Complementary and alternative medicine in rheumatology

Introduction 600 Herbal remedies (phytotherapy) 602 Physical and ‘hands-on’ therapies 604 Homeopathy 605 Other complementary and alternative medicines 606 The popularity of complementary and alternative medicine (CAM) among people with chronic diseases including arthritis is widely recognized.1 Up to one-third of arthritis sufferers have received CAM from CAM practitioners and CAM use prevalence has been reported at between 30–100% of patients with rheumatic disease....

Common upper limb musculoskeletal lesions

Shoulder (subacromial) impingement syndrome 518 Adhesive capsulitis 520 Lateral epicondylitis (tennis elbow) 522 For a detailed view on the differential diagnosis of the entire range of upper limb lesions, see Chapter 2, p 19 Shoulder impingement syndrome is caused by compression of the rotator cuff by the acromion. This results in shoulder pain, particularly when the patient reaches overhead or rolls over the shoulder at night. Weakness and loss of range of motion at the shoulder are also commonly reported:...

Systemic sclerosis and related disorders

Epidemiology and diagnostic criteria 364 Cutaneous features of scleroderma and their treatment 368 Systemic features of the disease, investigation, and treatment 372 Antifibrotic and immunosuppressive therapies for systemic sclerosis 378 Summary—the approach to systemic sclerosis 380 Scleroderma-like fibrosing disorders 382 • Scleroderma is a spectrum of rare disorders ranging from limited to generalized, non-systemic to systemic, and environmental to autoimmune rheumatic disease. Generalized scleroderma, systemic sclerosis, predominantly affects women and is associated with production of collagen, widespread microvascular damage, and inflammation....

The antiphospholipid (antibody) syndrome

Introduction 344 Epidemiology and pathology 345 Clinical features of antiphospholipid syndrome 346 Treatment of antiphospholipid syndrome 348 Catastrophic antiphospholipid syndrome 350 The antiphospholipid syndrome (APS) was first described in the 1980s and comprises arterial and venous thrombosis with or without pregnancy morbidity in the presence of anticardiolipin (ACL) antibodies or the lupus anticoagulant (LAC). It can be primary, or secondary to other autoimmune diseases, most commonly systemic lupus erythematosus (SLE) (...