strain or ligamentous injury. A further 15-20% of patients have mechanical low back pain with an identifiable cause such as degenerative disc or joint disease. 

Prompt diagnosis can prevent joint damage in psoriatic arthritis

20 Dec 2017Registered users

Psoriatic arthritis (PsA) is a chronic, autoimmune inflammatory condition that can affect up to 30% of patients with psoriasis. It is part of the seronegative spondyloarthropathy group of rheumatic diseases which also includes reactive arthritis and ankylosing spondylitis. It can be a multisystem disease affecting the eyes, the gut and the tendons and is associated with comorbidities such as ischaemic heart disease and metabolic syndrome. Early diagnosis is key as structural joint damage can occur within two years of disease onset. 

Early recognition pivotal in the management of spondyloarthritis

20 Dec 2017Registered users

The spondyloarthritis group is divided into two main subgroups: axial spondyloarthritis and peripheral spondyloarthritis. These may exist as separate entities or coexist in the same patient. Classically, axial spondyloarthritis presents with insidious onset inflammatory lower back pain, which is typically worse in the morning and after rest, and improves with activity. Peripheral spondyloarthritis can present with peripheral joint pain and/or swelling, swelling of the digits (dactylitis), tendon and entheseal pain that is not secondary to a mechanical cause. Early referral of patients with suspected spondyloarthritis to specialist care is strongly recommended as this can improve long-term outcomes.

Improving joint pain and function in osteoarthritis

16 Dec 2016Paid-up subscribers

Osteoarthritis has become a major chronic pain condition. It affects more than 10% of adults and accounts for almost 10% of health service resources. The impact of osteoarthritis is amplified by underuse of effective muscle strengthening exercises and a focus on often less effective and poorly tolerated analgesic therapies. Muscle strengthening and aerobic exercise have been shown to improve joint pain and function. Weight loss not only improves joint pain and function but has a myriad of other health benefits.

Diagnosis and management of polymyalgia rheumatica

16 Dec 2016Paid-up subscribers

Polymyalgia rheumatica (PMR) is a common inflammatory condition of unknown aetiology. There is no specific diagnostic test for PMR but the usual pattern is a commensurate rise in CRP and ESR. A small proportion of PMR patients will have normal inflammatory markers. At diagnosis and each follow-up visit it is imperative to consider the potential for associated giant cell arteritis (GCA). If there is any suspicion of GCA, urgent discussion with the rheumatologist should take place that day.

Evaluating the patient with low back pain

22 Dec 2015Paid-up subscribers

In the UK, low back pain is the most common cause of disability in young adults and every year 6-9% of adults consult their GP about back pain. A thorough history and examination is required to exclude an alternative diagnosis, such as pain arising from the hip or trochanteric bursa and to categorise patients as having: serious spinal pathology, nerve root/radicular pain or non-specific back pain.

Diagnosis and management of osteoporosis

22 Dec 2015

Osteoporosis is a common condition characterised by low bone mineral density and an increased risk of fragility fractures. It affects up to 30% of women and 12% of men at some point in their lives. The diagnosis of osteoporosis can be confirmed by DEXA but this should only be performed in patients who have an increased risk of fracture on the basis of clinical risk factors. DEXA should be considered if the 10-year risk of major osteoporotic fracture is > 10%.




Self-management pivotal in osteoarthritis

22 Apr 2014Paid-up subscribers

Osteoarthritis remains a clinical diagnosis and importantly radiographic changes and joint symptoms may be poorly correlated. All patients with clinical osteoarthritis should be advised about activity and exercise irrespective of age, comorbidity, pain severity or disability. A rheumatological opinion should be sought if there is doubt regarding the diagnosis or symptoms persist despite treatment. [With external links to the evidence base]

Early recognition improves prognosis in elderly onset RA

22 Jan 2014Paid-up subscribers

Age at onset is particularly relevant in RA as the presentation may differ in elderly onset RA (EORA) compared with young onset RA (YORA). Patients with EORA frequently report a more acute presentation, especially if positive for rheumatoid factor (RF). Fever, fatigue and weight loss appear to be more common in EORA. Although small joints are most frequently involved in the RA population overall, there is common involvement of large joints in EORA and these proximal symptoms may mimic polymyalgia rheumatica (PMR). [With external links to the evidence base]

Improving outcomes in patients with psoriasis

24 Jan 2013Paid-up subscribers

The majority of patients with psoriasis can be managed in primary care, although specialist care may be necessary at some point in up to 60% of cases. Patients with erythrodermic or generalised pustular psoriasis should be referred for a same day dermatological opinion, and if psoriatic arthritis is suspected, early referral for a rheumatological opinion is recommended. Recent guidance from NICE and SIGN will contribute significantly to the care of psoriasis sufferers in both primary and secondary care. [With external links to the evidence base]

Preventing osteoporotic fractures in older people

24 Jan 2011Registered users

Until recently, the management of osteoporosis was centred around the use of diagnostic thresholds based on bone mineral density (BMD) measured at the spine or hip by dual x-ray absorptiometry (DXA). This was reflected in UK guidance for the identification of individuals at high fracture risk from the Royal College of Physicians (RCP).The guidance was based on an opportunistic case-finding strategy where physicians were alerted to the possibility of osteoporosis and high fracture risk by the presence of clinical risk factors associated with fracture. This provided a trigger for the measurement of BMD, and treatment was considered in those with a BMD value that lay in the range of osteoporosis as defined by the WHO. Treatment was, however, also recommended for women with a prior fragility fracture without necessarily measuring BMD. Since the development of these guidelines, it has become apparent that the presence of several of the risk factors used to trigger a BMD test is associated with a fracture risk greater than can be accounted for by BMD alone. [With external links to the evidence base]

Diagnosing joint pain in older people

20 Jan 2010Paid-up subscribers

 Musculoskeletal disease is the most common cause of chronic pain and disability in older people. The prevalence in those over 75 is 83% in the UK. Older adults with arthritis have been reported to make significantly greater use of medical services compared with those without.Joint pathology may lead to reduced mobility, increased risk of falls, low energy, dependency and depression. Chronic pain itself is strongly associated with psychological distress and fatigue. Overall, arthritis places an enormous burden on the individual and on society. Therefore, the importance of correctly diagnosing and managing joint pain in the elderly is paramount and the GP is central to this process. [With external links to the evidence base]

Diagnosing shoulder pain

01 Jan 2009Paid-up subscribers

The prevalence of shoulder disorders has been reported to range from 7 to 36% of the population accounting for 1.2% of all GP consultations. Shoulder pain has been said to be the second most common musculoskeletal complaint presenting in primary care. On average GPs are consulted approximately seven times each week for a complaint relating to the neck or upper extremity; three of these consultations will be for new complaints or new episodes. [With external links to the evidence base]