Dr moorthy arthritis awareness clash ppt 2011 2


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  • 1. Singh O. Epidemiology of rheumatic diseases. Rheumatology . 2000;39(suppl 2):3-12. 2. Macgregor AJ, Skillman AJ. Classification and epidemiology. In: Klippel JH, Dieppe PA, eds. Rheumatology . Vol 1. 2nd ed. London, UK: Mosey; 1998:2.1-2.6. Almost 30% of people give up work with a year Prevalence 1% of adult population
  • MAYBE group the smaller numbers together ie 5-10 visits??
  • Paleopathological evidence in Mexico, not until recently found in skeletons before 1600s in Europe Tobacco from central and south America
  • Dr moorthy arthritis awareness clash ppt 2011 2

    1. 1. Dr A Moorthy MB, MRCP(UK) Rheum,FRCP Edin CONSULTANT RHEUAMTOLOGIST Have You got the - S Factor ?......
    2. 2. What is Arthritis? <ul><li>Aches and pain </li></ul><ul><li>Old age disease </li></ul><ul><li>Wear and tear </li></ul><ul><li>I am too young to get arthritis… </li></ul>
    3. 4. <ul><li>Inflammatory back pain </li></ul>
    4. 5. What is arthritis? <ul><li>Auto immune condition </li></ul><ul><li>Immune system misbehave </li></ul><ul><li>Debilitating , distressing , long term condition </li></ul>
    5. 6. Arthritis….. <ul><li>Rheumatoid arthritis </li></ul><ul><li>Osteo arthritis </li></ul><ul><li>Ankylosing spondylitis </li></ul><ul><li>Psoriatic arthritis </li></ul>
    6. 9. NAO July 2009 <ul><li>580,000 Adults with diagnosis </li></ul><ul><li>26,000 new cases every year </li></ul><ul><li>Delay in seeking help </li></ul><ul><li>1/3 -1/2 3 months before see GP </li></ul><ul><li>GP referral 4 visits </li></ul><ul><li>First three months crucial </li></ul>
    7. 10. NICE RA <ul><li>1.5 men and 3.6 women developing RA per 10,000 people per year. </li></ul><ul><li>12,000 people developing RA per year in the UK. </li></ul><ul><li>RA is two to four times greater in women than men. </li></ul>
    8. 11. RA <ul><li>1/3people stop work within 2 years of onset, and this prevalence increases thereafter. </li></ul><ul><li>Cost estimated at between £3.8 and £4.75 billion per year. </li></ul><ul><li>Clearly this disease is costly to the UK economy and to individuals. </li></ul>
    9. 12. Long term prognosis <ul><li>29% at yr 1, 40% yr 5 have to give up work </li></ul><ul><li>80% disabled by yr 20 </li></ul><ul><li>Joint replacement in 25% of patients </li></ul><ul><li>Reduced life expectancy** </li></ul><ul><li>- infections </li></ul><ul><li>- malignancy?/ lymphoma </li></ul><ul><li>- accelerated atherogenesis </li></ul><ul><ul><li>**Vandenbroucke et al 1984 </li></ul></ul>
    10. 13. Burden to economy RA-Health economy <ul><li>direct costs to the NHS and associated healthcare support services </li></ul><ul><li>indirect costs to the economy, including the effects of early mortality and lost productivity </li></ul><ul><li>the personal impact of RA and subsequent complications for people with RA and their families. </li></ul>
    11. 15. Management <ul><li>Early referral </li></ul><ul><li>Early Inflammatory arthritis </li></ul><ul><li>Our mission is remission </li></ul>
    12. 16. A key element in successful patient care in RA is early recognition of the disease. Public awareness of the clinical presentation and potential consequences of a RA is still poor and many patients wait too long before presenting their symptoms to medical professionals (Westhovens et al., Belgian 2005 data, unpublished).
