Best Practice & Research Clinical Rheumatology RSS feed: Current Issue. Evidence-based updates of best clinical practice across the spectrum of musculoskeletal conditions Best Practice and Research Clinical Rheumatology keeps the clinician or trainee informed of the latest developments and current recommended practice in the rapidly advancing fields of musculoskeletal conditions and science. The series provides a continuous update of current clinical practice. It is a topical serial publication that covers the spectrum of musculoskeletal conditions in a 4-year cycle. Each topic-based issue contains around 200 pages of practical, evidence-based review articles, which integrate the results from the latest original research with current clinical practice and thinking to provide a continuous update. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. The review articles seek to address the clinical issues of diagnosis, treatment and patient management. Management is described in practical terms so that it can be applied to the individual patient. The serial is aimed at the physician in both practice and training. The Best Practice and Research Clinical Rheumatology series provides up-to-date and expert information and opinion by drawing on Guest Editors and authors renowned for their expertise. This ongoing review of topics makes the serial ideally suited to supporting everyday clinical practice, for training needs as well as for maintaining knowledge and competency. Volume 22 (Volume 2008) 1. Connective tissue diseases M. Matucci-Cerinic & D. Furst 2. Musculoskeletal science T. Pap & U. Muller-Ladner 3. How to manage chronic musculoskeletal conditions - the principles P. Brooks & P. Conaghan 4. Miscellanous inflammatory musculoskeletal conditions J. Sibilia & H. Zeidler 5. Musculoskeletal conditions in the developing world G. Mody & R. Handa 6. Imaging in musculoskeletal conditions M. Cimmino and W. Grassi Volume 23 (2009) 1. Early rheumatoid arthritis 2. Vasculitis 3. How to do - practical procedures 4. Back pain 5. Systemic lupus erythematosus 6. Osteoporosis Volume 24 (2010) 1. Osteoarthritis 2. Paediatric rheumatology 3. How to manage chronic musculoskeletal conditions - a systematic approach to specific problems 4. Pharmacotherapy 5. Spondylo-arthropathies 6. Prevention / epidemiology This free sample chapter is being provided to demonstrate the Journal's approach to topics across the spectrum of musculoskeletal conditions.http://www.bprclinrheum.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Best Practice & Research Clinical Rheumatology1521-6942241February 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.bprclinrheum.com/article/PIIS152169420900165X/abstract?rss=yesEditorial Board/Aims and Scope10.1016/S1521-6942(09)00165-XBest Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-2iiiiiihttp://www.bprclinrheum.com/article/PIIS1521694209001235/abstract?rss=yesUntil the late 20th century, osteoarthritis (OA) was thought to represent a passive consequence of wear and tear, a degenerative condition of cartilage that was an inevitable consequence of aging. Our 21st century model, in contrast, considers OA to be an inflammatory, cell-driven condition affecting the whole joint, including not only cartilage but also bone, synovium, muscles, and ligaments and is influenced by age, mechanical stress, and genetic traits. Recent research has helped elucidate the roles played by chondrocytes, soluble mediators, and mechanical receptors. Increased understanding of the biochemical and biophysical events involved ultimately may open the door to specific disease-modifying therapeutic interventions for this most common of joint diseases.PrefaceF. Berenbaum10.1016/j.berh.2009.10.003Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-212http://www.bprclinrheum.com/article/PIIS1521694209000862/abstract?rss=yesOsteoarthritis is a major musculoskeletal cause of disability in the elderly, but current therapeutic approaches are insufficient to prevent initiation and progression of the disease. Genetic studies in humans have identified molecules involved in signalling cascades that are important for the pathology of the joint components. These include the bone morphogenetic protein (BMP) signalling, the wingless-type signalling and the thyroid pathway as well as apoptotic-related molecules. There is emerging evidence indicating that inflammatory molecules related to cytokine production, prostaglandin and arachidonic acid metabolism are also involved in susceptibility to osteoarthritis. All of these pathways are likely targets for pharmacological intervention. Genetic variation also affects pain due to osteoarthritis highlighting molecular mechanisms for pain relief. Moreover, combinations of genetic markers can be used to identify individuals at high risk of osteoarthritis and risk of total joint arthroplasty failure, which should facilitate the application of preventive and disease management strategies.The clinical relevance of genetic susceptibility to osteoarthritisAna M. Valdes, Tim D. Spector10.1016/j.berh.2009.08.005Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-2314http://www.bprclinrheum.com/article/PIIS1521694209000849/abstract?rss=yesAlthough older age is the greatest risk factor for osteoarthritis (OA), OA is not an inevitable consequence of growing old. Radiographic changes of OA, particularly osteophytes, are common in the aged population, but symptoms of joint pain may be independent of radiographic severity in many older adults. Ageing changes in the musculoskeletal system increase the propensity to OA but the joints affected and the severity of disease are most closely related to other OA risk factors such as joint injury, obesity, genetics and anatomical factors that affect joint mechanics. The ageing changes in joint tissues that contribute to the development of OA include cell senescence that results in development of the senescent secretory phenotype and ageing changes in the matrix including formation of advanced glycation end-products that affect the mechanical properties of joint tissues. An improved mechanistic understanding of joint ageing will likely reveal new therapeutic targets to slow or halt disease progression. The ability to slow progression of OA in older adults will have enormous public health implications given the ageing of our population and the increase in other OA risk factors such as obesity.Why is osteoarthritis an age-related disease?A. Shane Anderson, Richard F. Loeser10.1016/j.berh.2009.08.006Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-21526http://www.bprclinrheum.com/article/PIIS152169420900093X/abstract?rss=yesUltrasound (US) is a valuable tool for imaging musculoskeletal changes in osteoarthritis. It shows early and late findings related to inflammation and structural damage. Sonography is a safe tool, which has recently registered an increasing and widespread use, it being considered as a bedside procedure in the clinical assessment of rheumatic patients. Its applications in osteoarthritis are related to easy accessibility of equipment, low cost, short duration of single examinations and the possibility of performing a multiregional joint evaluation in the same scanning session. Permitting an extensive evaluation of most joint changes present in osteoarthritis, it gives the opportunity to monitor disease progression and perform a follow-up of the response to different local and systemic treatments. US-guided procedures are commonly performed with safety, reliability and optimal patient tolerance. Development in technology and technique with improvement of new research studies will further amplify the diagnostic role of ultrasound in osteoarthritis in the near future.Imaging the joint in osteoarthritis: a place for ultrasound?Annamaria Iagnocco10.1016/j.berh.2009.08.012Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-22738http://www.bprclinrheum.com/article/PIIS1521694209000850/abstract?rss=yesThe knee is one of the most common joints affected by osteoarthritis (OA), frequently with clinical presentation by middle age or even earlier. Accumulating evidence supports that knee OA progression is often driven by biomechanical forces, and the pathological response of tissues to such forces leads to structural joint deterioration, knee symptoms and reduced function. Well-known biomechanical risk factors for progression include joint malalignment and meniscal tear. The high risk of OA after knee injury demonstrates the critical role of biomechanical factors also in incident disease in susceptible individuals. However, our knowledge of the contributing biomechanical mechanisms in the development of early disease and their order of significance is limited. Part of the problem is our current lack of understanding of early-stage OA, when it starts and how to define it.The role of biomechanics in the initiation and progression of OA of the kneeMartin Englund10.1016/j.berh.2009.08.008Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-23946http://www.bprclinrheum.com/article/PIIS1521694209000837/abstract?rss=yesSince surfaces become irregular and debris from cartilage and meniscus gets released into the joint cavity of osteoarthritic joints, washing away this debris and attendant crystals, smoothing rough surfaces and repairing tears might help patients with disease. Such interventions are accomplished during an arthroscopy, when a fibre-optic endoscope and surgical instruments are inserted into the knee. While initial uncontrolled case series suggested that arthroscopy alleviated pain in patients with osteoarthritis, large randomised trials have suggested that arthroscopy has a limited role as a treatment of osteoarthritis.Arthroscopy as a treatment for knee osteoarthritisDavid T. Felson10.1016/j.berh.2009.08.002Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-24750http://www.bprclinrheum.com/article/PIIS1521694209000874/abstract?rss=yesOver the past few decades, significant progress has been made with respect to new concepts about the pathogenesis of osteoarthritis (OA). This article summarises some of the knowledge we have today on the involvement of the subchondral bone in OA. It provides substantial evidence that changes in the metabolism of the subchondral bone are an integral part of the OA disease process and that these alterations are not merely secondary manifestations, but are part of a more active component of the disease. Thus, a strong rationale exists for therapeutic approaches that target subchondral bone resorption and/or formation, and