1 / 32

Hot Topics in Rheumatology

Hot Topics in Rheumatology. Prof. MG Molloy. Overview. Rheumatoid Arthritis Psoriatic Arthritis Vasculitides: SLE Osteoarthritis Osteoporosis. Rheumatoid arthritis. RA is a condition involving inflammation of the joints It has the potential to result in serious joint damage

lola
Télécharger la présentation

Hot Topics in Rheumatology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hot Topics in Rheumatology Prof. MG Molloy

  2. Overview • Rheumatoid Arthritis • Psoriatic Arthritis • Vasculitides: SLE • Osteoarthritis • Osteoporosis

  3. Rheumatoid arthritis • RA is a condition involving inflammation of the joints • It has the potential to result in serious joint damage • It may come on suddenly or appear slowly over time • Its symptoms may include pain, swelling, stiffness in the joints, and general tiredness

  4. Rheumatoid Arthritis • 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 • Multiple causes • Compared to general population • Women lose 10 years, men lose 4 years

  5. Who is affected by RA? • RA is one of the most common forms of inflammatory arthritis • Affects about 1% of the world’s population • Occurs 2 to 3 times more often in women than in men • In most cases it develops between the ages of 25 and 50

  6. RA: Multisystem disease • Extra-articular: • Cardiac • coronary heart disease • Pulmonary • fibrosis • Haematological • Anaemia • Ophthalmology • Dermatology • Renal

  7. Cardiac disease in RA • Mortality in RA is unchanged in 40yrs despite DMARDS • Patients unlikely to report symptoms of angina • Not all IHD risk is due to traditional risk factors nor drugs such as Pred use, HRT DM etc • Control BP, cholesterol etc • High index of suspicion: cardiology referral

  8. Management RA

  9. Medications for RA • Nonsteroidal anti-inflammatory drugs (NSAIDs) • Corticosteroids • Disease-modifying antirheumatic drugs (DMARDs) • Biologics • Combination

  10. DMARD options • Hydroxychloroquine • Sulphasalazine • Methotrexate • Azathioprine • Slow onset, reasonably effective • Leflunomide • Pyrimidine inhibitor • Effect and side effects similar to those of MTX

  11. DMARDs Combination or monotherapy • No superiority of traditional combination DMARD therapy over monotherapy • Some trials did not control for glucocorticoid use • Review of studies since 2000 have shown that step-up therapy of Leflunomide +MTX is superior but, with significant toxicity

  12. Methotrexate • Commonest DMARD • 30 year experience • Monitoring: monthly FBC, ESR, CRP, Bioprofile, LFTs • Complications: • Haem:Neutropenia, thrombocytopenia, ? Leukemia • Liver dysfunction

  13. New Biologics • Infliximab ( chimeric monoclonal antibody to TNF) • Etanercept (soluble TNF receptor) • Adalimumab (humanised monoclonal antibody to TNF) • Rituximab (anti-CD 20 ) • Anti-Interleukin 6 (in clinical trials for JRA)

  14. Biologic agents in RA • Indication: Refractory RA • Prior to commencing: CXR, Mantoux • Contraindications/Precautions: • Previous TB, COPD, Chronic infections, HIV

  15. Biologic agents in RA • Monitoring: • Monthly bloods: FBC, ESR, CRP, Bioprofile • Regular physical examination • Beware infection • NB: Normal WCC, ESR, CRP does not exclude infection

  16. New drugs • Rituximab (anti- CD 20)- in use • Epratuzumab anti-CD22 – better risk profile than ritux • Anti-CD4 – was good but CD4 counts dropped so low trials stopped • Efalizumab – anti-CD11a –used in psoriasis, no good in PSA • CTLA4-Ig (in trials)- binds CD80/86 and blocks cell activation • Alefacept- binds LFA-3 • Anti-RANKL • SOCS • IL1-trap • Anti-IL6 receptor antibody • Soluble IL-15 receptor antagonist – 62% ACR 20 scores in high dose group • Other targets – IL-12, IL-17, IL-18, IL-23, IL-27,IFN alpha and gamma

  17. Summary RA • RA – early treatment = better outcome • MTX good monotherapy in many patients • Combo therapy of traditional DMARDs is possibly superior but conflicting studies • Biologics =higher expectations • Currently combo biologics +MTX better than biologic monotherapy • Are biologics capable of inducing remission in early disease – then do we switch to mainteance therapy with MTX – unknown yet • Anti – CCP antibody - predictor of erosive disease course

  18. Spondyloarthropathies Ankylosing Spondylitis Psoriatic arthropathy

  19. Ank Spond

  20. Ank Spond • Diagnosis: • Clinical: Backpain and stiffness: EMS • Age 20-40yrs male • Xray: late changes • Treatment: • Exercises, NSAIDS • Biologics

  21. Gout & PseudogoutCrystal arthropathies

  22. Gout uric acid deposition • Clinical • Monoarticular • The most painful arthropathy • Treatment • NSAIDS • Allopurinol: prophylaxis • Colchicine: • Nausea, vomting, diarrhoea

  23. Pseudo-gout • 2nd, 3rd MCPs, wrists, shoulders, knees, feet • Associations: • Haemochromatosis • Age • Treatment • Underlying disease • NSAIDS

  24. Vasculitides SLE

  25. SLE

  26. Management of SLE

  27. Osteoarthritis

  28. Osteoarthritis

  29. Osteoporosis

  30. Osteoporosis • Diagnosis

  31. Osteoporosis • Management

  32. Thankyou

More Related