Rheumatology Top Tips in General Practice

1
Rheumatology Top Tips in General Practice

• Dr Chris Deighton
• Department of Rheumatology
• Derbyshire Royal Infirmary

2
My justification for being here

• Consultant Rheumatologist 16 years
• Chairman Clinical Affairs Committee British
  Society for Rheumatology
• Clinical Advisor to the NICE RA Management
  Guidelines
• Derby County Season Ticket Holder

3
Overview

• 1 minute on preventing arthritis
• 10 minutes on OA
• 10 minutes on RA
• 9 minutes on whatever the devil you like

4
1 minute on prevention

• Regular exercise
• Keep weight down
• Ban smoking
• Change sex of half the population

5
OA

• NICE OA Guidelines 27/2/08
• Key priorities for implementation

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OA - Exercise

• Should be a core treatment irrespective of age,
  comorbidity, pain severity or disability and
  should involve local muscle strengthening and
  general aerobic fitness.

7
OA - Arthroscopy

• Lavage and debridement should not be offered
  unless there is a clear history of mechanical
  locking

8
OA - Drugs

• Paracetamol for pain relief
• Topical NSAIDs for knee or hand OA
• Then NSAIDs, COX2s or opioids
• Prescribe NSAIDs and COX2s with cheapest PPI
• The use of glucosamine and chondroitin is not
  recommended

9
RA

• NICE Guidelines
• Consultation 8 August - 3 October 2008

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RA - Referral

• Refer any person suspected of persistent
  synovitis of undetermined cause, and urgently if
• the small joints of the hands or feet are
  affected
• more than one joint is involved
• there has already been a delay of 3 months or
  longer between onset of symptoms and seeking
  medical advice.

11
RA - Early diagnosis

• People with suspected RA who are seronegative for
  rheumatoid factor should have their anti-CCP
  antibodies tested.

12
RA - Early treatment

• In people with recent onset of active RA,
  treatment with a combination of DMARDs (including
  methotrexate and glucocorticoids) should be
  offered as soon as possible, ideally within three
  months of the onset of persistent symptoms.

13
RA - Early monitoring

• In all patients with early active disease, key
  constituent parts of disease activity and CRP
  should be measured monthly (using a composite
  score such as DAS28) until an agreed level of
  disease control has been achieved by appropriate
  treatment.

14
RA - The MDT

• In order to ensure the optimal use of the MDT,
  all people with RA should have access to a named
  member of the team (e.g. the specialist nurse)
  who has been designated as the person responsible
  for coordinating the various aspects of their
  care

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Overview

• 1 minute on preventing arthritis
• 10 minutes on OA
• 10 minutes on RA
• 9 minutes on whatever the devil you like