A short presentation aimed at primary care docs walking them through the mechanism and pitfalls in diagnosing inflammatory arthritis. Part of the Rheumatology Toolbox workshop. Stats for an irish population.
What about Xrays?• Early erosions mean trouble• Serial xrays used to monitor progression• Could wait until rheumatologist assessment
Rheumatoid Arthritis: Typical Course• Damage occurs early in most patients • 50% show joint space narrowing or erosions in the first 2 years • By 10 years, 50% of young working patients are disabled • Death comes early • Women lose 10 years, men lose 4 years Pincus, et al. Rheum Dis Clin North Am. 1993;19:123–151.
Rheumatoid Arthritis• Key points: • The sicker they are and the faster they get that way, the worse the future will be • Early intervention can make a difference • Essential to establish a treatment plan early in the disease
Results ESR normal CRP 9mg/dl Negative CCP Negative RFNo response to NSAID’s
Response to IM methyl-prednisolone in inflammatory hand pain: Evidence for a targeted clinical, ultrasonographic and therapeutic approach. Patients with inflammatory hand pain IM methylprednisolone (MP) Response (primary outcome) at 4 weeks Responders who relapsed received repeat IM MP and HCQ.Karim Z, Quinn MA, Wakefield RJ, et al Ann Rheum Dis. 2007;66(5):690-2
Results• 77% no synovitis clinically• 73% responded to IM MP• Predictors of response - US detected synovitis (p<0.001) - RF +ve (p=0.04)• 86% who remained on HCQ reported a benefit at 1yr.
ConclusionsIn inflammatory polyarthralgia• RF• steroid response may be a sign of subclinical disease• HCQ may be a valid early treatment optionRA prevention ?
Pain all over and no clues• SLE - don’t forget the ANF• Fibromyalgia• Menopausal arthralgia• Hypothyroidism• Depression / anxiety• Malignancy
The Hot knee• Septic arthritis less likely in healthy• Look for clues outside jt• In young adults think inflammatory• In middle age think inflammatory / crystal• In elderly consider everything
Inflammatory arthritis in 7 mins in general practice? in 7 mins in general practice?