Evaluation of the primary/secondary care interface in relation to a primary care rheumatology service

Objective The rheumatology department at The Royal Oldham Hospital developed a primary care service aimed at bridging the gap between primary and secondary care for patients with potential rheumatological conditions, and this was given the name rheumatology Tier 2. The objective of this study was to evaluate this primary care rheumatology service (Tier 2)in order to assess its validity, patient satisfaction and effectiveness. Design Ten patients participated in individual semi-structured interviews. Three GPs were interviewed individually, and two GPs formed a focus group. Thematic analysis was used to interpret the findings. Setting Patients were recruited from seven consecutive rheumatology Tier 2 clinics. GPs were recruited from Oldham Primary Care Trust (PCT) as this was the main source of patient referrals for the service. Results The key findings were in relation to the integration of primary healthcare and hospital services, i.e. the primary/secondary care interface. This highlighted the importance of early assessment, diagnosis and treatment of patients with suspected inflammatory arthritis. Conclusion Early diagnosis and treatment with disease-modifying anti-rheumatic drugs improves patients’ outcomes. The rheumatology Tier 2 service built on this evidence and provided a rapid assessment and referral to secondary care for those patients with suspected inflammatory arthritis

Recent advances: rheumatology

No abstract available

The Scope and Scale of Clinical Research Accomplished by Rheumatologists Early in Their Careers

[Excerpt] The scope and scale of clinical research is unknown for any medical or surgical specialty beyond snap shots of the broad aims and expenditures of research programs sponsored by federal agencies or the pharmaceutical industry. As a consequence, the workforce and workplace for clinical investigation is enigmatic and unexamined even after explicit warnings that an essential arm for advancing clinical practice is disabled. The present study was designed to examine the nature and extent of investigative activity prevailing among rheumatologists early in their careers. This assessment provides a lens on: i) the fraction of early career rheumatologists who engage in investigative rheumatology, ii) the scope and scale of research in musculoskeletal diseases, iii) funding available for investigative work, iv) the impact of research-intensive institutions, and NIH-K-series awards on research, and v) the demographic backgrounds of early career rheumatologists. The results provide important new insights about the early career workforce for discovery and innovation in rheumatology. The findings integrate demographic, normative, and predictive data to provide the first estimate of the scope and scale of clinical investigation within rheumatology. The results also justify interventions for promoting investigative work, and ultimately advancing the clinical practice of rheumatology

Recent advances: rheumatology

No abstract available

Predictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis:Results from the Norfolk Arthritis Register

Objectives: Early remission is the current treatment strategy for patients with inflammatory polyarthritis (IP) and RA. Our objective was to identify baseline factors associated with achieving remission: sustained (SR), intermittent (IR) or never (NR) over a 5-year period in patients with early IP.  Methods: Clinical and demographic data of patients with IP recruited to the Norfolk Arthritis Register (NOAR) were obtained at baseline and years 1, 2, 3 and 5. Remission was defined as no tender or swollen joints (out of 51). Patients were classified as NR or PR, respectively, if they were in remission at: no assessment or ⩾3 consecutive assessments after baseline, and IR otherwise. Ordinal regression and a random effects model, respectively, were used to examine the association between baseline factors, remission group and HAQ scores over time.  Results: A total of 868 patients (66% female) were included. Of these, 54%, 34% and 12% achieved NR, IR and SR, respectively. In multivariate analysis, female sex (odds ratio, OR 0.47, 95% CI: 0.35, 0.63), higher tender joint count (OR = 0.94, 95% CI: 0.93, 0.96), higher HAQ (OR = 0.59, 95% CI: 0.48, 0.74), being obese (OR = 0.70, 95% CI: 0.50, 0.99), hypertensive (OR = 0.67, 95% CI: 0.50, 0.90) or depressed (OR = 0.74, 95% CI: 0.55, 1.00) at baseline were independent predictors of being in a lower remission group. IR and SR were associated with lower HAQ scores over time and lower DAS28 at year 5.  Conclusion: Women with higher tender joint count and disability at baseline, depression, obesity and hypertension were less likely to achieve remission. This information could help when stratifying patients for more aggressive therapy

