The impact of pain on systemic rheumatic diseases
Publication date: Available online 27 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Piercarlo Sarzi-Puttini , Fabiola Atzeni , Daniel J. Clauw , Serge Perrot Pain is associated with the different types of rheumatic syndromes because it is often the most troubling symptom of patients affected by any of these diseases. Some risk factors clearly play a major role in the clinical expression of pain and related syndromes, including genetics, age, gender, co-morbidities, traumas and psychological patterns, but there are no specific clinical, laboratory or neuroimaging markers that can indic...
Source: Best Practice and Research Clinical Rheumatology - June 27, 2015 Category: Rheumatology Source Type: research

Septic arthritis in immunocompetent and immunosuppressed hosts
Publication date: Available online 16 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Dingyuan Alvin Wang , Paul Anantharajah Tambyah Septic arthritis has long been considered an orthopedic emergency. Historically, Neisseria gonorrhoeae and Staphylococcus aureus have been the most common causes of septic arthritis worldwide but in the modern era of biological therapy and extensive use of prosthetic joint replacements, the spectrum of microbiological causes of septic arthritis has widened considerably. There are also new approaches to diagnosis but therapy remains a challenge, with a nee...
Source: Best Practice and Research Clinical Rheumatology - June 25, 2015 Category: Rheumatology Source Type: research

How to measure chronic pain: New concepts
This article reviews some of the instruments used to assess chronic pain, including newly developed and well-established validated multidimensional instruments and health-care monitoring systems based on information and communication technology, and it discusses their advantages and limitations. (Source: Best Practice and Research Clinical Rheumatology)
Source: Best Practice and Research Clinical Rheumatology - June 25, 2015 Category: Rheumatology Source Type: research

Neuroimaging of chronic pain
Publication date: Available online 19 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Tobias Schmidt-Wilcke Chronic pain is an important public health problem, and there is a need to understand the mechanisms that lead to pain chronification. From a neurobiological perspective, the mechanisms contributing to the transition from acute to subacute and chronic pain are heterogeneous and are thought to take place at various levels of the peripheral and central nervous system. In the past decade, brain imaging studies have shed light on neural correlates of pain perception and pain modulatio...
Source: Best Practice and Research Clinical Rheumatology - June 25, 2015 Category: Rheumatology Source Type: research

Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases
Publication date: Available online 25 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Worawit Louthrenoo Widespread use of immunosuppressive drugs, both conventional disease-modifying antirheumatic drugs (cDMARDs) and biologic disease-modifying antirheumatic drugs (bDMARDs), in autoimmune rheumatic diseases (ARDs) has been found to be associated with the reactivation of underlying latent viruses. The clinical features of virus reactivation can sometimes mimic flare of the underlying ARDs. The correct diagnosis and management of such reactivation is crucial, as increasing the dose of imm...
Source: Best Practice and Research Clinical Rheumatology - June 25, 2015 Category: Rheumatology Source Type: research

Baillière's best practice rheumatology edition on work and MSDs
Publication date: Available online 15 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Dame Carol Black (Source: Best Practice and Research Clinical Rheumatology)
Source: Best Practice and Research Clinical Rheumatology - June 16, 2015 Category: Rheumatology Source Type: research

HIP osteoarthritis and work
Publication date: Available online 10 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): E. Clare Harris , David Coggon Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in ag...
Source: Best Practice and Research Clinical Rheumatology - June 12, 2015 Category: Rheumatology Source Type: research

Vasculitis related to viral and other microbial agents
Publication date: Available online 11 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Gim Gee Teng , W. Winn Chatham Vasculitis due to infection may occur as a consequence of the inflammation of vessel walls due to direct or contiguous infection, type II or immune complex-mediated reaction, cell-mediated hypersensitivity, or inflammation due to immune dysregulation triggered by bacterial toxin and/or superantigen production. As immunosuppressive therapy administered in the absence of antimicrobial therapy may increase morbidity and fail to effect the resolution of infection-associated v...
Source: Best Practice and Research Clinical Rheumatology - June 12, 2015 Category: Rheumatology Source Type: research

Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis
Publication date: Available online 12 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Manjari Lahiri , William G. Dixon There are currently 10 licensed biologic therapies for the treatment of rheumatoid arthritis in 2014. In this article, we review the risk of serious infection (SI) for biologic therapies. This risk has been closely studied over the last 15 years within randomised controlled trials, long-term extension studies and observational drug registers, especially for the first three antitumour necrosis factor (TNF) drugs, namely infliximab, etanercept and adalimumab. The risk of...
Source: Best Practice and Research Clinical Rheumatology - June 12, 2015 Category: Rheumatology Source Type: research

