Qualified, late specialism training

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting mainly the sacroiliac joints and spine, resulting in pain, stiffness, and reduced movement. Over the past decade there have been major advances in many aspects of the disease, including a broadening of the disease description to axial spondyloarthritis (axSpA). While the many advances have transformed the lives of patients with axSpA, they have also increased complexity for non-specialists in this area. This handbook contains a timely update of the key developments and current state of play in axSpA. It is intended primarily for the many healthcare professionals who encounter patients with this condition, in both primary and secondary care settings. It will also be of interest to the wider medical and research community.The handbook is written by rheumatologists with active research programmes and clinical expertise in these conditions. The topics covered include:

• the clinical features

• extra-articular manifestations and complications

• the impact on patients’ lives

• the major advances in genetics and pathogenesis

• imaging advances

• classification criteria and diagnosis (and the important differences between these)

• treatment advances (particularly TNF inhibitors and upcoming biologics)

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Fibromyalgia syndrome is a common condition afflicting 2–5% of the population. It is commoner in females than males. The dominant symptom is chronic widespread pain. However, fatigue, sleep disturbance, depression, anxiety, stiffness, and cognitive dysfunction are also common. The American College of Rheumatology in 1990, 2010, and 2011 published classification and diagnostic criteria for fibromyalgia syndrome. Although they were primarily designed for research, these criteria have been commonly used in routine clinical practice. One of the characteristic clinical findings in fibromyalgia syndrome is ‘tenderness’ on mild pressure/palpation. This is a manifestation of allodynia—pain caused by subnoxious stimuli. The major pathophysiology that underpins allodynia is central sensitization, in which alterations in the nociceptive system within the central nervous system cause pain to be amplified. Research with modern neuroimaging techniques, such as functional magnetic resonance scan, showed that pain is ‘real’ in patients with fibromyalgia syndrome. Many national and international societies recognizing the healthcare burden of fibromyalgia syndrome have published recommendations/guidelines on diagnosis and management. They emphasized the importance of a positive diagnosis and management strategy to empower patients to cope with fibromyalgia syndrome. Importantly, treatment of fibromyalgia syndrome should be tailored to the individual patient, addressing their particular needs and additional symptoms other than pain. In most patients, it involves a combination of education, and non-pharmacological and pharmacological treatments. Although these treatments are not curative, they improve symptoms and quality of life that benefit not only patients, but also healthcare providers and society.Less

It is the most common form of inflammatory arthritis in adults, and leads to recurrent flares of severe joint damage and musculoskeletal disability. Although treatment targets are well defined, gout management is currently poor, with low levels of treatment targets achieved. The last decade has seen major advances in the understanding and treatment of gout. This handbook summarizes key scientific advances, including new insights into mechanisms of hyperuricaemia, acute gouty arthritis, and joint damage. Principles of gout diagnosis and management are discussed in detail, with practical information about use of well-established agents and also newer therapies. Gout-specific research tools are outlined to assist clinicians with interpretation of the latest scientific literature in gout. Future strategies for improved gout management are also discussed.Less

Myositis, or the idiopathic inflammatory myopathies (IMM) are a group of rare autoimmune diseases of considerable health significance. Features include muscle weakness, raised skeletal muscle enzymes, and characteristic histopathological changes. IIM can be split into polymyositis (PM), dermatomyositis (DM), and inclusion body myositis (IBM). If diagnosed promptly PM and DM can be treated with immunosuppression, but IBM currently cannot be treated. Summarizing the current understanding of the epidemiology, genetic and environmental risk factors, and clinical features, this handbook gives practical strategies for laboratory investigations and treatment paradigms. Future strategies and ongoing trials are also discussed.Less

Based around the core curriculum for specialist trainees, Oxford Case Histories in Rheumatology contains over 40 well-structured, peer-reviewed cases from the Oxford Hospitals, giving detailed coverage of the specialty, including diagnostic and management dilemmasLess

