Gouty arthritis: An approach for general practice

Gout is a common crystal-induced inflammatory arthritis, the prevalence and clinical complexity of which is increasing in the face of a growing aged population with multiple co-morbidities. Recent epidemiological studies emphasise that lifestyle factors strongly influence the development of hyperuricaemia and gout. Moreover, there is growing evidence that gout isan independent risk factor for cardiovascular disease. Acute attacks of gout are extremely painful and disabling, and if repeated attacks go untreated, chronic deforming arthritis ensues. Early diagnosis and appropriate therapy is essential to reduce long-term disability. Identification of monosodium urate crystals on synovial fluid analysis is the gold standard in gout diagnosis. Nonsteroidal anti-inflammatory drugs and oral or intra-articular corticosteroids remain central to the treatment of acute attacks.  Prophylactic colchicine use, during the intercritical period, reduces gout flares, a common complication on initiation of urate-lowering therapy (ULT). Allopurinol is the treatment of choice when ULT is indicated. Gout management is suboptimal in many patients because of non-adherence to treatment and underutilisation of available treatments. Treating totarget: a serum uric acid level < 0.35mmol/l, prevents crystal deposition in joints and soft tissues, thereby preventing acute attacks and ongoing inflammation, as well as decreasing the size and number of tophi. Treatment strategies should include attention to cardiovascular risk. The family practitioner is paramount to gout management which should be individualised. Emphasis should be placed on ongoing education and prevention

Current approach to diagnosis and management of osteoarthritis

Osteoarthritis (OA) is a common chronic degenerative joint disorder and a major cause of pain and disability, especially in the elderly. The prevalence is steadily rising due to an increase in life expectancy and certain lifestyle factors. OA is a complex dynamic process involving all tissues of the joint organ. Multiple risk factors are associated with the occurrence and progression of OA. There is extreme variability in presentation at different joint sites and between individuals. Management of OA involves a comprehensive approach consisting of preventative measures and numerous therapeutic modalities which should be tailored to individual needs. The family practitioner plays a vital role in the diagnosis of OA, the initiation of treatment and the ongoing monitoring of the condition

Social aspects of living with rheumatoid arthritis: a qualitative descriptive study in Soweto, South Africa – a low resource context

<p>Abstract</p> <p>Background</p> <p>Rheumatoid Arthritis (RA) is a chronic illness with important functional, social and employment consequences. We therefore undertook a cross-sectional study, using the International Classification of Functioning, Disability and Health framework, to investigate the personal and social consequences of RA in women, living under largely impoverished conditions.</p> <p>Methods</p> <p>A qualitative case study design was used with a convenience sample of 60 women with RA living in Soweto, South Africa. Semi-structured in-depth interviews were conducted to cover a range of experiences including onset of disease, treatment, environmental barriers and facilitators, employment, and social inclusion in family and community life. The outcomes are described according the International Classification of Functioning, Health and Disability framework at the body, person and societal levels and looking at both personal and environmental factors.</p> <p>Results</p> <p>The main features of living with RA were pain, muscle stiffness at the body level, difficulties in doing various activities such as mobility, washing, dressing, domestic activities, using transport and obtaining and maintaining employment at the person level. At the societal level the participants described difficulties moving around, interacting socially and taking part in community activities, fulfilling social roles and earning a living. Environmental facilitators such as assistive devices and health care services improved functioning. Barriers such as physical environments, lack of transport and basic services, such as electricity, and attitudes of others lead to social exclusion, loss of a sense of self and independence. Low income, lack of sufficient public transport, and sparse basic services were poverty features that exacerbated negative experiences.</p> <p>Conclusion</p> <p>The experiences of living with RA in a low resource context are similar to those in mid- and high resource contexts, but are exacerbated by poverty and the lack of basic services. Pain and social exclusion are some of the key experiences of women with RA living in Soweto. The ICF provides a useful framework for describing and understanding the complexity of these experiences.</p