Pain in systemic connective tissue diseases
Publication date: Available online 6 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Manuela Di Franco , Laura Bazzichi , Roberto Casale , Piercarlo Sarzi-Puttini , Fabiola Atzeni Pain is frequent in patients with connective tissue diseases (CTDs), particularly those affected by systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) in which it is virtually ubiquitous and can have different causes. The SLE classification criteria include pain associated with musculoskeletal involvement, which are frequently the initial symptom of SLE and can include arthralgia, arthritis and/or...
Source: Best Practice and Research Clinical Rheumatology - June 10, 2015 Category: Rheumatology Source Type: research

Pain in primary Sjögren's syndrome
Publication date: Available online 6 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Claudio Vitali , Nicoletta Del Papa Joint and muscle pain are commonly observed in patients with primary Sjögren's syndrome (pSS). Different types of pain can be distinguished, that is, articular pain, neuropathic pain and widespread pain. Articular pain is due to more or less evident synovitis, usually involving peripheral joints such as hand joints, wrists, knees and ankles. Drugs used to treat rheumatoid arthritis, or lupus synovitis, are also employed for articular involvement in pSS. Pure sens...
Source: Best Practice and Research Clinical Rheumatology - June 10, 2015 Category: Rheumatology Source Type: research

Pain management in cryoglobulinaemic syndrome
Publication date: Available online 8 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Salvatore Scarpato , Fabiola Atzeni , Piercarlo Sarzi-Puttini , Antonio Brucato , Luca Quartuccio , Maurizio Pietrogrande , Giuseppe Monti , Massimo Galli Cryoglobulinaemic syndrome (CS) includes clinical signs and symptoms that range from the classic triad of Meltzer and Franklin (purpura, weakness and arthralgias) to multiple organ involvement, and it may be characterised by nociceptive or neuropathic pain. Both types of pain use the same pathways and neurotransmitters, but nociceptive pain has an ada...
Source: Best Practice and Research Clinical Rheumatology - June 10, 2015 Category: Rheumatology Source Type: research

Knee pain, knee injury, knee osteoarthritis & work
Publication date: Available online 9 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Gurdeep S. Dulay , C. Cooper , E.M. Dennison Symptomatic knee osteoarthritis (OA) can be viewed as the end result of a molecular cascade which ensues after certain triggers occur and ultimately results in irreversible damage to the articular cartilage. The clinical phenotype that knee OA can produce is variable and often difficult to accurately predict. This is further complicated by the often poor relationship between radiographic OA and knee pain. As a consequence, it can be difficult to compare studi...
Source: Best Practice and Research Clinical Rheumatology - June 10, 2015 Category: Rheumatology Source Type: research

The words of pain in complex regional pain syndrome
Publication date: Available online 9 June 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Roberto Casale , Fabiola Atzeni , Ignazio Francesco Masala , Piercarlo Sarzi-Puttini Complex regional pain syndrome (CRPS) encompasses a wide range of painful conditions, but it is characterised by continuing (spontaneous and/or evoked) limb pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional, with distal predominance usually but not related to a specific nerve territory or dermatome, and it is usually associated with ab...
Source: Best Practice and Research Clinical Rheumatology - June 10, 2015 Category: Rheumatology Source Type: research

Back pain: Prevention and management in the workplace
Publication date: Available online 31 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Frederieke G. Schaafsma , Johannes R. Anema , Allard J. van der Beek Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there...
Source: Best Practice and Research Clinical Rheumatology - May 31, 2015 Category: Rheumatology Source Type: research

Rheumatic effects of vibration at work
Publication date: Available online 30 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Keith T. Palmer , Massimo Bovenzi Occupational exposures to vibration come in many guises, and they are very common at a population level. It follows that an important minority of working-aged patients seen by medical services will have been exposed to this hazard of employment. Vibration can cause human health effects, which may manifest in the patients that rheumatologists see. In this chapter, we identify the health effects of relevance to them, and review their epidemiology, pathophysiology, clinica...
Source: Best Practice and Research Clinical Rheumatology - May 30, 2015 Category: Rheumatology Source Type: research

