UCLH Members Meet: Arthritis Dr Jessica Manson June 2016 - - PowerPoint PPT Presentation

UCLH Members Meet: Arthritis

Dr Jessica Manson June 2016

Structure of talk

1.

Brief introduction to Rheumatology

• Department at UCLH
• What kind of patients do we see?

2.

What is arthritis?

• Definitions
• Cases

3.

Role of the CNS

4.

Research in our department

Rheumatology team at UCLH

• 14 consultants
• 4 CNS (Sam Moore, lead nurse)
• Infusion clinic staff
• 3 full time registrars
• 3+ research registrars
• F1 and CMT (50%)
• Research strong department

Which patients do we see?

• Referral from GPs and from other hospitals
• 50-60 Clinics a week
• 4300 new appointments and 16000 follow-ups per year
• In patients
• Very few beds
• Day case unit
• Infusions
• Urgent reviews

4

5

Rheumatology: what we do

200 400 600 800 1000 1200 1400 1600 Total inflamm arthritis Total AIRD Total Pain/OA/HM Total bone Total misc

Diagnosis % IA 40 Pain/OA/ HM 21 AIRD 17 Bone 12 Misc 10

Subtotals, 3 month data

What is arthritis?

6

Arthritis Inflammatory Rheumatoid arthritis Spondylo- arthropathy Crystal arthropathy Autoimmune rheumatic disease Non- inflammatory Osteoarthritis Tendonopathy

3 cases…

• All presented with joint pain
• Different diseases
• Different management

8

Osteoarthritis case

• 67 year old woman
• Known obesity, type II diabetes
• Localized pain and restricted ROM
• Base of thumb
• Lumps of fingers
• Right shoulder
• Right knee
• Pain worse on use and end of the day
• Stiff fingers in the morning

9

Osteoarthritis: patterns of disease

http://www.arthritisresearchuk.org

10

Osteoarthritis of the hand

11

12

Osteoarthritis: what the patient can do

• Pain killers
• Work a bit
• Keep active
• Walking >6000 steps a day predicts good outcome
• ver 2 years in knee OA
• Lose weight
• Obesity is a risk factor for OA, even in non-weight

bearing joints

13

Osteoarthritis: what doctors can do

Dispelling myths

• It is not wear and tear
• It is not an inevitable process as we get older
• Early changes do not inevitably proceed

Treatments

• Phsyiotherapy
• Analgesia
• Surgery

Research

• We need a disease modifying drug

14

Rheumatoid arthritis case

• 21 computer programmer
• 4 month history of pain in multiple joints
• Mainly hands and knees
• Early morning stiffness 4 hours
• Fatigue

On examination

Investigations: blood tests

• High inflammatory markers
• But not always
• Antibodies in blood
• But not always

17

Inflammatory arthritis Start treatment Discharge No evidence of inflammatory arthritis MSK US Clinical assessment Diagnosis clear Diagnosis unclear

What to do when it is not clear

1 Normal scan 3 Erosion 2 Synovitis 4 Osteophyte

Rheumatoid arthritis: management

• Treat aggressively and early
• Steroids
• Disease modifying drugs
• Methrexate, sulphasalzine, hydroxychloroquine
• Biologics
• The role of NICE

SLE case

• 30 year woman
• 3/12 history joint pain, small joints of hands
• Incapacitating fatigue
• Rash on face on exposure to sunlight
• Rash on hands

What is lupus?

1 Malar rash 2 Discoid rash 3 Photosensitivity 4 Oral ulcers 5 Non-erosive arthritis 6 Pleuritis/pericarditis 7 Renal disorder 8 Neurological disorder 9 Haematological order 10 Immunologic disorder 11 Positive ANA

SLE: management and outcome

• Long term treatment with immunosuppression
• ?lifelong
• Careful monitoring especially at high risk times eg

pregnancy In this case:

• Stable, chronic disease
• Working full time
• 2 children

SLE: prognosis

• Hugely improved in last 50 years but…
• 10 year survival in UK about 95%
• Which means 5% don’t survive 10 years

25

Summary

1.

Arthritis is not a diagnosis

2.

Most of our work is done in out-patients looking after inflammatory pathology

3.

We have a desperate need for a drug to treat

• steoarthritis

4.

The last 10-15 years has seen a transformation in the way rheumatoid arthritis is managed

5.

Patients often get to know us very well, and vice- versa!

Thank-you. Any questions?