Transcript Rheumatoid Arthritis Dr Chandini Rao Consultant Rheumatologist

Rheumatoid Arthritis
Dr Chandini Rao
Consultant Rheumatologist
Overview
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What is RA?
What causes it?
How does it present?
How is it treated?
Current concepts
Future plans
What is it?
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Chronic, progressive, autoimmune
disease
Causes inflammation in joints
(especially hands, wrists, feet)
Systemic condition
What is inflammation?
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Normal body defence mechanism
Increased blood flow
Blood cells produce chemical
messengers to continue the process
Heat, swelling, redness, pain, loss of
function
Who does it affect?
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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
What causes RA?
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Genetics
Environment
Genetics
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1st degree relative: 2-7 fold risk
Identical twin: 15% chance of RA
Need an environmental trigger as
well
Environment
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Geography
Hormones
Infection
Smoking
Diet
How does it present?
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Joint pain
Joint swelling
Morning stiffness
Fatigue
Weight loss
Flu-like symptoms
How is RA diagnosed?
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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
How is RA treated?
General Principles:
 Patient education/self-management
 Multi-professional team care
 Medication
 Surgery
Symptomatic Treatments
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Education/support
Rest/relaxation
Joint protection
Physiotherapy
Painkillers
Anti-inflammatory drugs
Steroids
Joint injections
Pain Management Clinics
Reduction of Joint Damage
Disease-modifying drugs
(DMARDS)
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Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine
Azathioprine
Ciclosporin
Gold
Penicillamine
Biologic drugs
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Anti-TNF therapy
(Infliximab, Etanercept,
Adalimumab,
Certolizumab)
Rituximab
Abatacept
Tocilizumab
Golimumab
Goals of Therapy
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To relieve pain, stiffness, swelling,
fatigue
To prevent joint damage/disability
To improve quality of life
? To achieve disease remission
“Window of Opportunity”
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Starting disease-modifying therapy
within 12 weeks of symptom onset
significantly reduces future joint
damage
Challenges!
Early Arthritis Clinics
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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”)
Annual Review Clinics
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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
Achievements of people with RA
Thank You!