    13. 17. Management <ul><li>Early referral </li></ul><ul><li>Early Inflammatory arthritis </li></ul><ul><li>Our mission is remission </li></ul>
    14. 18. Understanding of the disease
    15. 19. Introduction <ul><li>National Audit Office (2009) </li></ul><ul><li>Efficiency and effectiveness of services for people with Rheumatoid Arthritis (RA) in England </li></ul><ul><li>Patients with musculoskeletal symptoms delay seeking medical attention from GPs </li></ul><ul><li>Delays in referral to rheumatologists </li></ul><ul><li>Lack of coordinated multidisciplinary services </li></ul><ul><li>No consistent support or information regarding arthritis or employment </li></ul><ul><li>NICE Rheumatoid Arthritis (2009) </li></ul><ul><li>Emphasises early referral and the importance of patient education and self-management plans. </li></ul>
    16. 20. RA -National Audit Office <ul><li>Between ½- ¾ delay seeking help </li></ul><ul><li>Patient visit GP 4 times before refer to specialists </li></ul><ul><li>Average length of time from symptom onset and treatment is 9 months </li></ul>
    17. 22. Patient Education & Awareness on Arthritis Dr Sonia Panchal Dr A Moorthy Dr A Samanta
    18. 23. GP Visits (N=56)
    19. 24. GP Visits With your symptoms, how many times did you visit your GP before a referral was made to Rheumatology? (N=110)
    20. 25. Rheumatology Referral (N=110)
    21. 26. Prescription Exemption (N=56)
    22. 27. <ul><li>Inflammatory Arthritis? Have you got the ‘S’ Factor?Stiffness - Early morning joint stiffness lasting more than 30 minutes </li></ul><ul><li>Swelling - Persistent swelling of one joint or more, especially hand jointsSqueezing – </li></ul><ul><li>Squeezing the joints is painful in inflammatory </li></ul>
    23. 29. The message to the general public <ul><li>‘ If you have any symptoms highlighted in the poster which might possibly relate to either rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, which are the three most common forms of inflammatory arthritis, then seek help from your GP, don’t delay’. </li></ul>
    24. 31. Referral for specialist treatment <ul><li>Refer urgently if any of the following apply: </li></ul><ul><li>the small joints of the hands or feet are affected </li></ul><ul><li>more than one joint is affected </li></ul><ul><li>there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice. </li></ul><ul><li>NICE guidelines 2009 </li></ul>
    25. 32. EAC: <ul><li>Symptoms present for at least 4 weeks but less than 1 year </li></ul><ul><li>Early morning stiffness of > 30 mins </li></ul><ul><li>AND ANY ONE OF THE FOLLOWING: </li></ul><ul><li>3 or more swollen joints </li></ul><ul><li>Tender/involved metacarpophalangeal joints </li></ul><ul><li>Tender/involved metatarsophalangeal joints </li></ul>
    26. 33. First, aim at remission induction as soon as possible using intensive initial treatment strategies secondly, once that objective is reached, treat to target based on disease monitoring and prompt treatment adaptation in the case of derailing
    27. 35. diagnosis
    28. 39. Early diagnosis <ul><li>Key for successful treatment </li></ul><ul><li>Better outcome for treatment </li></ul><ul><li>Less disability </li></ul><ul><li>Increase productivity </li></ul><ul><li>Increase gain to economy </li></ul><ul><li>Productivity gain </li></ul>
    29. 40. <ul><li>Referral for specialist treatment </li></ul><ul><ul><li>Refer urgently: small joints hand & feet, >1 joint, >3/12 </li></ul></ul><ul><li>Multidisciplinary Team </li></ul><ul><ul><li>Access to named member of team to coordinate care </li></ul></ul><ul><li>Diet & complimentary therapies </li></ul><ul><ul><li>No evidence – Mediterranean diet </li></ul></ul><ul><ul><li>Short term benefit </li></ul></ul><ul><li>Patient information </li></ul><ul><ul><li>Verbal & written information </li></ul></ul><ul><li>Self-management programmes </li></ul>
