Inflammatory Illnesses

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Inflammatory Illnesses
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Aims

• Appreciate the impact of inflammatory illnesses
  on patients lives
• Know how to identify and manage common
  inflammatory disorders in Primary Care

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impact
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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

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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

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Cost of Rheumatoid Arthritis estimated at 3.8 -
4.75 billion
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• 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?

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• 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?

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• 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?

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• 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?

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• 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 Sampsons care should you
  cover?
• What 2 additional factors does the Quality
  Outcomes Framework specify that you cover?

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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
• Sjogrens Syndrome
• Polymyositis/Dermatomyositis