Rheumatoid Arthritis

Dr Chandini RaoConsultant Rheumatologist

Overview

What is RA? What causes it? How does it present? How is it treated? Current concepts Future plans

What is it?

Chronic, progressive, autoimmune disease

Causes inflammation in joints (especially hands, wrists, feet)

Systemic condition

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

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

What causes RA?

Genetics Environment

Genetics

1st degree relative: 2-7 fold risk

Identical twin: 15% chance of RA Need an environmental trigger as well

Environment

Geography Hormones Infection Smoking Diet

How does it present?

Joint pain Joint swelling Morning stiffness Fatigue Weight loss Flu-like symptoms

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

How is RA treated?

General Principles: Patient education/self-management

Multi-professional team care Medication Surgery

Symptomatic Treatments

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)

Methotrexate Sulfasalazine Leflunomide Hydroxychloroquine Azathioprine Ciclosporin Gold Penicillamine

Biologic drugs

Anti-TNF therapy (Infliximab, Etanercept, Adalimumab, Certolizumab)

Rituximab Abatacept Tocilizumab Golimumab

Goals of Therapy

To relieve pain, stiffness, swelling, fatigue

To prevent joint damage/disability

To improve quality of life ? To achieve disease remission

“Window of Opportunity”

Starting disease-modifying therapy within 12 weeks of symptom onset significantly reduces future joint damage

Challenges!

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”)

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

Achievements of people with RA

Thank You!