Rheumatology

ABSTRACT: Pay for performance (P4P) is causing physicians to examine how they provide care individually and collectively within local health systems. It is the most recent attempt by Medicare and commercial payers to reduce the cost and improve the outcomes of health care. Understanding P4P and deciding how to manage the multiple programs being implemented by payers will challenge physicians' ethics and practice resources. Improving health care for musculoskeletal diseases will require cooperation among the specialties that share responsibility for this care and improved methods for coordinating and documenting it. (J Musculoskel Med. 2009;26:207-212)

Shoulder pain has many causes: tendinopathy, impingement, rotator cuff tear, adhesive capsulitis ("frozen shoulder"), and arthritis. This review describes tests that can help narrow the differential diagnosis.

Gout is associated with a high disease burden in older patients, probably translating into poor health-related quality of life (HRQOL) in addition to a higher rate of health care utilization and expenditures. The negative influence on HRQOL in these patients is attributable to the direct musculoskeletal manifestations and associated comorbidities, including the metabolic syndrome, renal failure, and cardiovascular and cerebrovascular disease.

Levels of moderate-to-vigorous physical activity (MVPA) in adolescence-a factor often associated with obesity, as well as morbidity and mortality in adulthood-show consistent patterns of change in relation to patient age, sex, social class, and geographical area. In countries where the influence of social class is less strong, there may be a moderating effect of context in the development of PA habits acquired in childhood.

A collaborative primary care–based intervention for patients with chronic pain may be more effective than usual care. Many improvements are modest but meaningful for patients who are older and have long-standing pain, multiple medical problems, and high rates of disability.

A new clinical practice guideline for low back pain (LBP) favors the use of noninvasive treatments over interventional procedures and suggests shared decision making between physicians and patients for better outcomes. Issued by the American Pain Society (APS), the guideline provides clinicians with several recommendations to help determine the best approaches to treating patients with LBP.

The gait of runners whose kinematics place them at high risk for common running injuries and conditions may be retrained with the use of real-time feedback. Students in the University of Delaware's Biomechanics and Movement Science (BIOMS) program are conducting projects to determine how effective such retraining may be in preventing patellofemoral pain syndrome (PFPS), knee osteoarthritis (OA), and tibial fractures.

Poor posture can lead to loss of shoulder range of motion, chronic pain, walking deficits, neck-related headaches, and the inability to exercise, warns Greg Thielman, PT, EdD, assistant professor of physical therapy at the University of the Sciences in Philadelphia. In keeping with National Correct Posture Month in May, Dr Thielman offers the following tips to help patients improve their posture:

A new study shows that Actemra, used to treat rheumatoid arthritis, is beneficial in preventing joint structural damage and promoting remission.

A recently completed Phase II proof-of-concept trial demonstrated that patients with rheumatoid arthritis given methotrexate were more likely to report an improvement in signs and symptoms than those given a placebo.

Pundits, analysts, and other industry observers have been weighing in with their thoughts on what the President's proposals will call for, what effect they may have on the nation's healthcare system, their chances of being enacted, and how we're going to pay for it all.

Though healthcare is often considered a recession-proof industry, the cost of healthcare is never far from patients� minds in trying financial times.

A new tissue scaffold built by MIT researchers, in collaboration with colleagues from Cambridge University, stimulates bone and cartilage growth and may be a potential new target for treating arthritis.

Learn about the struggles patients with rheumatoid arthritis face everyday.

As a consequence of playing the role of the weekend warrior, recreational athletes often present with knee or leg pain. Generally, these patients can be categorized in 1 of 3 age-related groups (although, paradoxically, the injuries are not necessarily age-dependent):

Clinicians caring for patients with musculoskeletal disorders may see patients who have underlying conditions that typically are evaluated and managed by allergy and immunology specialists. Although diagnosis of these conditions may be challenging, new insights into their pathogenesis have led to advances in diagnosis and therapy.

You may remember the story of Harvard Medical School grad and CIO of CareGroup John Halamka who was an huge advocate of using implantable radio-frequency identification chips to give patients the option of being a walking EMR. Halamka actually had one of these chips implanted in his arm in late 2004, and the PR frenzy began.

The Taipei Veterans General Hospital in the Department of Physical Medicine and Rehabilitation evaluated the impact of rheumatoid arthritis on patients� lives and the aspect of their lives that may change as a result of the diagnosis.

Musculoskeletal rehabilitation student researchers at the Spaulding Rehabilitation Hospital in Boston are developing wearable monitoring systems that will allow physicians to monitor patient activity and physiology remotely over extended periods.

Researchers and clinicians often point to biomechanical elements, particularly aberrant biomechanical forces and pathological responses to them, as key factors in osteoarthritis (OA) disease progression.

Ultrasound may be a helpful tool for diagnosing and treating rheumatoid arthritis, a new study has found.

A carotid intima-media thickness (CIMT) evaluation can detect subclinical vascular disease in patients who have a low Framingham risk score (FRS) and a coronary artery calcium score (CACS) of 0. Two specific tests can identify early subclinical atherosclerosis: ultrasonography and CT.

The frequency of axial gout may be much higher than previously known, and it may occur in the absence of back pain. Physicians often are unaware of the potential existence of axial involvement in patients with gout, and the diagnosis may be missed even when CT scanning is obtained.

Long-term administration of chondroitins 4 and 6 sulfate (CS) can prevent joint structure degradation in patients with knee osteoarthritis (OA). Reduced loss of joint-space width (JSW) might be predictive of better OA outcomes.

There is increased mortality risk associated with all major osteoporotic fractures in patients of all ages and even with minor fractures in older patients for 5 to 10 years after the fracture. A subsequent fracture results in an increased risk for an additional period.

Personal health records, designed to help patients keep all of their medical records in one place and make it easier for doctors to access patient files, may actually lead to inaccurate information and, as a result, improper treatment, some doctors fear.

New research from the Netherlands has shown that genetic factors for rheumatoid arthritis may be a useful tool for determining patients at risk for the disease.

Advocates and patients have fought for years to raise awareness of fibromyalgia in the medical community and gain recognition for it as a legitimate illness.

This young woman sustained a hip fracture while running the Chicago Marathon. The case review suggests that training error was a critical factor. Be alert: Runners may experience stress fractures and ignore the pain.

There is extensive genetic sharing between rheumatoid arthritis (RA) and other autoimmune and associated diseases. Such sharing is evidenced by high familial risks of discordant autoimmune diseases in parents and offspring, singleton siblings, twins, and spouses.