Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions,it seems inappropriate to attribute it to stresses related to a person’s normal act...Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions,it seems inappropriate to attribute it to stresses related to a person’s normal activities.Conversely,sudden or unconditioned repetitive stresses appears the more likely culprit.Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy.Clinical evaluation by palpation and mani-pulation may be as effective as application of radiologic techniques.Recognition of the mechanical nature of the disease,including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.展开更多
Non-steroidal anti-inflammatory drugs have a fundamental and pivotal position in management of many of the disorders managed by rheumatologists.Promulgation of a false perspective of their toxicity has compromised our...Non-steroidal anti-inflammatory drugs have a fundamental and pivotal position in management of many of the disorders managed by rheumatologists.Promulgation of a false perspective of their toxicity has compromised our ability to advise our patients and participate in the management of their disorders. The literature sources, from which the false perspective derives, do not accurately reflect safety and fail to address the value of appropriate drug use monitoring.We, as rheumatologists, must stand up and proactively address engrained misconceptions-if we are to be able to continue to provide safe, effective care for our patients.展开更多
Erosive osteoarthritis is a term utilized to describe a specific inflammatory condition of the interphalangeal and first carpal metacarpal joints of the hands. The term has become a part of medical philosophical seman...Erosive osteoarthritis is a term utilized to describe a specific inflammatory condition of the interphalangeal and first carpal metacarpal joints of the hands. The term has become a part of medical philosophical semantics and paradigms, but the issue is actually more complicated. Even the term osteoarthritis(nonerosive) has been controversial, with some suggesting osteoarthrosis to be more appropriate in view of the perspective that it is a non-inflammatory process undeserving of the "itis" suffix. The term "erosion" has also been a source of confusion in osteoarthritis, as it has been used to describe cartilage, not bone lesions. Inflammation in individuals with osteoarthritis actually appears to be related to complicating phenomena, such as calcium pyrophosphate and hydroxyapatite crystal deposition producing arthritis. Erosive osteoarthritis is the contentious term. It is used to describe a specific form of joint damage to specific joints. The damage has been termed erosions and the distribution of the damage is to the interphalangeal joints of the hand and first carpal metacarpal joint. Inflammation is recognized by joint redness and warmth, while X-rays reveal alteration of the articular surfaces, producing a smudged appearance. This ill-defined, joint damage has a crumbling appearance and is quite distinct from the sharply defined erosions of rheumatoid arthritis and spondyloarthropathy. The appearance is identical to those found with calcium pyrophosphate deposition disease, both in character and their unique responsiveness to hydroxychloroquine treatment. Low doses of the latter often resolve symptoms within weeks, in contrast to higher doses and the months required for response in other forms of inflammatory arthritis. Reconsidering erosive osteoarthritis as a form of calcium pyrophosphate deposition disease guides physicians to more effective therapeutic intervention.展开更多
The future of rheumatology is predicated upon a return to basics.The advent and facile availability of laboratory testing led to reduction of emphasis on clinical skills.Recognition that immunologic abnormalities are ...The future of rheumatology is predicated upon a return to basics.The advent and facile availability of laboratory testing led to reduction of emphasis on clinical skills.Recognition that immunologic abnormalities are not limited to individuals who clearly have related pathologyprovides new motivation for reorientation of training programs to assure that graduates have appropriate information gathering,diagnostic and procedural skills.Inadequate accessibility to rheumatologic care requires innovative approaches and especially training and educating those individuals who provide primary care.While the rheumatologist can elicit the patient's history remotely,telerheumatology will be feasible only when the individual interacting physically with the patient has confidence in their examination skills and when those skills have been validated.Named syndromes or diseases will be modified to avoid impugning the individual or compromising their future access to health,disability and life insurance.Interventions will be pursued in a more cost-effective,evidence-based manner.The future of rheumatology is dependent upon the rheumatologist's ability to amortize the inadequate reimbursement for direct patient interaction,depending on skills of interpretation of standard X-rays,ultrasound performance and results.展开更多
文摘Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions,it seems inappropriate to attribute it to stresses related to a person’s normal activities.Conversely,sudden or unconditioned repetitive stresses appears the more likely culprit.Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy.Clinical evaluation by palpation and mani-pulation may be as effective as application of radiologic techniques.Recognition of the mechanical nature of the disease,including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.
文摘Non-steroidal anti-inflammatory drugs have a fundamental and pivotal position in management of many of the disorders managed by rheumatologists.Promulgation of a false perspective of their toxicity has compromised our ability to advise our patients and participate in the management of their disorders. The literature sources, from which the false perspective derives, do not accurately reflect safety and fail to address the value of appropriate drug use monitoring.We, as rheumatologists, must stand up and proactively address engrained misconceptions-if we are to be able to continue to provide safe, effective care for our patients.
文摘Erosive osteoarthritis is a term utilized to describe a specific inflammatory condition of the interphalangeal and first carpal metacarpal joints of the hands. The term has become a part of medical philosophical semantics and paradigms, but the issue is actually more complicated. Even the term osteoarthritis(nonerosive) has been controversial, with some suggesting osteoarthrosis to be more appropriate in view of the perspective that it is a non-inflammatory process undeserving of the "itis" suffix. The term "erosion" has also been a source of confusion in osteoarthritis, as it has been used to describe cartilage, not bone lesions. Inflammation in individuals with osteoarthritis actually appears to be related to complicating phenomena, such as calcium pyrophosphate and hydroxyapatite crystal deposition producing arthritis. Erosive osteoarthritis is the contentious term. It is used to describe a specific form of joint damage to specific joints. The damage has been termed erosions and the distribution of the damage is to the interphalangeal joints of the hand and first carpal metacarpal joint. Inflammation is recognized by joint redness and warmth, while X-rays reveal alteration of the articular surfaces, producing a smudged appearance. This ill-defined, joint damage has a crumbling appearance and is quite distinct from the sharply defined erosions of rheumatoid arthritis and spondyloarthropathy. The appearance is identical to those found with calcium pyrophosphate deposition disease, both in character and their unique responsiveness to hydroxychloroquine treatment. Low doses of the latter often resolve symptoms within weeks, in contrast to higher doses and the months required for response in other forms of inflammatory arthritis. Reconsidering erosive osteoarthritis as a form of calcium pyrophosphate deposition disease guides physicians to more effective therapeutic intervention.
文摘The future of rheumatology is predicated upon a return to basics.The advent and facile availability of laboratory testing led to reduction of emphasis on clinical skills.Recognition that immunologic abnormalities are not limited to individuals who clearly have related pathologyprovides new motivation for reorientation of training programs to assure that graduates have appropriate information gathering,diagnostic and procedural skills.Inadequate accessibility to rheumatologic care requires innovative approaches and especially training and educating those individuals who provide primary care.While the rheumatologist can elicit the patient's history remotely,telerheumatology will be feasible only when the individual interacting physically with the patient has confidence in their examination skills and when those skills have been validated.Named syndromes or diseases will be modified to avoid impugning the individual or compromising their future access to health,disability and life insurance.Interventions will be pursued in a more cost-effective,evidence-based manner.The future of rheumatology is dependent upon the rheumatologist's ability to amortize the inadequate reimbursement for direct patient interaction,depending on skills of interpretation of standard X-rays,ultrasound performance and results.