Multidisciplinary treatment for rheumatic pain
Publication date: Available online 29 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Irina Kudrina , Yoram Shir , Mary-Ann Fitzcharles Chronic pain experienced by patients with rheumatic conditions is recognized to contribute importantly to suffering. Multidisciplinary pain clinics that adhere to the biopsychosocial concept of pain management provide an effective treatment strategy for many with chronic pain. Other than for low back pain and fibromyalgia, little attention has been given to the specific experience of treating those with rheumatic diseases in such a setting. It is, howeve...
Source: Best Practice and Research Clinical Rheumatology - May 29, 2015 Category: Rheumatology Source Type: research

Infections and arthritis
Publication date: Available online 27 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Ashish Jacob Mathew , Vinod Ravindran Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogen...
Source: Best Practice and Research Clinical Rheumatology - May 28, 2015 Category: Rheumatology Source Type: research

Carpal tunnel syndrome and work
Publication date: Available online 27 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Lisa Newington , E. Clare Harris , Karen Walker-Bone Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes ‘nuisance’ symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification an...
Source: Best Practice and Research Clinical Rheumatology - May 28, 2015 Category: Rheumatology Source Type: research

How to investigate rheumatological diseases?
Publication date: Available online 28 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Vinod Ravindran , Richard Watts (Source: Best Practice and Research Clinical Rheumatology)
Source: Best Practice and Research Clinical Rheumatology - May 28, 2015 Category: Rheumatology Source Type: research

Assessment of spinal pain
Publication date: Available online 28 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): J. Braun , X. Baraliakos , A. Regel , U. Kiltz Spinal pain or back pain is a very common symptom that can have many reasons. The most studied location is low back pain, and it is considered to be nonspecific in the majority of cases. Only a small proportion of patients have axial inflammation as the major cause of their back complaints with chronic inflammatory back pain (IBP) as the most prominent clinical feature of spondyloarthritis (SpA). The recognition of IBP and patients with axial spondyloarthri...
Source: Best Practice and Research Clinical Rheumatology - May 28, 2015 Category: Rheumatology Source Type: research

Molecular mechanisms of pain in crystal-induced arthritis
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): R. Ramonda , F. Oliviero , P. Galozzi , P. Frallonardo , M. Lorenzin , A. Ortolan , A. Scanu , L. Punzi Crystal-induced arthritis (CIA) is characterized by an intense inflammatory reaction triggered by the deposition of monosodium urate, calcium pyrophosphate, and basic calcium phosphate crystals in articular and periarticular tissues. Severe, acute pain constitutes the most important clinical symptom in patients affected by these diseases. Pain along with redness, warmness, swelling, and stiffness in t...
Source: Best Practice and Research Clinical Rheumatology - May 24, 2015 Category: Rheumatology Source Type: research

Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s)
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Daniel J. Clauw Until recently, most clinicians considered chronic pain to be typically due to ongoing peripheral nociceptive input (i.e., damage or inflammation) in the region of the body where the individual is experiencing pain. Clinicians are generally aware of a few types of pain (e.g., headache and phantom limb pain) where chronic pain is not due to such causes, but most do not realize there is not a single chronic pain state where any radiographic, surgical, or pathological description of periphe...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Physical exercise as non-pharmacological treatment of chronic pain: Why and when
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Kirsten R. Ambrose , Yvonne M. Golightly Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety, and sleep disturbance, and they are treated alone or in combination by pharmacologic and non-pharmacologic approaches, such as physical activity (aerobic conditioning, mu...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

The child with joint pain in primary care
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): E.S. Sen , S.L.N. Clarke , A.V. Ramanan Joint pains are a common reason for children to present to primary care. The differential diagnosis is large including some diseases that do not primarily affect the musculoskeletal system. Although the cause for many patients will be benign and self-resolving, in rare cases the diagnosis is associated with long-term morbidity and mortality if not detected early and appropriately treated. These include primary and secondary malignancies, septic arthritis, osteomye...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Meta-analyses of pain studies: What we have learned
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Winfried Häuser , Thomas R. Tölle Meta-analysis is a statistical procedure that integrates the results of at least two independent studies. The biggest threats to meta-analysis are publication bias due to missing studies with negative results and low-quality evidence due to methodological limitations imposed by included studies. Tools to improve the quality of meta-analysis have been developed by the Cochrane Collaboration and by the Preferred Reporting Items for Systematic Reviews and Meta-An...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Arthropod-borne arthritides
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Lara J. Herrero , Adam Taylor , Stefan Wolf , Suresh Mahalingam Infections with several types of viral and bacterial pathogens are able to cause arthritic disease. Arthropod vectors such as ticks and mosquitoes transmit a number of these arthritis-causing pathogens, and as these vectors increase their global distribution, so too do the diseases they spread. The typical clinical manifestations of infectious arthritis are often similar in presentation to rheumatoid arthritis. Hence, care needs to be taken...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Role of autoantibody testing
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Amita Aggarwal Autoantibodies are the serological hallmark of autoimmune disease. Though their pathogenic role is debatable, they play an important role in the management of a patient with rheumatic disease. However, due to their presence in the general population as well as in multiple autoimmune diseases, the presence of an autoantibody alone does not make a diagnosis; the result has to be interpreted along with clinical findings. Similarly, the absence of autoantibody does not exclude a disease. The ...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

