Show Notes
Welcome Back Rheumatology Fans, Every once in a while, I get really excited. This is one of those once in a whiles… This Study (please go and download it etc so it counts for the authors stats and such) aimed to develop and initially validate a scoring system to aid us clinicians decision making for referral to Rheumatology in young people with possible Juvenile Idiopathic Arthritis (JIA). THANK YOU to the authors, I don’t know if I always say that enough. The Study Very briefly because the study design is not the crux of this post. The authors had 342 patients 61 (18%) of which had already been diagnosed with JIA. These were all under 16 and were presenting with joint pains being the primary reason for attendance. Their exclusion criteria included presence of fever (which is a primary symptom of systemic JIA and is a very important separate factor). They collected data from the patients at initial assessment, the patients were diagnosed or not with a specialist with JIA and then the authors did some clever statistical calculations to generate the scoring system. So basically, they gathered information, then the patients were diagnosed and then the authors worked out which were the most useful questions and assigned a scoring system to them based on statistical analysis. The Scoring Criteria The important part for MSK Clinicians, GPs, and anyone else seeing under 16s with joint pains. The authors recommend a score of 3+ providing a sensitivity of 95% bearing in mind this was an initial validation study as they were developing the score. If you use the score you MUST consider your own clinical reasoning and if you are ensure at all, seek advice. This score is still in relatively early in its validation and should not be relied upon too heavily. I have replicated this from the article material as I cannot currently find a downloadable/printable version. Useage Of The Tool Practically this tool is for use when your presenting patients primary complaint is joint pain WITHOUT fever. Of course we would also have considered other relevant pathology and mechanisms of injury. A score of 3+ on the tool supports referral to Rheumatology for further consideration the person has developed Juvenile Idiopathic Arthritis. I cannot stress enough that if you are not sure - get some advice! Further information on Juvenile Idiopathic Arthritis
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit rheumatologyphysio.substack.com/subscribe
More from Rheumatology.Physio Podcast
This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.com
This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.com
Welcome Back Rheumatology Fans, Ooof this is going to rattle some cages. Synopsis below but the best of this is watching the video. A recent news report about a woman with rheumatoid arthritis who was convicted of benefit fraud caught my attention. The case involved footage of her participating in activities including gym classes and running events despite having previously reported substantial limitations in her day-to-day function. I don’t know enough about the individual circumstances to comment on whether the judgement was appropriate. In fact, the reported offence appears to relate specifically to failing to notify the Department for Work and Pensions of a change in circumstances. But the story raises a broader issue that is highly relevant to people living with inflammatory arthritis and the clinicians treating them. Being physically active does not necessarily mean someone is not disabled. Rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and other long-term inflammatory diseases can be enormously variable. Symptoms may fluctuate over time, treatments can substantially improve function, and limitations in one activity do not necessarily predict someone’s ability to perform another. Exercise also forms an important part of rehabilitation. I might see someone who currently cannot run, play tennis or golf because their inflammatory arthritis is poorly controlled. Following improvements in medication and a structured rehabilitation programme, one of our explicit treatment goals might be to return them to those activities. For another person, the goal might simply be getting upstairs more comfortably. To achieve that, we may use relatively demanding strengthening exercises in a gym. Seeing that person performing a squat or leg press tells you very little, in isolation, about how easily they can negotiate their stairs later that day. That distinction matters. We should not create an environment where people receiving appropriate financial support become frightened of exercising because they worry that being seen in a gym, lifting weights or participating in sport could somehow be interpreted as evidence that they are no longer disabled. From a clinical perspective, I want people with inflammatory arthritis to be as active as their condition, preferences and circumstances allow. Where possible, that includes meeting general physical activity recommendations and incorporating cardiovascular and resistance exercise. There are good reasons for doing so. Maintaining physical activity can help protect muscle and bone, improve cardiovascular health and support broader long-term health outcomes. For some patients, returning to demanding exercise is itself a major marker of successful treatment. None of this means that changes in someone’s circumstances should not be reported where required. That is a separate issue. The important point is that exercise capacity and disability are not opposites. A person can exercise and still experience meaningful restrictions from inflammatory disease. They can also improve dramatically with treatment while continuing to have limitations elsewhere. As clinicians, we should be encouraging people towards greater function—not inadvertently giving them another reason to be afraid of achieving it.
This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.com
This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.com