In matory Arthritis in Clinical Practice
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In mmatory Arthritis
David L. Scott and Gabrielle H. Kingsley
in Clinical Practice
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David L. Scott Gabrielle H. Kingsley Department of Rheumatology Department of Rheumatology King,s College School of Medicine University Hospital Lewisham
London London
UK UK
Library of Congress Control Number: 2007934834
ISBN: 978-1-84628-932-3 e-ISBN: 978-1-84628-933-0
Springer-Verlag London Limited 2008c
Previously published in 2006 by Current Medicine Group Ltd. asInflammatory Arthritis (ISBN 978-1-85873-852-9)
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British Library Cataloguing in Publication Data Scott, David L.
Inflammatory arthritis in clinical practice 1. Arthritis - Chemotherapy 2. Arthritis I. Title II. Kingsley, Gabrielle III. Pugh, Non IV. Scott, David L., 1951-. Inflammatory medicine 616.7'22061
Contents
Author biographies vii
Abbreviations ix
1. Rheumatoid arthritis 1
Introduction 1 Diagnosis 2 Epidemiology 3 Pathogenesis 5 Joint swelling and tenderness 7
Natural history 12
Extra-articular disease 12
Infection and malignancy 15
Clinical assessment 15
Laboratory assessments 19
Radiological assessments 21
Outcome measures 23
Outcomes of rheumatoid arthritis 25
Predicting outcomes 29
Costs of rheumatoid arthritis 31
2. Spondyloarthropathies 32
Introduction 32 Epidemiology 33
Pathogenic mechanisms 33
Clinical features 36
Laboratory investigations 36 Imaging 38
Ankylosing spondylitis 40
Psoriatic arthritis 43
Reactive arthritis 43
Enteropathic arthritis 46
Undifferentiated spondyloarthropathies 46
3. Symptomatic drug treatment 48
Pain and other symptoms 48
Historical perspective 48
Simple analgesics 50
Compound analgesics 53
Non-steroidal anti-inflammatory drugs 53
Cyclooxygenase-2 drugs 58
4. Disease-modifying antirheumatic drugs 65 Background 65
Historical perspective 65
v
Treatment targets 66 Currently used conventional disease-modifying
antirheumatic drugs 67
Methotrexate 68 Leflunomide 74
Injectable gold 77
Other disease-modifying antirheumatic drugs 79 Combining disease-modifying antirheumatic drugs 81 Current best practice with disease-modifying
antirheumatic drugs 83
Conclusions 84
5. Biologics in rheumatoid arthritis 86 Introduction 86
Historical perspective 86
Tumour necrosis factor alpha 87 Interleukin-1-blocking agents 94
Novel biologic agents 95
Economic considerations 96
6. Systemic and local steroids 97
Introduction 97 Pharmacology and mechanism of action 97
Beneficial effects 97
Systemic steroids 98
Local steroids 101
7. Non-pharmacological therapy 103
Multidisciplinary approach 103 Communication 104 Therapies 104
Patient education 105
Rest 105
Physical therapy 105
Occupational therapy 107
Podiatry 108
Dietary intervention 108
Complementary therapies 110
Orthopaedic surgery 110
Index 113
vi Inflammatory Arthritis in Clinical Practice
Author biographies
vii He is Professor of Clinical Rheumatology at Kings College London and consultant rheumatologist at Kings College Hospital in London. After studying medicine in Leeds and clinical rheumatology training in Leeds and Birmingham, he completed an MD in Rheumatology at Birmingham University. He was a consultant rheumatologist at Homerton and
She is Reader in Rheumatology at Kings College London and consultant rheumatologist at Lewisham Hospital in London. After studying medicine in Bristol and clinical rheumatology training at Guy’s Hospital, she moved to an academic post at Guy’s and Lewisham Hospitals, where she completed a PhD in Rheumatology.
St Bartholomew’s Hospitals before moving to Kings College.
Professor David L. Scott
Dr. Gabrielle H. Kingsley
Abbreviations
ACR American College of Rheumatology
BASDAI Bath Ankylosing Spondylitis Disease Activity Index BASFI Bath Ankylosing Spondylitis Functional Index CLASS Celecoxib Long-term Arthritis Safety Study COX cyclooxygenase
CRP C-reactive protein CT computed tomography DAS Disease Activity Score
DEXA dual-energy X-ray absorptiometry DISH diffuse idiopathic skeletal hyperostosis DMARD disease-modifying anti-rheumatic drug ELISA enzyme-linked immunosorbent assays ESR erythrocyte sedimentation rate FBC full blood count
HAQ Health Assessment Questionnaire HIV human immunodeficiency virus HLA human leucocyte antigen ICAM intercellular adhesion molecule
IgA immunoglobulin A
IgG immunoglobulin G
IL-1 interleukin-1
MHC major histocompatibility complex MRI magnetic resonance imaging NSAIDs non-steroidal anti-inflammatory drugs OSRA Overall Status in RA
PEG polyethylene glycol PCR polymerase chain reaction RA rheumatoid arthritis SAA serum amyloid A
SMR standardized mortality ratio SpA spondyloarthropathies
TENS transcutaneous electrical nerve stimulation TNF-␣ tumour necrosis factor alpha
VAS visual analogue scale
ix
