rheumatology - the future...complex regional pain syndrome fibromyalgia foot pain gout joint...

Rheumatology - The Future

Dr Jeremy McNally MBBS, BSc (Hons), FRCP

Consultant Rheumatologist

The Royal Berkshire NHS Foundation Trust

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Rheumatology

− Multisystem disease ‘last of the general physicians’

− Multidisciplinary specialty (Nurse, physiotherapist, OT)

− Rapidly expanding field early diagnosis and treatment

− New targeted treatments in development

− Treatment allows patients to keep active and working

Navigating the Arthritis Maze

Ankylosing spondylitisAntiphospholipid syndromeBack painBehçet's syndromeCalcium crystal diseases (pseudogout)Carpal tunnel syndromeComplex regional pain syndromeFibromyalgiaFoot painGoutJoint hypermobilityJuvenile idiopathic arthritis (JIA, arthritis in

childhood)Knee painNeck painLupus

Osteoarthritis

Osteoarthritis of the knee

Osteomalacia (soft bones)

Osteoporosis

Paget's disease of bone

Patellofemoral pain syndrome

Polymyalgia rheumatica (PMR)

Polymyositis and dermatomyositis

Psoriatic arthritis

Raynaud's phenomenon

Reactive arthritis

Rheumatoid arthritis

Scleroderma

Shoulder pain

Sjögren's syndrome

Tennis elbow

Vasculitis

A to Z of Arthritis

Navigating the Arthritis Maze

What causes arthritis?

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Why me?

Genetics

Hormones

Environment

• Smoking

• Diet

Infection

• Viruses

Navigating the Arthritis Maze

Rheumatoid arthritis

• Chronic inflammatory arthritis

• Affects 0.8-1.0% of the population in the UK

• 3 times commoner in women

• Can affect any age - usually starts 40-60 years

Navigating the Arthritis Maze

‘Is it in the genes ?’

Navigating the Arthritis Maze

Christian Barnard (1922 – 2001)

Navigating the Arthritis Maze

Renoir (1841 – 1919)

Navigating the Arthritis Maze

What about smoking?’

Increases the risk of developing severe RA

Navigating the Arthritis Maze

‘Is it from what I eat?’

Mediterranean diet is protective

Navigating the Arthritis Maze

Navigating the Arthritis Maze

‘What about exercise?’

Navigating the Arthritis Maze

− Pre-clinical Disease

− Acute inflammation

− Persists, spreads, damages

− Chronic Disease – DAMAGE and DISABILITY

Rheumatoid arthritis

Early Treatment

Navigating the Arthritis Maze

Navigating the Arthritis Maze

The S factor

Navigating the Arthritis Maze

Early Arthritis

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Wallingford

Newbury (WBCH)

Townlands (Henley)

Woosehill (Woklingham)

Royal Berkshire Hospital(Reading)

Rheumatology Clinics`Care Closer to Home’

Navigating the Arthritis Maze

Adapted from: van der Heijde D. Ann Rheum Dis. 2001;60:iii47-iii50.

Disease Activity

Disability

Structural Damage

Reduce

Decrease

Prevent

Goals of Management in RA

Navigating the Arthritis Maze

The Evolving management of RA

“Rheumatism”(Guillaume de

Baillou)

“Rheumatoid Arthritis”(Sir Alfred

Garrod)

1591

1680s 1860sa

1859a

QuinineWillow Bark

1890sa

Manufactured Aspirin

1920s

Gold Injections

1940s

Steroids

1980s

Methotrexate(MTX)

1990s

Biologics

aAppelboom T. Rheumatology (Oxford). 2002;41(suppl 1):28-34.

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Anti-TNF alpha treatment (biologic therapy)

Navigating the Arthritis Maze

Navigating the Arthritis Maze

Navigating the Arthritis Maze

• Increase public awareness

• Early detection and aggressive treatment

• Remission is the mission (DMARDS/Biologics)

• ‘Personalised’ medicine (targeted therapies)

Summary

Navigating the Arthritis Maze

Thank you.

Dr Jeremy McNallyConsultant Rheumatologist

Royal Berkshire NHSFTWest Berkshire Community Hospital

0118 322 6559Ms Beverley Wright

jeremy.mcnally@royalberkshire.nhs.uk

Navigating the Arthritis Maze