Dr. Fahim Khan MBBS,MD,MRCP(UK),FRCPLondon,FRCP Edin, FACP Rheum

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Dr. Fahim KhanMBBS,MD,MRCP(UK),FRCPLondon,
FRCP Edin, FACP Rheum

• CONSULTANT RHEUMATOLOGIST
• Aut Even Hospital, Kilkenny
• Whitfield Clinic Waterford,The
• St Francis Hospital, Mullingar,
• .
• E mail rheumatologyclinics_at_gmail.com
• .

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TYPES OF ARTHRITIS

• NON INFLAMMATORY-
• DEGENERATIVE ARTHRITIS
• (OSTEOARTHRITIS)
• INFLAMMATORY ARTHRITIS-
• RHEUMATOID ARTHRITIS
• PSORIATIC ARTHRITIS
• GOUT
• ANKYLOSING SPONDYLITIS
• ARTHRITIS ASSOCIATED WITH INFLAMMATORY BOWEL
  DISEASE
• TICK BORN ARTHRITIS---LYME DISEASE
• LUPUS ARTHRITIS AND CONNECTIVE TISSUE DISORDERS
• POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS

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Osteoarthritis
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Osteoarthritis knees
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RHEUMATOID ARTHRITIS
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Psoriatic arthritis with DIP joint involvement
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PSORIATIC ARTHRITIS
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Gout
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Gout
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Lyme Disease
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Osteoporosis
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Fibromyalgia
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Malar Rash SLE
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Vasculitis
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Raynauds---Systemic sclerosis
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DERMATOMYOSITIS
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GCA

• headache

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Rheumatoid Arthritis AND NEW TREATMENTS

• A prevalence of 0.5-1 in diverse population
  worldwide,
• Annual incidence of 0.1-0.2/1000 in males and
  0.2-0.4/1000 in females.
• Cause unknown

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Rheumatoid ArthritisSYMPTOMS

• Morning stiffness of over an hour affecting joint
• Arthritis of Hands
• Arthritis in at least three joint areas, wrists,
  fingers etc
• Symmetric arthritis
• Rheumatoid nodules

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Pain, swelling and stiffness
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RHEUMATOID HAND

• BOUTTONAIRES DEFORMITY

• SWAN NECK DEFORMITY

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RHEUMATOID ARTHRITIS MRI WRIST
COLOUR DOPPLERS SYNOVITIS
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Damage from Rheumatoid Arthritis

• Joint erosions with deformities/poor quality of
  life
• skin ulcers(leg ulcers)
• Eye complications
• Lung fibrosis
• Kidney involvement( Nephrotic syndrome-
  Amyloidosis)
• Stomach ulcers
• Anaemia, stomach ulcers, gastric bleeding
• Pins and needles hands, carpal tunnel
  syndrome,peripheral neuropathy
• And many more

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Rheumatoid Arthritis complications
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Can we prevent this damage?
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Disease modifying antirheumatic drugs
therapy(DMARDs) AND BIOLOGICS

• Methotrexate
• Sulphasalazine
• Leflunomide
• Hydroxychloroquine
• Biologics( injections)
• Anti-TNF Alpha therapy,Infliximab, Eternacept,
  Adalimumad, Golimumab.
• Anti B Cell CD 20 Ab--Rituximab
• IL-1 receptor antagonist Anakinra,Anti IL6
  therapy-- Tocilizumab
• CTL4-Ig- Abatacept disrupts CD80/86 signal
  required for T-cell activation
• And many more noval therapies to come

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Current TNF Blockers in RA
TNF THERAPY
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CURRENT APPROACH TORheumatoid Arthritis.

• Education (News papers,Journals, Radio, TV, GP ,
  Public/ Community Meetings and more Education)
• Earlier recognition of symptoms patient---GP
• Earlier referral to specialist (Rheumatologist)
• Early Arthritis clinics (AUT EVEN HOSPITAL
  KILKENNY) Aiming to see patient within one week
  of referral.
• Earlier initiation of DMARD therapy perhaps
  earlier use of Biologics
• More and more research

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Thank You

• Dr Fahim Khan
• Consultant Rheumatologist
• Suite 6, The Ballinderry Clinic
• St Francis Private Hospital, Mullingar.