The use and abuse of diagnostic/classification criteria
We present the limits of current classification criteria, their use and abuse in clinical practice, and how they should be used with caution when applied in clinics. (Source: Best Practice and Research Clinical Rheumatology)
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Evolving spectrum of HIV-associated rheumatic syndromes
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Christine Fox , Karen Walker-Bone At the end of 2013, 35 million people worldwide were infected with HIV. The prognosis of HIV has been transformed by combination antiretroviral therapy (cART). Providing compliance is good, the use of cART has normalised the life expectancy of HIV-infected people leading to a growing population of people with chronic infection. Management of HIV patients has therefore needed to adapt in order to not only control viral activity but also manage long-term complications of ...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

How to investigate new-onset polyarthritis
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Ashok Kumar Polyarthritis comprises a large number of conditions ranging from rheumatoid arthritis (RA) to metabolic conditions such as ochronosis. Differential diagnosis begins with delineation of inflammatory from non-inflammatory disorders using laboratory markers of inflammation. The latter are good but they can be misleading. Laboratory tests help in the diagnosis of rheumatic diseases as well as their prognostication. The choice of serological tests should be based on clinical differential diagnos...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

How to investigate: Chronic pain
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Matthew Hague , Nicholas Shenker Chronic pain is defined as an unpleasant sensory and emotional experience persisting longer than the normal process of healing, usually longer than 3 months. About a fifth of the world's population is believed to suffer from chronic pain. In Europe, chronic pain accounts for nearly 500 m lost working days, and it costs the European economy >€34 billion (£28 billion) every year. Establishing a reliable diagnosis is the primary challenge in evaluatin...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Cost-effective use of investigations in developing countries
Publication date: Available online 23 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Anand N. Malaviya , Sanjiv Kapoor In recent years, the cost of health care around the world has risen at a rate that is deemed unsustainable. It has been estimated that 20% of this could be saved by rationalising laboratory investigations and reducing inappropriate requisitioning of the investigations. There are several reasons for the excessive, redundant, inappropriate or unnecessary investigations and procedures, which in some instances are unethical practices. The impact in financial terms is more i...
Source: Best Practice and Research Clinical Rheumatology - May 23, 2015 Category: Rheumatology Source Type: research

Pain in systemic inflammatory rheumatic diseases
Publication date: Available online 19 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Fabiola Atzeni , Ignazio Francesco Masala , Fausto Salaffi , Manuela Di Franco , Roberto Casale , Piercarlo Sarzi-Puttini The sometimes intense, persistent and disabling pain associated with rheumatoid arthritis (RA) and spondyloarthritis frequently has a multifactorial, simultaneously central and peripheral origin, and it may be due to currently active inflammation or joint damage and tissue destruction caused by a previous inflammatory condition. The symptoms of inflammatory pain symptoms can be parti...
Source: Best Practice and Research Clinical Rheumatology - May 21, 2015 Category: Rheumatology Source Type: research

Travel- and immigration-related problems in rheumatology
Publication date: Available online 20 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): T. Adizie , A.O. Adebajo Health problems are self-reported by up to 64% of travellers to the developing world. Traditionally, rheumatic symptoms are accorded little significance, but many travellers do return home with musculoskeletal complaints. The assessment of these patients is often hindered by the Western clinician's lack of familiarity with the types of infections that the patient may have encountered while travelling. Standard serological tests for autoimmune diseases can be unreliable in the se...
Source: Best Practice and Research Clinical Rheumatology - May 21, 2015 Category: Rheumatology Source Type: research

