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Brown S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2010

This article discusses the role of the nurse specialist in the management of patients with systemic sclerosis, focusing on helping patients to deal with the physical, psychological and social effects associated with digital ulcers.


Tansley S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust | Gunawardena H.,Clinical and Academic Rheumatology
Clinical Reviews in Allergy and Immunology | Year: 2014

The idiopathic inflammatory myopathies: polymyositis (PM) and dermatomyositis (DM) have been historically defined by broad clinical and pathological criteria. These conditions affect both adults and children with clinical features including muscle weakness, skin disease and internal organ involvement. Over the last few years, it has become increasingly apparent that using a clinico-serological approach, both DM and PM can be defined into more homogeneous subsets. A large number of antibodies are directed against cytoplasmic or nuclear components involved in key regulatory intra-cellular processes including protein synthesis, translocation and gene transcription within this disease spectrum. In addition, these autoantibodies are found in patients with clinical features other than myositis, in particular ‘idiopathic’ interstitial pneumonia emphasizing that these patients may in fact be a formes-frustes of autoimmune connective tissue disease. Other important findings are the identification of specific autoantibodies in both cancer-associated dermatomyositis, clinically amyopathic dermatomyositis and juvenile dermatomyositis, which previously were classically described as antibody-negative clinical subsets. Finally, work has highlighted how target autoantigens identified in the myositis-connective tissue disease overlap share common cellular mechanisms, which provides us with further insights into disease pathogenesis. © 2013, Springer Science+Business Media New York.


Brown S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2012

This article describes the characteristics of Raynaud's phenomenon, focusing on the role of the specialist nurse in diagnosis and management of the condition. Pharmacological and non-pharmacological treatment options are discussed, along with the importance of self-management. Advice is provided to help nurses enable patients to minimise episodes and improve symptoms. In the majority of cases, Raynaud's phenomenon is a treatable condition, and patients can learn to self-manage the disease.


Brown S.,Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
Lupus | Year: 2013

This paper considers the experiences of people with lupus in comparison with those with diabetes, and discusses the impact of lupus specialist nurses in information-giving and education under the guise of 'just in case' vs. 'just in time'. Now recognized as a difficult condition to diagnose, lupus can lead to significant worry and distress especially during delays to diagnosis and times of high disease activity. Providing appropriate, individualized information to people with lupus is embedded in specialist nursing practice and enables individuals to use the tools of self-management approaches in gaining control over everyday symptoms.


Jones G.T.,University of Aberdeen | Mertens K.,University of Aberdeen | Macfarlane G.J.,University of Aberdeen | Palmer K.T.,University of Southampton | And 8 more authors.
BMC Musculoskeletal Disorders | Year: 2014

Background: Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period. Methods/Design. Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis. Discussion. Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms. Trial registration. Registered on (reference number: ISRCTN79085082). © 2014 Jones et al.; licensee BioMed Central Ltd.

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