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Most forms of arthritis are 'undifferentiated' in the first few weeks to months. Many experts believe this stage presents a unique opportunity to influence the fate of a patient by initiating early treatment. The STIVEA trial attempted to define the true benefit of glucocorticoids in very early arthritis with regard to long-term outcomes.
A recent study of therapies for carpal tunnel syndrome suggests a clear benefit for surgery, although the investigators also found improvements in patients who received carefully structured, nonsurgical treatment.
The combination of heparin and aspirin is widely regarded as 'standard therapy' to increase rates of live birth in patients with recurrent pregnancy loss and positive antiphospholipid antibodies. However, this recommendation is based largely on expert opinion. Does a meta-analysis of randomized controlled trials support the practice?
In the absence of a safe and effective alternative treatment for chronic musculoskeletal pain, the prescription of opioid analgesics has escalated dramatically over the past decade. Their use, however, can be associated with the persistence, or even enhancement, of chronic pain, and might also induce powerful positively-reinforcing psychological effects that lead to clinical dependence, as outlined in this Review.
Individuals with chronic back pain or osteoarthritis often do not seek healthcare because of these problems, but instead make use of a range of self-care strategies. This article explores several aspects of self-management, and includes a review of the evidence for the effectiveness of various self-management programs for these two musculoskeletal conditions.
In this Review, the authors describe the emotional, cognitive and social context variables that contribute to arthritis pain, and how they have been used to develop psychological approaches to pain management.
Surgery for painful shoulder conditions is usually only considered when conservative treatment fails. This article outlines the features of and indications for surgery in common painful conditions that affect the shoulder.
Despite the high number of patients who present to their rheumatologist with pain, this symptom remains undertreated in the clinic. In this Perspectives, David Borenstein explores reasons for the undertreatment of pain in patients with rheumatic disease, and argues that the rheumatologist's role in this regard should be brought to the forefront.
IL-1 has an important role in the pathogenesis of many hereditary and non-hereditary autoinflammatory diseases. This Review examines the biological functions of IL-1 and the use of IL-1-targeting agents in the treatment of various human diseases.
With the aim of highlighting the challenges faced by rheumatologists, articles in this Focus issue of Nature Reviews Rheumatologydiscuss pharmacological and nonpharmacological therapies and how best to integrate these to achieve effective pain-relief for patients with chronic musculoskeletal diseases.
