Arthritis

1. Arthritis Cause and Cure

2. What is Arthritis? • Inflammation of a joint • Wear or damage • Inflammatory – RA, acute arthritis, gout • Infection

3. A Normal Joint

4. Osteoarthritis

5. Osteoarthritis • 8.5m people affected in UK • 1 in 10 have major disability • Age, increases with greater age • Genetics, in some • Obesity predisposes, loading • Women > men • Previous injury or damage • Occupational Overuse – footballers, athletes, pneumatic drills

6. Osteoarthritis • Cartilage becomes damaged and worn • Bone then becomes damaged • Osteophytes • Soft tissues become inflamed

7. Osteoarthritis • Pain and stiffness – worse in mornings, eases as day goes on • Limitation of full movement • Joints look bigger • Redness and swelling can occur but often sign of other types of arthritis

11. Osteoarthritis - Treatment • No Cure • Understand the disease • Reduce pain and stiffness • Maintain or improve mobility of affected joint or joints • Limit joint damage • Minimise disability • Minimise side effects

12. Osteoarthritis - Treatment • Exercise • Weight control • Shoes, insoles and other devices • Walking aids • Physio • OT

13. Osteoarthritis - Treatment • Paracetamol • Anti-inflammatories • Codeine • Steroid Injection • Surgery • Herbal creams and gels/diet

17. RheumatoidArthritis

18. Rheumatoid Arthritis • About 1 in 100 people • Can happen to anyone, not hereditary • Any age, most commonly between 40 and 60 • Women:men, 3:1

19. Rheumatoid Arthritis • Autoimmune disease • Immune system makes antibodies against tissues of the body • Trigger not known • In RA, antibodies formed against the synovium • This causes inflammation in and around joint • Over time inflammation causes damage to joint, cartilage and bones in joint.

20. A Normal Joint

21. Rheumatoid Arthritis • Commonly affects small joints of fingers, toes, wrists and ankles • Knees commonly affected • Less commonly, hips, shoulders, elbows and neck • Usually symmetrical • Can be few joints or multiple

22. Rheumatoid Arthritis • Pain, stiffness (particularly in the morning), swelling • Small painless nodules, particularly elbows and forearm (1 in 4) • Inflammation around tendons • Anaemia and tiredness • Fever, feeling unwell, weight loss and muscle aches • Inflammation in other organs – lungs, heart, eyes, arteries – potentially serious

23. Rheumatoid Arthritis • Diagnosed by symptoms and signs • Blood test – rheumatoid factor, positive in 2 out of 3 with RA – seropositive. 1 in 3 seronegative. • Raised inflammatory markers • X-ray of joints

26. Rheumatoid Arthritis - Complications • Higher risk cardiovascular disease (heart attack, angina, stroke) – reduced exercise, raised BP • Anaemia – medication (NSAIDs, steroids) • Infections (joints and elsewhere)- immunosuppression, steroids • Osteoporosis – drugs especially steroids, poor mobility • Tendon rupture • Carpal tunnel syndrome • Cervical myelopathy – dislocation of joints at top of spine causing pressure on spinal cord • Vital to start treatment early

27. Rheumatoid Arthritis - Treatment • Decrease disease activity as much as possible to reduce joint damage • Reduce pain and stiffness • Minimise disability caused by pain, stiffness and joint damage • Treat other symptoms of the disease • Reduce the risk of developing associated conditions such as cardiovascular disease and osteoporosis

28. Rheumatoid Arthritis - Treatment • Disease modifying anti-rheumatic drugs (DMARDs) • Block different chemicals in the inflammatory process • Methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, azathioprine, ciclosporin, mycophenolatemofetil (MMF) • Start as soon as possible, often 2 or more in combination • Can have serious side effects (liver, kidney, bone marrow) and need to be monitored closely • Can take weeks or months to be effective and treatment usually lifelong

29. Rheumatoid Arthritis - Treatment • Biologicals – cytokine modulators, monoclonal antibodies • Adalimumab, certulizumabpegol, etanercept, golimumab, infliximab, anakinra, abatacept, rituximab, tocilizumab • Mimic antibodies and produced by cloned human white blood cells • Typically block TNF-alpha (anti-TNF) an important chemical in the inflammatory pathway • Very expensive, have to be given by IV injection • After minimum 2 trials of DMARDs and have to be approved by CCG

30. Rheumatoid Arthritis - Treatment • Rest during flare-ups, splinting, heat, gentle massage, footwear • NSAIDs, ease pain stiffness and inflammation, but can cause GI bleeding, kidney problems and hypertension, usually prescribed with PPI to protect stomach • Painkillers, paracetamol and/or codeine • Steroids, either as short courses of tablets or as injection into inflamed joint

31. Rheumatoid Arthritis - Treatment • Try to keep active, maintain muscle tone and bulk to maintain function • Physiotherapy – maintain mobility, strengthen joints, provide splinting • OT – aids to daily activities • Surgery – joint replacement, correction of deformity • Treat complications

32. Rheumatoid Arthritis - Treatment • Try to reduce risks of associated diseases • Diet • Lose weight • Stop smoking • Dental hygiene – increased incidence of RA in people with gum disease, treating gum disease reduces activity of RA

33. Rheumatoid Arthritis • Prognosis improving • 2 in 10 relatively mild disease • 1 in 10 severely disabled • Remainder somewhere in between – may need to modify lifestyle but can lead full life