Confidence amongst multidisciplinary professionals in managing paediatric rheumatic disease in Australia

Objective. Interprofessional collaboration is a crucial component of care for children with rheumatic disease. Interprofessional care, when delivered appropriately, prevents disability and improves long-term prognosis in this vulnerable group. Methods. The aim of this survey was to explore allied health professionals’ and nurses’ confidence in treating paediatric rheumatology patients. Results. Overall, 117 participants were recruited, 77.9% of participants reported being “not confident at all,” “not confident,” or “neutral” in treating children with rheumatic diseases (RD) despite 65.1% of participants reporting having treated >1 paediatric rheumatology case in the past month. Furthermore, 67.2% of participants felt their undergraduate education in paediatric rheumatology was inadequate. “Journals” or “texts books” were used by 49.3% of participants as their primary source of continuing professional development (CPD) and 39.3% of participants indicated that they did not undertake any CPD related to paediatric rheumatology. Small group and online education were perceived to be potentially of “great benefit” for CPD. Conclusion. This paper highlights allied health professionals’ and nurses’ perceived inadequacy of their undergraduate education in paediatric RD and their low confidence in recognising and treating RD. Undergraduate and postgraduate education opportunities focusing on interprofessional collaboration should be developed to address this workforce deficiency

The prevalence of fibromyalgia in the general population : A comparison of the American College of Rheumatology 1990, 2010 and modified 2010 classification criteria

Copyright © 2014 American College of Rheumatology. Funded by University of Aberdeen Development TrustPeer reviewedPostprin

Navigating Unchartered Waters with USSONAR to Build an Integrative MSKUS Curriculum for MCV Rheumatology Fellowship Program

Musculoskeletal ultrasound (MSKUS) is an increasingly popular tool for the rheumatologist and less than 50% of rheumatology fellowship programs in the United States have a defined formal curriculum. The objectives here are to develop a formal and novel MSKUS curriculum for MCV Rheumatology program using an evidence-based 8-step model for our curriculum development. Results of Stage 1, situational analysis, showed unanimous need for dedicated need for MSKUS curriculum. While still early in this project, we hope to complete the remainder of the Stages by the end of 2017

Novel rheumatoid arthritis susceptibility locus at 22q12 identified in an extended UK genome-wide association study

© 2014 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.Peer reviewedPublisher PD

Patients Prescribed Anakinra for Acute Gout Have Baseline Increased Burden of Hyperuricemia, Tophi, and Comorbidities, and Ultimate All-Cause Mortality.

Objective:The interleukin-1 (IL-1) receptor antagonist anakinra is an effective, off-label option in acute gout flares, when conventional therapy options are narrowed. We performed a retrospective, randomized, case-controlled study to gain clinical insight on baseline factors for gout patients most likely to receive anakinra, and ultimate mortality of those who received anakinra. Methods:Of 1451 gout patients seen between January 2003 and January 2015 in a Veterans Affairs (VA) rheumatology group practice, under stringent managed care principles, 13 (100% male), who received anakinra at least once for flares, were compared with 1:4 age- and sex-matched gout controls. Each patient's first rheumatology encounter was studied by factor analysis for variables associated with later anakinra. Results:At baseline, patients that received anakinra had higher urate burden (palpable tophi [10/13] vs controls [16/52], P = .003), serum urate ([10.6 mg/dL] vs controls [7.6 mg/dL], P < .0001), and East Asian descent ([7/13] vs [16/52], P = .041). The anakinra group had higher ultimate all-cause mortality ([6/13] vs controls [7/52], relative risk [RR] = 3.43, 95% confidence interval [CI] = 1.39-8.48, P = .0076). Factor analysis showed baseline visit palpable tophus and statin use to be most strongly associated with later anakinra use. Increased mortality of anakinra users, as per a factorial analysis, was linked more strongly to comorbidities than to anakinra. Conclusions:At baseline rheumatology gout encounter, higher urate, palpable tophi, statin prescription, and East Asian descent were associated with later anakinra use for flares. Mortality was more closely associated to the presence of comorbidities at baseline rheumatology visit than to anakinra prescription