Shared care for rheumatology by Mharie Brandon

By Mharie Brandon

This publication specializes in the administration of a number of the rheumatic stipulations with an emphasis at the 'shared care' method, which promotes the winning collaboration among fundamental and secondary care providers.

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G. 5) Osteoarthritis is usually a slowly developing chronic disease although there may be spells of more rapid progression before the joint settles and becomes stable again. In some cases, however, progression can be rapid and patients can develop painful destructive changes over a relatively short space of time. This is sometimes seen in hip osteoarthritis, where patients can become severely disabled by pain and immobility over a short space of time. Joints can often show clinical, and occasionally radiographic, improvement.

They may have a long-term disease modifying effect, seem to be safe and appear to help osteoarthritic pain in some patients. They are not available on prescription in the United Kingdom but may be bought from health food shops. Chondroitin has a bovine origin, however, and this may be a cause for concern. ■ Joint replacement—in severe OA, where the condition has a significant impact on a patient’s life, joint replacement can provide major benefits in terms of pain relief and improved mobility. REFERRAL Most patients with mild to moderate OA will be managed within primary care provided there is access to physiotherapy and occupational therapy Consider referral in the following circumstances: ■ Doubt about the diagnosis.

20). Obliterative bronchiolitis can present with obstructive symptoms, but this is rare. 20 CT scan of lung fibrosis CARDIAC INVOLVEMENT Aseptic pericarditis occurs in about 33% of rheumatoid arthritis patients but is usually asymptomatic. Rheumatoid nodules can be found in cardiac tissue where, if it involves the conduction system, it can produce heart block. HAEMATOLOGICAL MANIFESTATIONS The commonest haematological feature is anaemia. While the normochromic normocytic anaemia associated with active phases of rheumatoid arthritis is common, chronic iron deficiency because of blood loss through the gastrointestinal tract is often a complication.

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