“Real-life” treatment of chronic pain: Targets and goals
Publication date: Available online 20 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Jacob N. Ablin , Dan Buskila Treating chronic pain is a complex challenge. While textbooks and medical education classically categorize pain as originating from peripheral (nociceptive), neuropathic, or centralized origins, in real life each and every patient may present a combination of various pain sources, types, and mechanisms. Moreover, individual patients may evolve and develop differing types of pain throughout their clinical follow-up, further emphasizing the necessity to maintain clinical dilig...
Source: Best Practice and Research Clinical Rheumatology - May 21, 2015 Category: Rheumatology Source Type: research

Psychological aspects of chronic musculoskeletal pain
Publication date: Available online 21 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Leslie J. Crofford Chronic musculoskeletal pain, by its very nature, is associated with negative emotions and psychological distress. There are individual differences in personality, coping skills, behavioral adaptation, and social support that dramatically alter the psychological outcomes of patients with chronic pain. Patients who have an aspect of central pain amplification associated with mechanical or inflammatory pain and patients with fibromyalgia (FM) are likely to exhibit higher levels of psych...
Source: Best Practice and Research Clinical Rheumatology - May 21, 2015 Category: Rheumatology Source Type: research

Update on the genetics of the fibromyalgia syndrome
Publication date: Available online 18 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Jacob N. Ablin , Dan Buskila Fibromyalgia syndrome (FMS), a condition characterized by chronic widespread pain and tenderness, is a complex condition considered to represent a paradigm of centralized pain. FMS has demonstrated a clear familial aggregation, and hence it is considered to have a genetic background. Multiple candidate-gene studies have been conducted in this field, focusing on target genes that play a role in the transmission and processing of pain. While many of these have focused in the p...
Source: Best Practice and Research Clinical Rheumatology - May 20, 2015 Category: Rheumatology Source Type: research

How to investigate multisystem disease
Publication date: Available online 18 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Richard A. Watts The investigation of the patient with possible systemic autoimmune rheumatic disease is potentially one of the most challenging areas of rheumatology as the differential diagnosis is potentially very broad. The investigative approach should not only be directed at confirming the diagnosis of an autoimmune rheumatic disease but also at excluding as best as possible the major alternative diagnoses of malignancy and infection. A systematic approach should yield a positive diagnosis in the ...
Source: Best Practice and Research Clinical Rheumatology - May 20, 2015 Category: Rheumatology Source Type: research

The association between rheumatoid arthritis and periodontitis
Publication date: Available online 1 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Michelle T. Leech , P.M. Bartold The relationship between rheumatoid arthritis and poor oral health has been recognised for many decades. The association between periodontal infection and the risk of developing RA has been the subject of epidemiological, clinical and basic science research in recent times. Converging and reproducible evidence now makes a clear case for the role of specific periodontal infective pathogens in initiating, amplifying and perpetuating rheumatoid arthritis. The unique enzymati...
Source: Best Practice and Research Clinical Rheumatology - May 16, 2015 Category: Rheumatology Source Type: research

The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity
This article focusses on the relationship between axial spondyloarthritis (axial SpA) and work productivity. It summarises the impact of this condition on work productivity, and it highlights the tools available to assess this. It also highlights the increasing role and potential of employers, health professionals and new treatments for enhancing work productivity for people with this condition. (Source: Best Practice and Research Clinical Rheumatology)
Source: Best Practice and Research Clinical Rheumatology - May 16, 2015 Category: Rheumatology Source Type: research

Shoulder disorders and occupation
Publication date: Available online 8 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Catherine H. Linaker , Karen Walker-Bone Shoulder pain is very common, and it causes substantial morbidity. Standardised classification systems based upon presumed patho-anatomical origins have proved poorly reproducible and hampered epidemiological research. Despite this, there is evidence that exposure to combinations of physical workplace strains such as overhead working, heavy lifting and forceful work as well as working in an awkward posture increases the risk of shoulder disorders. Psychosocial ris...
Source: Best Practice and Research Clinical Rheumatology - May 16, 2015 Category: Rheumatology Source Type: research

Psychological and psychosocial determinants of musculoskeletal pain and associated disability
Publication date: Available online 15 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Sergio Vargas-Prada , David Coggon Although much attention has been given to the physical determinants of common musculoskeletal complaints such as back and arm pain, research points to a stronger influence of psychological factors. Multiple studies have implicated poor mental health and somatisation (a tendency to worry about the common somatic symptoms) in the incidence and chronicity of musculoskeletal pain and associated disability. Also important are adverse beliefs about the prognosis of such diso...
Source: Best Practice and Research Clinical Rheumatology - May 16, 2015 Category: Rheumatology Source Type: research

