Faculty Bibliography

OBJECTIVES/OBJECTIVE:To explore patterns of real-world early RA (ERA) care across countries. METHODS:An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording. RESULTS:A total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen. CONCLUSIONS:This study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.

Opinion statement: Osteoarthritis is a progressive degenerative disease of the joints in which the articular cartilage within the joints deteriorates with associated juxta-articular bone formation. While the etiology of OA is still under investigation, preclinical studies have determined that the Wnt/beta-catenin signaling and bone morphogenic signaling pathways are important for the formation and repair of the joint tissues, and the effects are on both the phenotype and function of the joint tissue cells. In addition, individuals with polymorphisms in the gene, FRZB, that codes for the wnt signaling protein secreted frizzled related protein 3 (sFRP3) have higher risk of developing OA. A number of proof-of-concept preclinical studies have been performed on inhibitors of the Wnt signaling pathway, and have altered the disease progression. Proof of concept studies assessing the regenerative capacity of mesenchymal stem cells as treatments for painful knee OA have reported both encouraging and discouraging results. Therefore, the identification of the molecular pathways that are responsible for joint formation and repair has led to the development of new novel interventions for the treatment of OA that are now entering clinical trials. The ability to slow or reverse the progression of osteoarthritis may soon be within our reach.

Game consoles, handheld units, and laptops are commonly used by children. Students at schools in St. Louis, Missouri, were asked to complete questionnaires asking about type, duration, and pain levels in their wrists and fingers related to the devices they used. Roughly, 75% of students were found to be using one of the devices. Younger age, female gender, and longer playing duration were associated with increase wrist and finger pain. Use of gaming and laptops, especially in younger children and with longer duration of use, is associated with increased pain in fingers and wrists.