rheumatoid arthritis dr chandini rao consultant rheumatologist
TRANSCRIPT
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Rheumatoid Arthritis
Dr Chandini RaoConsultant Rheumatologist
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Overview
What is RA? What causes it? How does it present? How is it treated? Current concepts Future plans
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What is it?
Chronic, progressive, autoimmune disease
Causes inflammation in joints (especially hands, wrists, feet)
Systemic condition
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What is inflammation?
Normal body defence mechanism Increased blood flow Blood cells produce chemical messengers to continue the process
Heat, swelling, redness, pain, loss of function
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Who does it affect?
0.8% of UK population 3x more common in women Onset usually between ages 40 - 60
Approx 580,000 patients in UK 12,000 under age 16 NHS costs: £560 million/year Economy: £3.8-4.75 billion/year
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What causes RA?
Genetics Environment
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Genetics
1st degree relative: 2-7 fold risk
Identical twin: 15% chance of RA Need an environmental trigger as well
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Environment
Geography Hormones Infection Smoking Diet
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How does it present?
Joint pain Joint swelling Morning stiffness Fatigue Weight loss Flu-like symptoms
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How is RA diagnosed?
History Examination Blood tests- anaemia- raised inflammatory markers- rheumatoid factor/anti-CCP antibody
X-rays Ultrasound scan
Blood tests and X-rays may be normal in early RA
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How is RA treated?
General Principles: Patient education/self-management
Multi-professional team care Medication Surgery
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Symptomatic Treatments
Education/support Rest/relaxation Joint protection Physiotherapy Painkillers Anti-inflammatory drugs Steroids Joint injections Pain Management Clinics
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Reduction of Joint Damage
Disease-modifying drugs (DMARDS)
Methotrexate Sulfasalazine Leflunomide Hydroxychloroquine Azathioprine Ciclosporin Gold Penicillamine
Biologic drugs
Anti-TNF therapy (Infliximab, Etanercept, Adalimumab, Certolizumab)
Rituximab Abatacept Tocilizumab Golimumab
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Goals of Therapy
To relieve pain, stiffness, swelling, fatigue
To prevent joint damage/disability
To improve quality of life ? To achieve disease remission
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“Window of Opportunity”
Starting disease-modifying therapy within 12 weeks of symptom onset significantly reduces future joint damage
Challenges!
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Early Arthritis Clinics
Fast-track service to see people with suspected inflammatory arthritis within 4 weeks of referral
Strict referral criteria Investigations done at or before clinic visit
Aim to confirm diagnosis and start treatment at first visit
Monthly follow up to assess disease activity and adjust treatment accordingly (“Treat to Target”)
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Annual Review Clinics
Assess disease activity/damage Assess functional ability Check for associated conditions (heart disease, osteoporosis, depression)
Assess for complications (vasculitis, eye problems etc)
Referral to other members of MDT Assess the impact on quality of life
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Achievements of people with RA
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Thank You!