Medicine

Medicine RSS feed: Current Issue. Medicine is a continually updated, evidence based review journal covering internal medicine and its subspecialties. Medicine is an authoritative and comprehensive resource that provides all clinicians, irrespective of specialty, with ready access to up-to-date information on mechanisms of disease, diagnosis and management so that patient care may be optimized. The layout of the Journal, including the extensive use of colour and illustration, enables fast assimilation of key information. For ease of reference, Medicine is available in journal format and online. Medicine has an outstanding Editorial Board, plus an eminent group of 35 Chapter editors and over 750 authors, all of whom are recognized experts in their field. The editorial content of the Journal is assured by a rigorous peer review process.

Contents

top

Editorial Board

top

Rheumatology: introduction

It has been estimated that there are over 200 different types of musculoskeletal disorder. Although we cannot cover all of these diverse conditions in this issue of Medicine, a wide range of topics from crystal arthropathies to imaging joints are covered. We are living in a very exciting era for medicine in general and rheumatology in particular. Until recently, the treatments introduced for patients with arthritis were largely ad hoc but are now, by degrees, being replaced by therapies which target individual cells or molecules, because basic research strongly supports the view that they are actually responsible, in part, for the etiopathogenesis of these diseases. Although the best-known examples are the use of the tumour necrosis factor alpha-blockers in the treatment of patients with rheumatoid arthritis, these drugs have also been shown to be helpful in other conditions, including psoriatic arthritis and ankylosing spondylitis. In addition, new approaches are emerging for other diseases, such as the drug febuxostat which is effective in gout. These new drugs are being introduced to supplement and perhaps ultimately replace standard therapies.

top

The burden of musculoskeletal conditions

Abstract: Musculoskeletal conditions (MsC) are a major burden to the individual, society and the health service. Approximately 10% of GP consultations are for MsC. Most new 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 than rheumatoid arthritis (RA). The prevalence of MsC is higher in women and rises with age. It is likely that MsC prevalence will continue to rise as life expectancy increases. Costs for MsC include those to healthcare services, to society and indirect costs. One-fifth of all incapacity claims in Great Britain are for MsC. Combined costs for RA patients amount to £7000 per person affected per year. Major hip procedures cost on average £7800 and major knee procedures on average £4471. Risk factors for MsC include age and gender. The prevalence of certain MsC varies depending on ethnicity, lifestyle factors and genetic predisposition. The main consequences of MsC are chronic pain and disability. The burden of MsC is high and the impact of these conditions on the health service and society will continue to rise alongside increasing life expectancy.

top

The rheumatological history

Abstract: Rheumatological diseases include conditions that affect only limited regions of the locomotor system and also conditions that can have widespread systemic effects. The rheumatological history must reflect both of these aspects. The main symptoms of joint disease are pain, stiffness, swelling and deformity. It is also important to enquire about functional impairment and resultant disability. Systemic diseases can be associated with non-specific symptoms, such as fever, anorexia and weight loss. A careful systems review is important in eliciting specific symptoms.

top

Rheumatological examination

Abstract: 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’.

top

Synovial fluid tests

Abstract: Infection, crystal arthropathies, osteoarthritis, trauma and a variety of systemic diseases can create a painful, swollen peripheral joint of which septic arthritis is the most serious cause. Synovial fluid (SF) analysis is widely used to aid the diagnosis and management of both acute and chronic arthritis, and can be diagnostic in patients with bacterial infections or crystal-induced synovitis. Most native joints can be aspirated by any physician competent to do so, but where there is difficulty, joints can be aspirated under ultrasound guidance. In cases of suspected infected prosthetic joints, these must be referred to the orthopaedic surgeons for aspiration in theatre under strict asepsis. The SF should be sent to the laboratory promptly for microscopy, culture and crystal search using polarized light microscopy. Ordinarily SF is viscous, straw-coloured and essentially acellular, but in diseased states components of the SF can vary in characteristic ways. Although a positive Gram stain and culture can clinch the diagnosis of septic arthritis, the absence of organisms on Gram stain or a negative subsequent synovial fluid culture does not exclude a diagnosis of septic arthritis. A recent systematic review of the literature has shown that, although no investigation had sufficient sensitivity and specificity to confirm the diagnosis of septic arthritis in all cases, the single most useful investigation is synovial fluid microscopy and culture. All doctors in training should gain experience in joint aspiration to save delays in diagnosis.

