Andrew Harrison Rheumatologist Wellington Regional Rheumatology - PowerPoint PPT Presentation

First Presentation of Joint Pain Andrew Harrison • Rheumatologist • Wellington Regional Rheumatology Unit, HVDHB • Bowen Centre, Crofton Downs, Wellington • Assoc. Prof. in Medicine, University of Otago Wellington • Clinical Leader, Research, CCDHB

Disclosures • Advisory board member for AbbVie NZ and Pfizer NZ • Research grants from Roche and Abbvie • Sponsorship to attend conferences from AbbVie, Roche and Pfizer • Consultancy work for AbbVie to develop educational materials for GPs and rheumatologists

Disclaimer • No qualifications or experience in primary care

Learning Objectives • To provide a structured approach to the assessment of new- onset arthritis • To review the important data needed to inform diagnosis and prognosis • To understand the influence of different patterns of clinical and laboratory features on diagnosis and prognosis • To recognise the cases that require urgent referral and/or treatment to optimise long-term outcome

Why Bother?

Why Bother?

Rationale for Early Immunomodulatory Treatment • In RA, early use of corticoteroids improves long-term outcome • DMARDs • reduce symptoms • reduce erosive progression • reduce need for NSAIDs and long-term corticosteroids • Early treatment associated with drug-free remission

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory • Pain helped by activity worse with activity • Stiffness prolonged short-duration • Restricted movement helped by activity fixed • Swelling soft tissue hard tissue

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal ? objective synovitis • swelling/tenderness • MTP squeeze Consider : • RA • PsA • ReA • CTD • viral • OA • haemochromatosis • vasculitis: HSP / GPA

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal Large joint / proximal ? objective synovitis • swelling/tenderness • MTP squeeze Limb girdle Consider : Consider • RA • PMR • PsA • OA shoulders/hips • ReA • soft tissue syndromes • CTD • statin myopathy • viral • RA • OA • haemochromatosis • vasculitis: HSP / GPA

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal Large joint / proximal ? objective synovitis • swelling/tenderness • MTP squeeze Limb girdle Knee/ankle Consider : Consider : Consider • RA • PMR • SpA – PsA / ReA • PsA • OA knee/ankle • OA shoulders/hips • ReA • soft tissue syndromes • sarcoidosis • CTD • statin myopathy • polyarticular gout • viral • RA • pseudogout • OA • RA • haemochromatosis • undifferentiated • vasculitis: HSP / GPA

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal Large joint / proximal Axial ? objective synovitis ? Inflammatory back pain • swelling/tenderness ? SI / heel / costochondral • MTP squeeze Limb girdle Knee/ankle Consider : Consider : Consider : Consider • RA • ankylosing spondylitis • PMR • SpA – PsA / ReA • PsA • psoriatic SpA • OA knee/ankle • OA shoulders/hips • ReA • enteropathic SpA • soft tissue syndromes • sarcoidosis • CTD • Reactive SpA • statin myopathy • polyarticular gout • viral • degenerative spinal • RA • pseudogout • OA • RA disease • haemochromatosis • non-specific back pain • undifferentiated • vasculitis: HSP / GPA

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal Large joint / proximal Axial ? objective synovitis ? Inflammatory back pain • swelling/tenderness ? SI / heel / costochondral • MTP squeeze Limb girdle Knee/ankle Consider : Consider : Consider : Consider • RA • ankylosing spondylitis • PMR • SpA – PsA / ReA • PsA • psoriatic SpA • OA knee/ankle • OA shoulders/hips • ReA • enteropathic SpA • soft tissue syndromes • sarcoidosis • CTD • Reactive SpA • statin myopathy • polyarticular gout • viral • degenerative spinal • RA • pseudogout • OA • RA disease • haemochromatosis • non-specific back pain • undifferentiated • vasculitis: HSP / GPA

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal Large joint / proximal Axial ? objective synovitis ? Inflammatory back pain • swelling/tenderness ? SI / heel / costochondral • MTP squeeze Limb girdle Knee/ankle Consider : Consider : Consider : Consider • RA • ankylosing spondylitis • PMR • SpA – PsA / ReA • PsA • psoriatic SpA • OA knee/ankle • OA shoulders/hips • ReA • enteropathic SpA • soft tissue syndromes • sarcoidosis • CTD • Reactive SpA • statin myopathy • polyarticular gout • viral • degenerative spinal • RA • pseudogout • OA • RA disease • haemochromatosis • non-specific back pain • undifferentiated • vasculitis: HSP / GPA

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

A Diagnostic Algorithm Joint symptoms ? inflammatory ? non-inflammatory ? mechanical • Pain helped by activity worse with activity ? degenerative • Stiffness prolonged short-duration ? neuropathic • Restricted movement helped by activity fixed Consider : • Swelling soft tissue hard tissue • OA • soft tissue syndromes • FMS Small joint / distal Large joint / proximal Axial ? objective synovitis ? Inflammatory back pain • swelling/tenderness ? SI / heel / costochondral • MTP squeeze Limb girdle Knee/ankle Consider : Consider : Consider : Consider • RA • ankylosing spondylitis • PMR • SpA – PsA / ReA • PsA • psoriatic SpA • OA knee/ankle • OA shoulders/hips • ReA • enteropathic SpA • soft tissue syndromes • sarcoidosis • CTD • Reactive SpA • statin myopathy • polyarticular gout • viral • degenerative spinal • RA • pseudogout • OA • RA disease • haemochromatosis • non-specific back pain • undifferentiated • vasculitis: HSP / GPA

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations

Effective Use of Investigations