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The aim of this study was to assess whether axial spondyloarthritis (axial SpA) patients' supine position on the couch (OC) or on the floor (OF) affects intermalleolar distance (IMD) measurement and its Bath Ankylosing Spondylitis Metrology Index (BASMI) scoring, using all three versions of BASMI index. OC- and OF-IMDs were obtained for 43 axial SpA patients (M:F = 19:24). Age, gender, height, weight, body mass index (BMI), disease type and disease duration were also collected. Statistical analyses and correlations were performed as appropriate. Mean IMD measurements obtained with individuals in the two distinct measuring positions were not significantly different in the patients studied. Furthermore, there was a significant correlation between OC-IMD and OF-IMD values. There was no significant relationship between IMD and patient age, gender, height, weight, BMI, or disease duration. However, looking at disease type, IMDs of patients with ankylosing spondylitis (AS) were ~30 % greater than those with psoriatic arthritis (PsA) in our study population (p < 0.05). There were no significant differences between the measured patient characteristics that accounted for the greater IMDs of those diagnosed with AS. IMD measurements and resultant BASMI scores were the same whether the patient was positioned OC or OF in our axial SpA cohort. Unexpectedly, IMD measurements were significantly greater (~30 %) in AS patients than in axial PsA patients.

The aims are to assess whether medical students are interested in rheumatology as a training post during post-medical-school and prior to specialty training that is covered by foundation years (FY) training in the UK, to determine the time spent in the undergraduate training in rheumatology and whether the desire for musculoskeletal (MsK) medicine training (rheumatology and orthopaedics taken together) is enhanced during FY training and to analyse the rationale behind their choice for rheumatology alone or combined with orthopaedics. An online questionnaire was distributed to all 31 UK medical schools, addressed to fourth-, fifth- and sixth-year medical students. The questionnaire was completed by 256 students from 11 of 31 medical schools existed in the UK in 2009. Most respondents (n = 156; 60.9 %) received 3 weeks (96 h) exposure to rheumatology, whilst one-fifth (n = 53; 20.7 %) had received no exposure in rheumatology. A total of 122 students of the 256 that responded (47.6 %) would like to do rheumatology as part of their training and 116 (45.3 %) would like to have more posts available in rheumatology. However, when asked to choose 6 specialties, out of 21, which would be most useful for post-university training, rheumatology was amongst the bottom three, attracting only 9.4 % of respondent students. A total of 68 of 256 (26.5 %) students, however, expressed a desire for MsK medicine: 44/256 (17.1 %) for orthopaedics and 24/256 (9.4 %) for rheumatology. From a total of 49 of 256 (19.1 %) open-ended responses obtained, 25 (51 %) were from those medical students willing to have exposure in MsK medicine: 15 of 44 (34 %) willing to have orthopaedics and 10 of 24 (41.6 %) willing to have rheumatology. Analysis of the responses revealed that it is mostly the specialty choice that guides towards specialty training. One in five of the medical students responded to had received (actual or perceived) no exposure to rheumatology during their undergraduate years. Career choice that derived mostly from undergraduate exposure is the driving force behind medical students' choice for foundation year training.

There is currently no structured system for nurses or allied health professionals to undertake further training to become a nurse specialist (NSp) or nurse practitioner (NP) in rheumatology on-site, while working in a district general hospital setting. These shortcomings have prompted us to develop a structured pathway that could be followed by staff nurses who wish to become NSp in rheumatology. The proposed pathway aims to assist the nurses or therapists (physiotherapists, psychologists, occupational therapist, podiatrists, etc.) to develop a sound knowledge based on the rationale, safety, and high quality clinical care when monitoring of patients taking disease-modifying anti-rheumatic drugs (DMARDs) to ensure they acquire skills enabling them to provide safe, evidence-based effective patient-centered care. Near the end of the pathway, the trainee would be expected to have an understanding of the particularities of chronic arthritis conditions as well as screening, assessment, and monitoring of patients receiving DMARDs and biological agents. Tests for competencies are included and certification may be considered.

To determine whether the first presenting symptoms, the main problem that the disease is causing to patients, and the employment status at presentation of patients with early spondyloarthritis (SpA) in a multicultural/multiracial patient cohort are different between gender, race, and disease subgroups of the SpA spectrum (ankylosing spondylitis, enteropathic arthritis, psoriatic arthritis, or undifferentiated arthritis). All patients above the age of 16 years, with disease duration of less than 3 years since symptom onset, seen in clinic between 2004 and 2008 with spondyloarthritis (SpAs) were assessed regarding their first presenting symptom, the main problem caused by the disease, and their employment status. In addition, clinical parameters such as the degree of disease activity (measured by BASDAI, ESR, and CRP), functional ability (measured by BASFI), night pain, sleep disturbance, well-being over past week, and over past 6 months prior to assessment (measured by a 10 cm VAS; 0 = good health, 10 = worst possible) were obtained. Statistical analysis with Pearson's χ(2) test compared and correlated two groups, and one-way analysis of variance (ANOVA) was used when more than two groups were compared and correlated. A total of 96 patients [(male:female = 33:63; (34.4:65.6%), (mean age 43.8 ± (SD) 13.9)] with early SpA were assessed. They were of multiethnic background representing Caucasians (n = 52; 54.2%), Asians (n = 33; 34.4%), and Africans (n = 10; 10.4%) mixed race (n = 1; 1%). The disease spectrum consisted of ankylosing spondylitis (AS) (n = 12; 12.7%), enteropathic arthritis or SpA associated with inflammatory bowel disease (IBD) (n = 9; 9.4%), psoriatic arthritis (PsA) (n = 47; 49%), undifferentiated spondyloarthritis (USpA) (n = 27; 28.2%), reactive arthritis (n = 1;1%), and juvenile SpA (n = 1;1%). Back pain stated as the first presenting symptom by 45 patients (46.8%) (followed by knee pain) and joint pains as the main problem by 49 patients (51.7%), while 47 patients of 93 who replied on the employment section (50.5%) were working. The total group had BASDAI score of 5.91 (±2.1), ESR of 19.65 (±19.4) mmHg/h, CRP of 8.10 (±9.2) mmol/L, BASFI score of 4.51 (±2.57), night pain of 5.26 (±3.2), sleep disturbance of 5.24 (±3.03) well-being over past week of 5.9 (±2.7), and well-being over past 6 months of 6.4 (±2.5). Most patients had PsA at presentation. Comparisons between genders showed significantly more women to have knee pain as first presenting symptom than men. No differences between races found in the first presenting symptom, main problem caused to patients by disease, and employment, but Africans have significantly more sleep disturbance than other races. Comparisons between disease subgroups showed patients with AS to have significantly more back pain and hip pain as first presenting symptom and patients with IBD to have more joint pain as main problem caused by the disease.

Methotrexate (MTX) can be toxic to patients suffering from end stage renal disease (ESRD) on hemodialysis even at low doses. This increase in toxicity is more notable in terms of bone marrow suppression in the form of pancytopenia. Many methods of elimination including dialysis itself have been proven ineffective, and alternate treatments with anti-TNF alpha blockers can be considered.

There are a wide variety of medications available to treat patients with rheumatoid arthritis, many of which are considered unsafe during pregnancy. It is important to tailor a treatment regimen that stabilises the woman's disease prior to conception, using medications that are safe to continue throughout pregnancy and the post-partum period. Drugs that may be safely used during pregnancy include NSAIDs, corticosteroids, plus several DMARDs, including sulfasalazine and hydroxychloroquine. Drugs recommended to be stopped before pregnancy include methotrexate and leflunomide, plus the biologics: anti-TNF agents, rituximab and abatacept.