Osteoarthritis pain
Publication date: Available online 16 May 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Serge Perrot Osteoarthritis (OA) represents one of the most frequently occurring painful conditions. Pain is the major OA symptom, involving both peripheral and central neurological mechanisms. OA pain is initiated from free axonal endings located in the synovium, periosteum bone, and tendons, but not in the cartilage. The nociceptive message involves not only neuromediators and regulating factors such as neuronal growth factor (NGF) but also central modifications of pain pathways. OA pain is a mixed ph...
Source: Best Practice and Research Clinical Rheumatology - May 16, 2015 Category: Rheumatology Source Type: research

Role of vaccinations and prophylaxis in rheumatic diseases
Publication date: Available online 2 April 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Despoina Papadopoulou , Christos Tsoulas , Athanassios Tragiannidis , Nikolaos V. Sipsas Targeted strategies for reducing the increased risk of infection in patients with autoimmune rheumatic diseases include vaccinations as well as antibiotic prophylaxis in selected patients. However, there are still issues under debate: Is vaccination in patients with rheumatic diseases immunogenic? Is it safe? What is the impact of immunosuppressive drugs on vaccine immunogenicity and safety? Does vaccination cause ...
Source: Best Practice and Research Clinical Rheumatology - April 20, 2015 Category: Rheumatology Source Type: research

Role of genetics in infection-associated arthritis
Publication date: Available online 9 April 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Helen Benham , Philip C. Robinson , Athan C. Baillet , Linda M. Rehaume , Ranjeny Thomas Genetic discoveries in arthritis and their associated biological pathways spanning the innate and adaptive immune system demonstrate the strong association between susceptibility to arthritis and control of exogenous organisms. The canonical theory of the aetiology of immune-mediated arthritis and other immune-mediated diseases is that the introduction of exogenous antigenic stimuli to a genetically susceptible hos...
Source: Best Practice and Research Clinical Rheumatology - April 20, 2015 Category: Rheumatology Source Type: research

Ageing, musculoskeletal health and work
Publication date: Available online 15 April 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Keith T. Palmer , Nicola Goodson Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter, we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their jo...
Source: Best Practice and Research Clinical Rheumatology - April 20, 2015 Category: Rheumatology Source Type: research

The management of musculoskeletal disorders in the workplace
Publication date: Available online 19 April 2015 Source:Best Practice & Research Clinical Rheumatology Author(s): Ira Madan , Paul Robert Grime Musculoskeletal disorders are a major cause of suffering and disability among working-age adults. Although working in ergonomically unsound jobs may lead to the development of certain musculoskeletal disorders, it is increasingly recognised that well-designed work is generally good for health and individuals with musculoskeletal disorders generally benefit from working. This chapter explores how health-care professionals should assess patients' fitness for work, what fact...
Source: Best Practice and Research Clinical Rheumatology - April 20, 2015 Category: Rheumatology Source Type: research

Assessment and treatment of pain in children and adolescents
Publication date: April 2014 Source:Best Practice & Research Clinical Rheumatology, Volume 28, Issue 2 Author(s): Chitra Lalloo , Jennifer N. Stinson Pain is one of the most common and distressing symptoms experienced by children and adolescents with juvenile idiopathic arthritis. Pain is known to negatively affect all aspects of health-related quality of life, including physical, emotional, social, and role functioning. The valid and reliable assessment of pain is the first critical step to developing an effective plan for pain management. This chapter will address the following key questions: (1) What is the pr...
Source: Best Practice and Research Clinical Rheumatology - December 4, 2014 Category: Rheumatology Source Type: research

Therapeutic advancements in juvenile idiopathic arthritis
Publication date: April 2014 Source:Best Practice & Research Clinical Rheumatology, Volume 28, Issue 2 Author(s): Elizabeth A. Kessler , Mara L. Becker The treatment of juvenile idiopathic arthritis (JIA) has substantially evolved over the past two decades. Research has been conducted and is ongoing on how therapies can best be utilized either as monotherapy or in combination for enhanced efficacy. The introduction of biologic therapies that selectively target specific cytokines has changed the acceptable clinical course of childhood arthritis. In addition to the development and utilization of new therapeutic age...
Source: Best Practice and Research Clinical Rheumatology - December 4, 2014 Category: Rheumatology Source Type: research