This new rheumatology resource is aimed primarily at a specialist readership offering easily accessible current evidence based information on the management of rheumatological conditions. The content on management is based on the latest guidelines from the British Society for Rheumatology, the European League against Rheumatism, and the American College of Rheumatology.Less

The Oxford Handbook of Rheumatology, 4th edition, has been expanded and improved to incorporate paediatric and adolescent rheumatology. The format of the book is retained. The first four chapters offer a pragmatic guide to evaluating rheumatic and musculoskeletal diseases, showing how a differential diagnosis can be formed on the basis of symptoms, examination, and investigation findings, both for regional musculoskeletal and systemic generalized conditions. Part II comprises chapters on all the major rheumatic and bone diseases and autoimmune connective tissue diseases, such as rheumatoid arthritis, osteoarthritis, spondyloarthritis, systemic lupus erythematosus (lupus), crystal-induced musculoskeletal disease, juvenile idiopathic arthritis, antiphospholipid syndrome, Sjögren’s syndrome, osteoporosis, vasculitis, spinal disorders and back pain, and chronic pain syndromes, as well as new chapters on rare diseases and hereditary disorders. Part II includes chapters on drugs used in rheumatology practice, glucocorticoid injection therapy, and rheumatological emergencies. All chapters are updated to include details on paediatric and adolescent rheumatology, dealt with fairly cursorily in previous Handbook editions. Greatly expanded chapters are included on drugs used in rheumatology, pain syndromes, and the presentation of paediatric and adolescent disease.Less

Axial spondyloarthritis is a relatively new term, now becoming widely accepted in clinical practice, referring to inflammatory disease predominantly of the spine where the main symptom is back pain. The most common subset of AxSpA is ankylosing spondylitis. This is a rapidly evolving field with new diagnostic criteria and treatments, which are likely to evolve further. This book covers the significant recent advances in the epidemiology, genetics, pathogenesis, classification, and treatment of this disabling disease, from a truly global perspective.Less

The Oxford Textbook of Clinical and Biomedical Disorders of the Skeleton provides an up-to-date account of the ‘classic’ and ‘new’ metabolic disorders of the skeleton, and deals with their causes, clinical aspects, and treatment. Bone biology and investigation precede chapters on osteoporosis, osteomalacia and rickets, parathyroid bone disease, Paget disease, and the effects of malignancy on the skeleton. The ‘new’ metabolic bone disorders follow, with chapters on osteogenesis imperfecta, skeletal dysplasias, osteopetrosis, and osteosclerosis, Marfan syndrome, Ehlers–Danlos syndrome, enzyme defects and the skeleton, fibrous dysplasia, fibrogenesis imperfecta ossium, and ectopic mineralization. In all the latest known molecular causes are discussed and personal experiences of the disorders are described.Less

The Oxford Textbook of Osteoarthritis and Crystal Arthropathy provides full coverage of joint failure, and includes detailed sections on epidemiology, risk factors, clinical assessment, and investigations. There are also new in-depth sections on gout and other crystal arthropathies. Clinically relevant and easily understandable overviews of basic science, including pathology and pain physiology, along with critical appraisal of current guidelines, make this a highly valuable resource. Significant coverage is also given to patient education and the involvement of the patient in management planning.Less

This thoroughly revised fourth edition of the Oxford Textbook of Rheumatology reflects the changing face of the specialty and the many recent advances in the science, treatment, and understanding of rheumatic diseases. This resource investigates the presentation and management of rheumatic conditions at all ages. Where relevant, treatment approaches are evidence-based and cross-referenced to national and international guidelines. Each clinical chapter provides up-to-date treatment advice illustrated with clinical vignettes as appropriate, and the authors consistently emphasize the overlap of rheumatology with other disciplines.Less