    30. 41. symptom <ul><li>Pain </li></ul><ul><li>Stiffness </li></ul><ul><li>Swelling </li></ul><ul><li>Unwell </li></ul>
    31. 42. Diagnosis <ul><li>Specialist -- Rheumatology </li></ul><ul><li>Long- term treatment </li></ul><ul><li>New modality </li></ul><ul><li>Blood tests </li></ul><ul><li>Scan the joints </li></ul>
    32. 43. Understanding of the disease
    33. 44. Management <ul><li>Early referral </li></ul><ul><li>Early Inflammatory arthritis </li></ul><ul><li>Our mission is remission </li></ul>
    34. 45. Current Anti-TNF-  agents Adalimumab Human IgG1 Human Infliximab Mouse IgG1 Etanercept Human p75 Human IgG1
    35. 46. Rheumatoid Arthritis treatment targets Osteoclast Bone Complement Adapted from Arend WP, Dayer JM. Arthritis Rheum . 1990;33:305 – 15 Established Treatment Targets B cell T cell Antigen- presenting cells Synoviocytes Pannus Articular cartilage Chondrocytes Macrophage HLA -DR other cytokines IFN-  & Production of collagenase and other neutral proteases TNF  IL-1 Rheumatoid Factors, anti-CCP Immune complexes Neutrophil Mast cell
    36. 48. Tight control ……
    37. 51. There is also a need to educate medical professionals in order to facilitate the diagnostic process in the early disease phase. In several countries carefully trained patient-partners are put at the frontline of medical education, offering students and postgraduate professionals the unique opportunity of sharing patient experiences and hands on training in musculoskeletal examination.
    38. 52. Smoke gets in your joints? <ul><li>RA a modern disease </li></ul><ul><li>smoking a modern disease </li></ul><ul><li>RF more common in smokers* </li></ul><ul><li>RA risk is ‘puffed up’ in smokers* </li></ul><ul><li>RA erosions more severe in smokers, dose-dependent † </li></ul><ul><li>extra-articular features more common in smokers # </li></ul><ul><li>heavy smokers show abnormalities in circulating T lymphocytes, which may predispose to infection or malignancy </li></ul><ul><li>RA + smoking = CVS risk +++ </li></ul>D Sugiyama 2006*, KG Saag 1997 † , BM Nyhall-Walin 2006 #
    40. 54. Accelerated atherosclerosis <ul><li>Increased risk </li></ul><ul><li>Smoking </li></ul><ul><li>Annual Review </li></ul>
    41. 55. Person-centred care <ul><li>Treatment and care should take into account peoples’ needs and preferences. </li></ul><ul><li>People with RA should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. </li></ul>
    42. 58. Back pain…. <ul><li>Back pain </li></ul><ul><li>Pain better with exercise </li></ul><ul><li>Skin, eye problems </li></ul>
    43. 59. Inflammatory back pain <ul><li>Ankylosing spondylitis </li></ul><ul><li>Delay in diagnosis </li></ul><ul><li>Early diagnosis </li></ul><ul><li>Better out come </li></ul>
    44. 60. <ul><li>Inflammatory back pain </li></ul>
    45. 64. treatment <ul><li>Traditional treatment </li></ul><ul><li>Target therapy </li></ul><ul><li>New expensive drugs </li></ul><ul><li>Control the symptom </li></ul>
    46. 65. Take home messages….. <ul><li>Auto immune diseases are common </li></ul><ul><li>Better understanding </li></ul><ul><li>Target therapy </li></ul><ul><li>Emerging new treatments </li></ul>
    47. 66. Message…. <ul><li>See your doctor early </li></ul><ul><li>Early referral to specialist </li></ul><ul><li>Early treatment is key </li></ul>
    48. 68. Confused……
    49. 69. Thank you ……
    50. 70. NASS Meeting……. <ul><li>Monday Nov 14 th </li></ul><ul><li>clinical Education centre LGH </li></ul><ul><li>6- 9 PM </li></ul>