Is this gout? No - it's acute pyrophosphate arthitis
Patients may book an appointment directly with either Chelsfield Park Hospital or Sevenoaks Medical Centre but a letter of referral is always required. If you wish to discuss a patient you can either contact my secretary, Karen Brickenden (020 8302 2678 ext 4347) or email me direct.
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It may save time for patients if some pre-referral tests have been done in general practice. However there are some tests which are not helpful and some which can confuse; thus rheumatoid factor may be elevated slightly and is not significant if the titre is below 1:16 (25IU) and antinuclear antibodies are quite commonly weakly positive without significance. HLA B-27 is positive in 95% of patients with ankylosing spondylitis, but also in 8% of the normal population. A negative test is thus statistically significant at the 5% level, but a positive test is not.
The context of these tests is also important.
Is this gout? No - it's acute pyrophosphate arthitis
Serum urate is likewise not helpful to make a diagnosis of gout as it may be normal in gout and high in normal people. Gout can only be definitely confirmed by finding uric acid crystals in a joint aspirate.
This X-ray shows extensive bony bridging due to Forestier's disease. The patient was asymptomatic.
X-rays are largely unhelpful; osteoporosis cannot be diagnosed from them, and degenerative changes are normal after the age of 55. The mismatch beteen symptoms and radiological signs is substantial.
The acute hot joint (This protocol is designed for A&E use but may direct your thinking; see a national version below))
Examination of the painful shoulder
Vaccinations in immunocompromised patients (BSR guidelines)
Osteoporosis treatment (Greenwich/Bexley guidelines)
"Mouse Arm" : dystonia from computer use, and tips on how to help
Royal College of Physicians "Working for Patients" - Rheumatology
BSR/BHPR guideline for the management of RA (the first 2 years)
Management of the hot swollen joint in adults (joint BSR, BHPR, BOA, RCGP & BSAC guideline)
Raynauds and Scleroderma: an up to date guide
TNF-alpha prescribing guidelines:
All three conditions are now covered by NICE guidelines and we are prescribing biologics for all of the above conditions