The third edition of this definitive and highly-regarded reference resource provides a comprehensive review of vasculitis, a fascinating array of life-threatening and minor conditions caused by inflammatory syndromes and diseases that affect the blood vessels. This resource uniquely brings together concepts from both the biological and clinical aspects of vasculitis. Research in clinical immunology now invigorates the entire area of vasculitis and shapes a rational approach to pathogenesis, diagnosis, and treatment, which is the substance of this text. Over 40 chapters cover known vasculitic conditions, and are illustrated with over 250 full-colour photographs of clinical and pathologic findings, diagrams, and tables. Separate sections are devoted to basic science, clinical manifestations commonly seen in vasculitis, imaging and percutaneous interventions, individual diseases and syndromes, as well as conditions which can mimic vasculitis. Many of the conditions are rare, and it is the exceptional clinician who has much experience with more than a few of these; thus, the invaluable experience of the international team of authors makes this new edition truly indispensable.Less

Paediatric Rheumatology, second edition is an indispensable resource for the identification and management of rheumatological diseases of children and young people. As well as covering common and rare musculoskeletal problems, there are also chapters on rheumatological emergencies designed for quick reference, and essential core clinical skills of relevance to the full spectrum of paediatric rheumatological disease. This second edition is fully updated, including state-of-the-art descriptions of new autoinflammatory diseases, advances in genetics in paediatric rheumatology, up-to-date guidance on the treatment of JIA, vasculitis, SLE, JDM, and other connective tissue diseases. Highlights of the second edition include alignment of management approaches for paediatric rheumatological diseases with recent evidence-based / consensus European guidelines; a description of North American treatment approaches to JIA; updated chapters on more specialist interventions including immunization in the immunosuppressed, and haematopoietic stem cell transplantation; and sections describing approaches to the management of rheumatological diseases in developing countries. Bone diseases are also described in detail including CRMO, skeletal dysplasias, and metabolic bone diseases. The second edition also includes a colour plate depicting rashes presenting in paediatric rheumatological conditions. This second edition is fully endorsed by the British Society for Paediatric and Adolescent Rheumatology (BSPAR), and many members of BSPAR have contributed most of the chapters. This second edition thus provides fully updated clinical guidelines and supporting information needed to successfully manage children and young people with rheumatological conditions.Less

Polymyalgia rheumatica and giant cell arteritis are related conditions almost exclusively occurring in older people. Polymyalgia rheumatica is considered to be the rheumatic disease that is subject to the widest variations of clinical practice, partially due to the considerable uncertainty related to diagnosis and outcomes. Giant cell arteritis, an inflammatory form of vasculitis, may present with a broad spectrum of clinical manifestations and can be complicated by acute ischaemic events, the most serious of which is permanent blindness. Early recognition and adequate treatment of the condition is thus necessary to prevent loss of independency of patients and to maintain their quality of life.Less

Part of the Oxford Rheumatology Library series, this practical online reference summarizes the important recent developments that have been made in the understanding of the pathogenesis, diagnosis and management of rheumatoid arthritis for the wide audience of clinicians who manage patients with this condition.Less

This resource reflects the most current thinking and understanding in the field, as presented by a team of international clinical experts.

Systemic lupus erythematosus (SLE) is a systemic, autoimmune disease that can affect any part of the body, causing the immune system to attack the body’s cells and tissue, and resulting in inflammation and tissue damage. It is characterized by the presence of autoreactive B and T cells and the production of a broad, heterogeneous group of autoantibodies (autoAb); the absence of a unique presentation makes its diagnosis difficult, even for qualified clinicians. Systemic Lupus Erythematosus focuses on providing a practical approach to the assessment and management of patients with this complex, multisystem, autoimmune disease, in order to improve the diagnosis and treatment of the disease and its complications. It provides detail on the history and epidemiology of SLE alongside comprehensive sections on clinical features, treatment, and special situations. As well as detailing the challenging management issues of SLE, this title provides an overview of the numerous investigations specific to the condition, assessment of disease activity, symptomatic treatment, patient education, and biologic therapies. A specific section on juvenile-onset systemic lupus erythematosus also provides the practising clinician with the knowledge needed to manage this distinct and aggressive stage of SLE.Less