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Bond D.,Royal National Hospital for Rheumatic Diseases
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2013

This article provides an overview of ankylosing spondylitis, including signs and symptoms, diagnosis and management. The article focuses on the difficulties and delays associated with diagnosing this chronic inflammatory disease and developments in diagnostic criteria. Changes in the management of patients with the disease are also discussed, particularly in light of anti-tumour necrosis factor therapy. Source


Bhalla A.K.,Royal National Hospital for Rheumatic Diseases
Best Practice and Research: Clinical Rheumatology | Year: 2010

There is no agreed definition of osteoporosis in pre-menopausal women. The International Society for Clinical Densitometry recommends using Z-score, and women with Z-scores of -2.0 or lower should be defined as having a bone density that is 'below the expected range for age'. The diagnosis is more readily made in the presence of a low-trauma fracture. The relationship between low bone mineral density (BMD) in young pre-menopausal women and its associated fracture risk is not the same as in older women with a low BMD. Between 50% and 90% of pre-menopausal women will have an underlying secondary cause, the most common being eating disorders, anorexia nervosa and use of glucocorticoids. Management should focus on identifying the underlying cause and treating it where possible. The use of pharmacological therapy under other circumstances should be considered carefully. Women with only low BMD and no other risk factors probably require no pharmacological intervention. Those with low BMD and secondary causes or with a severely low BMD, or those who have fragility fractures, may require treatment with anti-resorptive agents, which can include oestrogen, bisphosphonates, calcitonin, calcitriol or anabolic therapy with teriparatide. Selective oestrogen receptor modulators (SERMs) should be avoided as they cause further bone loss in menstruating women. Alendronate and risedronate have been licensed for use in glucocorticoid-induced osteoporosis. These drugs accumulate in the human skeleton and have been shown to cross the placenta and accumulate in newborn rats. The effects on human pregnancy are unclear, although normal pregnancies have been reported. Pre-menopausal women with osteoporosis should be followed up until the BMD is stable, which can usually be ascertained by follow-up scans at 18-36-month intervals. © 2010 Elsevier Ltd. All rights reserved. Source


Rachapalli S.,Royal National Hospital for Rheumatic Diseases
Clinical Rheumatology | Year: 2011

Despite the advent of magnetic resonance imaging and musculoskeletal ultrasound, the plain radiographs of the hands and feet remain an important tool for a practising rheumatologist both in clinical and research settings. This review focuses on providing a historical overview of commonly used methods of scoring radiographs in rheumatoid arthritis and discusses technical issues related to radiographic scoring, limitations and advantages of radiographs, and current recommendations regarding reporting radiographic data in clinical trials. © Clinical Rheumatology 2010. Source


Tansley S.L.,Royal National Hospital for Rheumatic Diseases | McHugh N.J.,Royal National Hospital for Rheumatic Diseases | Wedderburn L.R.,University College London
Arthritis Research and Therapy | Year: 2013

Adult and juvenile dermatomyositis share the hallmark features of pathognomic skin rash and muscle inflammation, but are heterogeneous disorders with a range of additional disease features and complications. The frequency of important clinical features such as calcinosis, interstitial lung disease and malignancy varies markedly between adult and juvenile disease. These differences may reflect different disease triggers between children and adults, but whilst various viral and other environmental triggers have been implicated, results are so far conflicting. Myositis-specific autoantibodies can be detected in both adults and children with idiopathic inflammatory myopathies. They are associated with specific disease phenotypes and complications, and divide patients into clinically homogenous subgroups. Interestingly, whilst the same autoantibodies are found in both adults and children, the disease features remain different within autoantibody subgroups, particularly with regard to life-threatening disease associations, such as malignancy and rapidly progressive interstitial lung disease. Our understanding of the mechanisms that underlie these differences is limited by a lack of studies directly comparing adults and children. Dermatomyositis is an autoimmune disease, which is believed to develop as a result of an environmental trigger in a genetically predisposed individual. Age-specific host immune responses and muscle physiology may be additional complicating factors that have significant impact on disease presentation. Further study into this area may produce new insights into disease pathogenesis. © 2013 BioMed Central Ltd. Source


Tansley S.L.,Royal National Hospital for Rheumatic Diseases | Betteridge Z.E.,University of Bath | McHugh N.J.,Royal National Hospital for Rheumatic Diseases
Current Opinion in Rheumatology | Year: 2013

PURPOSE OF REVIEW: The purpose of this study is to review recent advances in the diagnostic utility of autoantibodies in dermatomyositis. RECENT FINDINGS: Alternative nonspecialist testing methods have been developed for anti-transcription intermediary factor 1 gamma, anti-MDA5 and anti-nuclear matrix protein 2, which are potentially exploitable by any hospital laboratory. Although these have yet to be validated for diagnostic use, it is likely that testing for myositis-specific antibodies will soon become readily available. SUMMARY: The identification of myositis-specific autoantibodies provides both diagnostic and prognostic information and offers a unique opportunity to adopt a stratified approach to treatment. Their identification, in many cases, should prevent the need for invasive diagnostic tests such as muscle biopsy. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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