top

Imaging

Abstract: Plain radiography plays an important role in the differential diagnosis of arthritis. Rheumatoid arthritis is associated with erosion, osteopenia and soft tissue swelling in a diffuse, bilateral symmetrical distribution in the proximal hands and feet. In contrast, seronegative arthritis shows bony proliferation and often involves the axial skeleton. Radiographic features of osteoarthritis are joint space narrowing, subchondral sclerosis, cysts and osteophytes. Newer techniques of magnetic resonance imaging and ultrasound show great promise for the early detection of arthritis and the demonstration of early response to treatment.

top

Crystal arthropathies

Abstract: Crystal arthropathies are a diverse group of disorders characterized by deposition of various minerals in joints and soft tissues leading to inflammation. The patterns of presentation for different types of crystal arthritis are often characteristic enough to differentiate them from each other and from other types of inflammatory arthropathies, but mistakes can be made, leading to delayed or incorrect management. Gout is the most common of all the crystal arthropathies, and its prevalence and clinical complexity appear to be increasing. In addition to gout, which is caused by monosodium urate crystal precipitation, two other main crystal types can be associated with inflammatory symptoms because of their deposition in and around joints. These are calcium pyrophosphate dihydrate, which causes pseudogout, and basic calcium phosphate (BCP/hydroxyapatite). The most accurate way of diagnosing the common forms of crystal-associated arthritis is through the identification of specific crystal types in synovial fluid, although this is less reliable for BCP. Crystal arthritis can cause severe pain, and management generally revolves around the control of acute flares, followed by prevention of recurrent episodes, where possible. For many years the prophylaxis of gout has depended largely on the use of allopurinol, but new drugs such as febuxostat may prove to be useful for those patients who cannot tolerate allopurinol. Biologic treatments are similarly providing exciting novel treatment strategies as the pathophysiology of the disorder becomes better understood.

top

Osteoarthritis

Abstract: Osteoarthritis (OA) is the most common form of joint disease, and its impact is set to grow as the prevalence of obesity rises and our elderly population increases. Many clinicians regard OA as being simply a disease of ‘wear and tear’, and by implication one in which disease modification is not possible. Such prejudices have led to significant academic apathy in this disease, which is reflected not only in our poor understanding of disease pathogenesis but also in the accurate classification of disease, and the development of sensitive tools for diagnosis and prognostic assessment. The recent identification of key degradative enzymes in cartilage, and the use of mouse models to study disease pathogenesis have greatly changed our outlook. The next decade is likely to see significant advances in our understanding of and treatment for this condition.

top

What's new in… Sport and exercise medicine

Sport and exercise medicine is the UK's youngest medical speciality, having been granted speciality status in 2005. For many years sports physicians have provided medical support to elite sportspersons. However, there is now a concerted effort to deliver sports medicine to recreational sportspersons, and to develop the emerging concept of exercise medicine – making health-enhancing physical activity available to the whole nation. People who train seriously and compete in their sport are frequently injured. The most common injuries are to muscle, tendon or bone. In recent years the mechanisms underlying the capacity of musculoskeletal tissues to regenerate from injury have been elucidated. With increased understanding of the pathophysiology of injury, directed therapeutic technologies such as platelet-rich plasma, which utilizes the body's own healing mechanisms, have been developed. It is not just injuries from which people engaging in exercise can suffer. Although the benefits of regular moderate-intensity exercise on morbidity and mortality are uncontestable, people who engage in more intensive exercise can develop difficulties with the respiratory, cardiac and endocrine systems, but these problems can usually be dealt with by a sport and exercise medicine physician. Finally, health-enhancing physical activity by the UK population is being encouraged in order to prevent morbidity from obesity and type 2 diabetes.

top

Self-assessment/CPD

in the UK the incidence (new-onset diagnosis) of osteoarthritis (OA) and rheumatoid arthritis (RA) is approximately the same

top

Health Insurance

Your health insurance policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy.

