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Musculoskeletal disorders remain the most common cause of physical disability in an ageing population. The importance of increased cardiovascular disease in this group is being recognized. The dramatic therapeutic impact of the cytokine specific inhibitors in the treatment of inflammatory joint disease has been balanced by the controversy over the potential cardiovascular toxicity of the newer selective...
Standardized assessments of general physical function (e.g. walking unaided) and the ability to perform tasks of daily living are widely used in rheumatology, both in clinical practice to assess disease severity and progression, and in clinical research to evaluate the effectiveness of treatment. Some measure of physical function is now included in the core data set recommended for inclusion in all...
Surgery for osteoarthritis (OA) is generally reserved for patients who find non-surgical options ineffective. Surgery aims to reduce or eliminate pain and restore function and there are many ways to achieve this. The choice should be tailored to the needs of the patient with particular reference to the specific joint affected and the degree of pathological change. Surgical treatments for OA covered...
Rheumatological diseases include conditions which affect limited regions of the locomotor system only and also conditions which can have widespread systemic affects. The rheumatological history must reflect both of these aspects. The main symptoms of joint disease are pain, stiffness, swelling and deformity. Functional impairment and resultant disability must also be inquired about. Systemic diseases...
Back pain will affect 60–80% of the population in industrialized countries. Most back pain (90%) will settle in 6 weeks. For the majority of patients keeping active and optimization of analgesia using regular simple analgesic agents will suffice. This article will describe how to identify back pain red flags indicative of serious spinal pathology, how to assess for markers of chronicity (yellow flags)...
Primary osteoarthritis (OA) describes a common group of joint conditions in which cartilage and bone are affected. The sites most frequently affected are hand, knee, hip and spine. Risk factors include systemic features such as age, sex and race as well as local factors including joint alignment and muscle strength. Genes play an important role, with an estimated heritability of OA of 40–60%. Previously...
Laboratory investigations play an important role in the diagnosis of rheumatic disorders but many tests are of limited specificity. It is therefore important to select tests in the light of careful clinical assessment rather than blindly sending off a battery of requests, as the results may be confusing. We review the frequency of autoantibodies in different disorders and their value for diagnosis...
The locomotor system is extensive and locomotor problems are common. The most efficient and effective way to examine the locomotor system is to perform a screening examination, the GALS (gait, arms, legs, spine) screen, followed by a more detailed examination of any abnormal findings. This detailed, regional examination of individual joints follows the principles of ‘look, feel, move, function’.
The current ‘gold standard’ investigation of coronary atherosclerosis is invasive coronary angiography. In the UK, more than 250,000 cardiac catheterizations are performed each year. Less than 40% of these are percutaneous interventional procedures and many patients are found to have normal coronaries or only minimal disease. During cardiac catheterization, a single investigation can establish diagnosis...
Musculoskeletal conditions are a major burden to the individual, society and the health service. Most new musculoskeletal GP consultations are for self-limiting conditions such as soft tissue rheumatism, chronic widespread pain and arthralgia. Incident cases of osteoarthritis are ten times more common compared to rheumatoid arthritis. The prevalence of musculoskeletal conditions is more common in...
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