Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.Electronic supplementary materialThe online version of this article (doi:10.1007/s10067-014-2841-6) contains supplementary material, which is available to authorized users.

Artificial intelligence (AI) has penetrated the field of medicine, particularly the field of radiology. Since its emergence, the highly virulent coronavirus disease 2019 (COVID-19) has infected over 10 million people, leading to over 500,000 deaths as of July 1 st , 2020 . Since the outbreak began, almost 28,000 articles about COVID-19 have been published ( https://pubmed.ncbi.nlm.nih.gov ); however, few have explored the role of imaging and artificial intelligence in COVID-19 patients—specifically, those with comorbidities. This paper begins by presenting the four pathways that can lead to heart and brain injuries following a COVID-19 infection. Our survey also offers insights into the role that imaging can play in the treatment of comorbid patients, based on probabilities derived from COVID-19 symptom statistics. Such symptoms include myocardial injury, hypoxia, plaque rupture, arrhythmias, venous thromboembolism, coronary thrombosis, encephalitis, ischemia, inflammation, and lung injury. At its core, this study considers the role of image-based AI, which can be used to characterize the tissues of a COVID-19 patient and classify the severity of their infection. Image-based AI is more important than ever as the pandemic surges and countries worldwide grapple with limited medical resources for detection and diagnosis.

Rheumatic and musculoskeletal diseases (RMDs) encompass a spectrum of degenerative, inflammatory conditions predominantly affecting the joints. They are a leading cause of disability worldwide and an enormous socioeconomic burden. However, worldwide deficiencies in adult and paediatric RMD knowledge among medical school graduates and primary care physicians (PCPs) persist. In October 2017, the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD), an international think tank of RMD and related experts, met to discuss key challenges and opportunities in undergraduate RMD education. Topics included needs analysis, curriculum content, interprofessional education, teaching and learning methods, implementation, assessment and course evaluation and professional formation/career development, which formed a framework for this white paper. We highlight a need for all medical graduates to attain a basic level of RMD knowledge and competency to enable them to confidently diagnose, treat/manage or refer patients. The importance of attracting more medical students to a career in rheumatology, and the indisputable value of integrated, multidisciplinary and multiprofessional care are also discussed. We conclude that RMD teaching for the future will need to address what is being taught, but also where, why and to whom, to ensure that healthcare providers deliver the best patient care possible in their local setting.

Background The use of interferon gamma-release assays (IGRA) has become a very useful tool in the detection of latent tuberculosis (LTB) among patients on biological disease modifying anti-rheumatic drugs (bDMARDs). The IGRA offers some advantages over the intradermal tuberculin skin test (TST), such as, no requirement to re-schedule the patient for the test reading, the elimination of the inter-reader variability and higher specificity. These features facilitate the decision making when deciding which patients require tuberculosis (TB) chemoprophylaxis before starting bDMARDs, particularly in world regions with high incidence of vaccinated individuals and new TB cases. In our tertiary level hospital, the IGRA QuantiFERON-TB Test® (Cellestis Ltd, Australia), was introduced as routine screening test for LTB in late 2008 together with the usual chest X-ray, initially run concurrently and then substituting the old TST in most of the cases. Objectives In this report, we present the benefits of its use in decreasing the number of active TB cases among rheumatoid arthritis (RA) patients prescribed bDMARDs in our centre. Methods An audit was undertaken through the electronic medical record system of our hospital, which was implemented from January 2011 for all medical documentation. All RA patients aged 18 and over seen in the rheumatology outpatient clinic between Jan 2011 and September 2013 and on bDMARDs at any time during this period were identified. Among the cohort of RA patients on bDMARDs, we searched for patients with diagnosis of active TB or receiving anti-TB triple/quadruple therapy. Results were compared to previous RA cohort from the same hospital from the period 2003-2008, which was facilitated by two of the authors of this present paper who worked in our hospital during this period. Results Ninety-seven individuals diagnosed with RA and treated with any of the bDMARDs available during the study period were found. There were no documented cases of TB or active TB treatment among the 97 individuals on bDMARDs during the 34-month audit period. This contrasts with the three cases of TB reactivation among the 86 patients who received bDMARDs in our centre from 2003 to 2008. Conclusions Our data suggest that the IGRA QuantiFERON-TB Test® is more useful than the TST for the LTB screening in adult population on bDMARDs. This is particularly important in mixed populations with a high percentage of individuals being nationals from endemic countries in TB. Our recommendation is to systematically use IGRA in such settings, repeating this on an annual basis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5158