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 CNS 3. Research in our department 4.

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

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

What is arthritis? 6

Arthritis Inflammatory Autoimmune Rheumatoid Spondylo- Crystal rheumatic arthritis arthropathy arthropathy 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

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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

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

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

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 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!

Thank-you. Any questions?