We are committed to your health more then others. Online-Insurance_advisor can offer you better options. Our plans provide long-term protection and comprehensive medical coverage for you and your family.

We are helping our customers by:

• Organizing access and coverage for medical services, prescription drugs, medical devices and diagnostic testing at the best possible cost
• Designing programs that help people get the right care from the right place at the right time
• Offering wellness programs and support to help people stay healthy and use medical care more wisely
• Simplifying service and administration

Everyone’s different. That's why Online-Insurance-Advisor has a huge range of health cover options – you’ll find the right level of hospital, extras or package cover for you, your partner and family here.

online-insurance-advisor.com

Worlds Best Pharmacy

The name says it all. This is the best online pharmacy on the web. The index page is set to show the most polular ED products, while the menu and quicksearch allow to find products in other categories.

worlds-best-pharmacy.com

Indian Meds

A most recent indian-themed, ethnic site. Includes generic and original (brand) products. al our standard navigational tools and support options are available. This site converts nicely on general pharmaceutical traffic as it has products for vurtually any need.

indianmeds.org

Health Insurance Quote health insurance quote california health insurance quote free health insurance quote health insurance online quote individual health insurance quote health insurance quote texas florida health insurance quote instant online health insurance quote family health insurance quote health care insurance quote instant health insurance quote arizona health insurance quote cheap health insurance quote small business health insurance quote affordable health insurance quote illinois health insurance quote arizona free health insurance quote health and medical insurance quote california health insurance online quote affordable individual health insurance quote private health insurance quote health insurance quote wisconsin california group health insurance quote california individual health insurance quote health insurance quote georgia missouri health insurance quote individual health insurance quote online self employed health insurance quote health insurance ohio quote free health insurance quote texas california life and health insurance quote health and life insurance quote online health insurance quote for child colorado health insurance quote affordable family health insurance quote health insurance life quote health insurance low cost health insurance family health insurance health insurance quote affordable health insurance texas health insurance california health insurance individual health insurance health insurance company florida health insurance short term health insurance health and dental insurance health insurance illinois health insurance houston cheap health insurance health insurance coverage student health insurance health insurance dallas temporary health insurance child health insurance health insurance chicago health insurance lead private health insurance free health insurance arizona health insurance health insurance indianapolis health insurance las vegas health insurance jacksonville health insurance in california health insurance nashville health insurance miami health insurance philadelphia affordable california health insurance health insurance new york long term care health insurance health insurance provider health insurance cincinnati medical health insurance california individual health insurance north carolina health insurance health insurance atlanta health insurance pittsburgh health insurance dayton health insurance greenville health insurance orlando oxford health insurance health insurance new orleans health insurance online health insurance denver michigan health insurance ohio health insurance personal health insurance health insurance indiana free health insurance quote online health individual insurance quote texas california family health insurance quote affordable health insurance quote online florida health insurance instant quote indiana health insurance quote free instant health insurance quote california free health insurance quote student health insurance quote health insurance quote short term michigan health insurance quote minnesota health insurance quote dental health insurance quote health insurance quote virginia best health insurance quote california cheap health insurance quote north carolina health insurance quote california care health insurance quote southern california individual health insurance quote health insurance quote new jersey personal health insurance quote low cost health insurance quote illinois affordable health insurance quote oregon health insurance quote instant health insurance quote california health insurance quote tennessee