Medicine
Acute aortic dissection is an uncommon, potentially life-threatening illness. In the USA (population about 240 million), the incidence is at least 6000 cases/year. The precise incidence is difficult to determine because many cases are undiagnosed. In large autopsy series, the prevalence is 0.2–0.8%. The peak incidence of aortic dissection is in the sixth and seventh decades of life; men are affected...
This contribution focuses on specific aspects of antihypertensive drug treatment, but it is important to remember that reduction of blood pressure is simply an evidence-based strategy for reducing overall cardiovascular and coronary heart disease (CHD) risk. The current recommendation is that patients with a 10-year CHD risk of 15% or more are ‘eligible’ for antihypertensive drug treatment as a primary...
The pericardium comprises an inner serous membrane (the visceral pericardium) composed of a single layer of mesothelial cells attached to the cardiac surface and epicardial fat, and an outer fibrous layer (the parietal pericardium). Arterial blood supply is derived from small branches of the aorta, the internal mammary and the musculophrenic arteries, and innervation is via the vagus and left recurrent...
In Western societies, 15–20% of the adult population has hypertension defined as a blood pressure of more than 160/95 mm Hg. In light of recent evidence, however, hypertension is now generally defined as a blood pressure of more than 140/90 mm Hg, and thus the prevalence is more than 20%. This change in definition mainly reflects the results of large-scale, randomized, placebo-controlled prospective...
Tests are requested in rheumatology: • to assist in making a diagnosis • to help determine the prognosis, aiding appropriate management • to follow the course of disease, response to treatment or side-effects from treatment. Without tests, diagnosis, prognosis, management and monitoring would be considerably more difficult. However, it must be emphasized that tests cannot be interpreted...
Several rheumatological disorders are associated with an increased incidence of malignancy as part of the spectrum of their clinical manifestations. These associations are sometimes relatively specific (e.g. primary Sjögren's syndrome with lymphoma) and surrogate markers of malignancy are often helpful in predicting their development (e.g. paraproteinaemia in rheumatoid arthritis (RA)). Malignancy...
Osteoarthritis is an abnormality of synovial joints characterized by softening, splitting and fragmentation (fibrillation) of articular cartilage not attributable to direct contact with inflammatory tissue. This is usually accompanied by subchondral sclerosis and bone cysts, joint space narrowing and bony outgrowths at the joint margins (osteophytes). Osteoarthritis is the most common chronic joint...
A combined clinical and radiological approach is essential in the diagnosis and management of rheumatological disorders and their complications. There is significant overlap between the radiological features of several rheumatic disorders; therefore, close collaboration is required between clinician and radiologist when selecting the appropriate imaging modality and interpreting the result.
Standardized assessments of general physical function (e.g. walking unaided) and the ability to perform tasks of daily living have been used in rheumatology since the late 1930s. They are often used as measures of disease severity and progression, and increasingly to evaluate the effectiveness of treatment. Their popularity is largely based on the ubiquitous relevance of physical function to most...
Musculoskeletal complaints in children and adolescents are common, occurring in 4–30% of individuals. The differential diagnosis is wide, but in most cases the cause is mechanical (rather than inflammatory) and there are usually no severe long-term sequelae. However, it must be remembered that severe and potentially life-threatening conditions such as malignancy and non-accidental injury can also...
A wide range of diseases may affect the musculoskeletal system, from minor regional soft tissue conditions (e.g. tennis elbow), to life-threatening systemic connective tissue diseases (e.g. systemic lupus erythematosus, SLE). The taking of a rheumatological history must therefore be flexible. Appropriate information must be gathered to make a quick diagnostic hypothesis, and time and understanding...
Author Biography Steve Young Min PhD MRCP is Specialist Registrar in Rheumatology at the Freeman Hospital, Newcastle upon Tyne, UK. Ian D Griffiths FRCP is Consultant Rheumatologist at the Freeman Hospital, Newcastle upon Tyne, UK, and Senior Clinical Lecturer at the University of Newcastle upon Tyne.
Genes and environment are important in all disease. Usually, interactions between the two produce the disease phenotype with varying roles for each factor; pure environmental or genetic diseases are uncommon. Methods are now available to elucidate the genetic basis of the most common and most important disorders in rheumatology, and the ways in which environmental influences (infection, food intake,...
Rheumatoid arthritis (RA) is characterized by infiltration of inflammatory cells into the joint. The synovial membrane becomes highly vascularized and the inflammatory cells release cytokines and growth factors. These agents cause the synovial fibroblasts to proliferate, forming pannus tissue, and synovial cells and chondrocytes to release proteolytic enzymes. Destruction of bone and cartilage then...
Rheumatoid arthritis (RA) causes pain and loss of function as a result of damage to synovial joints. The damage is caused by inflammation that is driven by cell-cell messengers or cytokines such as tumour necrosis factor α (TNFα). Blockade of TNF with new therapeutic agents such as infliximab, etanercept and adalimumab produces considerable clinical benefits for individuals with severe RA. However,...
The locomotor system can be difficult to examine because it involves many different anatomical structures. A full examination is time-consuming and seldom necessary. Most rheumatologists perform a short screening examination followed by a more detailed assessment of the affected structures, with additional examination of other systems if indicated. Variations in examination technique reflect individual...
The musculoskeletal disorders encompass diseases of the locomotor system and, traditionally, multisystem connective tissue disorders. Metabolic bone disease and autoimmune connective tissue diseases are discussed in MEDICINE 29:12 and 30:10 respectively.
‘Gout’ is the term used to describe the constellation of clinical features that result from deposition of microcrystals of monosodium urate monohydrate or uric acid from hyperuricaemic body fluids. These features include acute arthritis, tenosynovitis, bursitis or cellulitis, tophaceous deposits, renal disease and urolithiasis. Prolonged hyperuricaemia is necessary but not sufficient for the development...
Fibromyalgia is a recognizable disorder that can be helped by appropriate management, though more research is required to improve understanding of the causes and to develop new therapeutic agents. Patients deserve a positive and sympathetic approach from clinicians.