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

UCLH Members Meet: Arthritis Dr Jessica Manson June 2016 Structure of talk Brief introduction to Rheumatology 1. Department at UCLH What kind of patients do we see? What is arthritis? 2. Definitions Cases Role of the


  1. UCLH Members Meet: Arthritis Dr Jessica Manson June 2016

  2. Structure of talk Brief introduction to Rheumatology 1. Department at UCLH  What kind of patients do we see?  What is arthritis? 2. Definitions  Cases  Role of the CNS 3. Research in our department 4.

  3. 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

  4. 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 Subtotals, 3 month data 1600 Diagnosis % 1400 1200 IA 40 1000 Pain/OA/ 21 HM 800 AIRD 17 600 400 Bone 12 200 Misc 10 0 Total inflamm Total AIRD Total Total bone Total misc arthritis Pain/OA/HM 5

  6. What is arthritis? 6

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

  8. 3 cases…  All presented with joint pain  Different diseases  Different management 8

  9. 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

  10. Osteoarthritis: patterns of disease http://www.arthritisresearchuk.org 10

  11. Osteoarthritis of the hand 11

  12. 12

  13. Osteoarthritis: what the patient can do  Pain killers  Work a bit  Keep active  Walking >6000 steps a day predicts good outcome over 2 years in knee OA  Lose weight  Obesity is a risk factor for OA, even in non-weight bearing joints 13

  14. 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

  15. Rheumatoid arthritis case  21 computer programmer  4 month history of pain in multiple joints  Mainly hands and knees  Early morning stiffness 4 hours  Fatigue

  16. On examination

  17. Investigations: blood tests  High inflammatory markers  But not always  Antibodies in blood  But not always 17

  18. What to do when it is not clear Clinical assessment Diagnosis clear Diagnosis unclear Inflammatory arthritis No evidence of MSK US inflammatory arthritis Start treatment Discharge

  19. 1 Normal scan 3 Erosion 2 Synovitis 4 Osteophyte

  20. Rheumatoid arthritis: management  Treat aggressively and early  Steroids  Disease modifying drugs  Methrexate, sulphasalzine, hydroxychloroquine  Biologics  The role of NICE

  21. 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

  22. 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

  23. 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

  24. 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

  25. Summary Arthritis is not a diagnosis 1. Most of our work is done in out-patients looking after 2. inflammatory pathology We have a desperate need for a drug to treat 3. osteoarthritis The last 10-15 years has seen a transformation in 4. the way rheumatoid arthritis is managed Patients often get to know us very well, and vice- 5. versa!

  26. Thank-you. Any questions?

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