Recent advances: Rheumatology

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Rajan Madhok, consultant rheumatologist,
Hilary Kerr, specialist registrar in rheumatology,
Hilary A Capell (gcl101@clinmed.gla.ac.uk), consultant rheumatologist

Centre for Rheumatic Diseases, Royal Infirmary, Glasgow G4 0SF

Correspondence to: H A Capell

The health consequences and fiscal burden of musculoskeletal diseases has been acknowledged but never fully addressed. An agenda unveiled by the World Health Organization to redress the balance sets specific goals for the next 10 years (the bone and joint decade). These include a 25% reduction in the expected increase in morbidity from rheumatoid arthritis, osteoporosis, and osteoarthritis.

Methods

We have reviewed advances in rheumatology that can be easily integrated into routine clinical practice and highlighted areas where appropriate treatment has been shown to prevent later disability or morbidity. References are supplied for published trials and systematic reviews.

Osteoarthritis

The chronic disease model of illness advocates patients as managers of their disease. In a trial to assess this model in 211 patients with osteoarthritis of the knee, Mazzuca et al reported greater benefits over one year in a self care group compared with standard treatment.1

Diet

Cross sectional studies and studies of longitudinal cohorts have shown that obesity increases the risk of osteoarthritis of the knee in both men and women,2 primarily by increasing forces across the knee. An imbalance of growth factors affecting the cartilage and underlying bone may also contribute. Weight loss reduces symptoms as well as improving functional ability.3 High vitamin C intake is associated with a threefold reduction in progression of osteoarthritis of the knee.4 Progression of osteoarthritis of the knee and hip is faster in people with lower vitamin D concentrations. 5 6 However, as yet there is no evidence that vitamin supplementation improves symptoms.

Physical activity

Previous knee surgery and injury are risk factors for osteoarthritis of the knee, as are occupational kneeling and squatting. Observations in the Framingham heart cohort confirm that heavy physical occupational and leisure activity, particularly in obese people, predispose to subsequent osteoarthritis of the knee.7