Inflammatory Illnesses

Aims

• Appreciate the impact of inflammatory illnesses on patients’ lives

• Know how to identify and manage common inflammatory disorders in Primary Care

impact

Impact• Common

– Gout 1.4% and RA 1% prevalence– PMR 12 new cases/yr Penistone Practice

• Disability– 30% patients with RA disabled after 10 yrs

• Premature mortality– Raised CVD risk, Temporal Arteritis associated with

vascular complications– A 50 yr old with RA dies 4 yrs earlier than a 50 yr old

without

Impact• Complications

– From the disease itself– From the medications (steroids, DMARDs)

• Psychological well-being– 13-20% patients with RA depressed– associated with level of pain, increased functional

disability,social stress and lack of social support

• Fertility– Women may take longer to conceive– Medications may affect fertility

Cost of Rheumatoid Arthritis estimated at £ 3.8 - 4.75 billion

• Mr Smith (64yrs) presents with pain in his right foot. He has Type 2 Diabetes, CKD stage 3 and drinks 34 units alcohol/week. You diagnose him as having gout.– How are you going to treat this acute flare?

• Over the next 4 months he has 4 further flares:– How will you help reduce the frequency of episodes of

gout?

• Mrs Simpson (79 yrs) presents c/o a 3 week hx of pains in both shoulders. You suspect she may have PMR and check some blood tests.– What investigations do you request?– How will you treat Mrs Simpson if ixn suggest

PMR?– Is there anything else to consider?

• Mr Senior (82 yrs) comes to see you a day after presenting to a colleague with a right sided headache. Your colleague checked some blood tests as he thought a diagnosis of GCA was a possibility: CRP 18, ESR 28. His headache has got slightly worse since then and he c/o feeling “rotten”.– What is your plan?

• Miss Sampson (43 yrs) presents c/o a 6 week hx of painful,stiff joints in the hands. On examination she clinically has evidence of synovitis of the small joints. She is desperate for some good pain relief as co-codamol and ibuprofen have not helped so far. You suspect she may have an inflammatory arthritis, possibly RA.– What tests might you request?– How will you treat her pain?– What referral will you make, if any, at this point?

• Miss Sampson has now been on Methotrexate for 6 months for her RA and has attended today for her Annual Review.– What aspects of Miss Sampson’s care should

you cover?– What 2 additional factors does the Quality

Outcomes Framework specify that you cover?

Match the antibody to the illness

• dsDNA• Jo-1• Ro (SS-A)• La (SS-B)• Sm (Smith)• Anti-CCP• Scl-70/Centromere• U1RNP

• Scleroderma• Rheumatoid Arthritis• SLE• Mixed Connective

Tissue Disease• Sjogren’s Syndrome• Polymyositis/

Dermatomyositis