Current rheumatology reports
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In the last 20 years, the clinician educator has become an integral, indispensable part of the academic team. Competition for clinical revenue and increased rigor of mandating physician competency and evidenced-based treatments have created a niche in academia in which the clinician educator can thrive. Academic clinician educators are needed in adult and pediatric rheumatology. ⋯ Clinician educators must be better prepared for teaching, stimulated to create new curricula and methods of evaluation, and provided opportunities to publish their work. Faculty development programs and advanced degrees in education are essential, and promotion criteria must be modified. Clinician educators have a place in academia, but they must continue to thrive as master clinicians, innovators in competency-based teaching methods and evaluation, and contributors to the literature.
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Hip fractures are among the most important causes for disability, reduced quality of life, and death in older persons. Hip fracture patients are typically characterized by older age and a large complexity in their underlying conditions, comorbidities, and clinical histories. ⋯ This paper illuminates the current issues and recommendations for post-operative hip fracture care. Efforts to improve osteoporosis assessment and management, the multidisciplinary team approach, and clinical pathways are areas that have received attention recently.
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Osteoarthritis is the most common form of arthritis and is a leading cause of disability in the elderly. Given the anticipated increase in osteoarthritis prevalence, the need to identify risk factors for incident osteoarthritis, osteoarthritis progression, osteoarthritis-associated physical function decline, and disability is an especially high priority. ⋯ Recent studies have identified risk factors associated with progression of the disease including varus-valgus alignment, bone marrow edema lesions, varus thrust, a reduced hip abduction moment, and obesity. Predictors of function decline in osteoarthritis include lower self-efficacy, knee laxity, less aerobic exercise, worse joint proprioception, and greater knee pain.
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There has been a dramatic increase in our understanding of fibromyalgia throughout the past 14 years since the publication of the 1990 American College of Rheumatology classification criteria. Before 1990, and for most of the 20th century, fibromyalgia was considered to be predominantly a muscle disorder; now the critical abnormality is described as "central sensitization." However, central sensitization has to have an initial genesis and nociceptive stimuli from painful foci in muscle are increasingly recognized as being relevant to the development of fibromyalgia. ⋯ However, some clues are emerging from the role of diverse stimuli in activating glial cells and the role of disordered cytokine networks. Some predictions about future developments in fibromyalgia are ventured based on the current state of knowledge.
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Urate is the major inert end product of purine degradation in higher primates in contrast to most other mammals because of the genetic silencing of hepatic oxidative enzyme uricase. The kidney plays a dominant role in urate elimination. The kidney excretes 70% of the daily urate production. ⋯ Recently, we have identified the urate-anion exchanger URAT1 (SLC22A12) in the human kidney and found that defects in SLC22A12 lead to idiopathic renal hypouricemia. URAT1 is targeted by uricosuric and antiuricosuric agents that affect urate excretion. Molecular identification of urate transporting proteins will lead to the new drug development for hyperuricemia.