data evaluating the drugs targeting bone remodelling raise the hope that new treatment options for OA may become available.Targeting subchondral bone for treating osteoarthritis: what is the evidence?Steeve Kwan Tat, Daniel Lajeunesse, Jean-Pierre Pelletier, Johanne Martel-Pelletier10.1016/j.berh.2009.08.004Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-25170http://www.bprclinrheum.com/article/PIIS1521694209000916/abstract?rss=yesOsteoarthritis (OA) is often a progressive and disabling disease, which occurs in the setting of a variety of risk factors – such as advancing age, obesity and trauma – that collude to incite a cascade of pathophysiological events within joint tissues. An important emerging theme in OA is a broadening of focus from a disease of cartilage to one of the ‘whole joint.’ The synovium, bone and cartilage are each involved in pathological processes that lead to progressive joint degeneration. Additional themes that have emerged over the past decade are novel mechanisms of cartilage degradation and repair, the relationship between biomechanics and biochemical pathways, the importance of inflammation and the role of genetics. In this article, we review the molecular, clinical and imaging evidence that synovitis is not an ‘incidental finding of OA’, but plays a significant role in disease pathogenesis, and could therefore represent a target for future treatments.Targeting the synovial tissue for treating osteoarthritis (OA): where is the evidence?Mukundan Attur, Jonathan Samuels, Svetlana Krasnokutsky, Steven B. Abramson10.1016/j.berh.2009.08.011Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-27179http://www.bprclinrheum.com/article/PIIS1521694209000898/abstract?rss=yesTo be able to prevent progression of osteoarthritis, the knowledge of prognostic factors of this progression is important. If certain prognostic factors are modifiable, they may enhance our ability to reduce osteoarthritis progression. Even if these prognostic factors are not modifiable, they can still be used to identify high-risk groups, which may have implications for patient information and the perspective of medical treatment. Prognostic factors of progression are reviewed here, mainly for hip and knee osteoarthritis as most data available concern these localisations. Areas of further research are highlighted.What are the best markers for disease progression in osteoarthritis (OA)?P.P. Cheung, L. Gossec, M. Dougados10.1016/j.berh.2009.08.009Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-28192http://www.bprclinrheum.com/article/PIIS1521694209000928/abstract?rss=yesFor the most part, non-pharmacological approaches are recommended for osteoarthritis treatment. This recommendation is based mainly on biomechanical observations leading to a modulation of the symptomatic loading joint. Approaches include orthoses, insoles, exercise, diet and patient education. The approach used for each osteoarthritis site must be adapted for the individual patient. Here, we use an evidence-based approach, including the European League Against Rheumatism (EULAR) and Osteoarthritis Research Society International (OARSI) recommendations, to summarise the non-pharmacological treatments available for knee, hip and hand osteoarthritis and to help the physician in daily clinical practice.Non-pharmacological approaches for the treatment of osteoarthritisFrançois Rannou, Serge Poiraudeau10.1016/j.berh.2009.08.013Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-293106http://www.bprclinrheum.com/article/PIIS1521694209000825/abstract?rss=yesA systematic review of the clinical trials in osteoarthritis registered on the public website of the Clinical Trials Data Bank at the National Institutes of Health (NIH) has been performed. Such a review should cover the majority of the ongoing or forthcoming trials in the disease. This review focusses on trials designed to test safety and/or efficacy of targeted therapies in osteoarthritis.Targeted therapies in osteoarthritis: a systematic review of the trials on www.clinicaltrials.govFrancis Berenbaum10.1016/j.berh.2009.08.007Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-2107119http://www.bprclinrheum.com/article/PIIS1521694209001223/abstract?rss=yesWe reviewed three recently published guidelines for the management of osteoarthritis (OA) and considered the evidence and potential for implementation. From this we propose a minimum standard of care, or a ‘core set’ of interventions, that should be offered to all patients with OA of the hip and/or knee. Eight core recommendations emerged where it is recommended that health-care professionals:An integrated, chronic disease model of care is proposed to best implement OA management and a check list of clinical indicators/performance measures is provided.Developing a minimum standard of care for treating people with osteoarthritis of the hip and kneeLyn March, Bhasker Amatya, Richard H. Osborne, Caroline Brand10.1016/j.berh.2009.10.002Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-2121145http://www.bprclinrheum.com/article/PIIS1521694209001697/abstract?rss=yesIndex10.1016/S1521-6942(09)00169-7Best Practice & Research Clinical Rheumatology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Rheumatology2010-02-01241S1521-6942(09)X0008-2II