1. Rheumatology What we do & How to help Ronan Mullan

2. Role of A Rheumatologist Rheumatologist General Practice Hospital Doctors A&E Government Diagnose & Treat Service development Research Advocacy YOU!

3. Goals of Rheumatology Treatment Rheumatologist referrals Inflammatory Diseases ↑ Mortality ↑ Morbidity Non inflammatory Diseases No Mortality limitied Morbidity Managed with you long- term by a Rheumatology Multidisciplinary Team Managed by primary care with input/advice From Rheumatology Multidisciplinary Team YOU!

4. Managing Inflammation Inflammation Can be good and bad Activation of the Immune System Vital in fighting infection & Wound Repair Influenza Acute Immune Activation against FLU Muscle Ache / Joint Pain Low Energy Fatigue / Weight loss Destruction of Virus! Rheumatoid Arthritis Chronic Immune Activation against Joints Muscle Ache / Joint Pain Low Energy Fatigue / Weight loss Chronic Destruction of Joints Return to Health Chronic Progressive Illness

5. Problems with Chronic Inflammation Leads to long lasting permanent effects Increased risk of catching infections Increased rates of coronary vascular disease Increased Insulin Resistance Reduced Muscle mass, physical weakness Osteoporosis All can be prevented with Timely Diagnosis and Treatment

6. <2.6-3.2-5.1>5.1 DAS28 HOMA-IR * RA disease activity causes chronic insulin Resistance 3.3

7. Rheumatoid Arthritis Psoriatic Arthritis Ankylosing Spondylitis Reactive Arthritis Lupus Vasculitis Polymyalgia Rheumatica InflammatoryNon Inflammatory Gout Pseudogout Osteoarthritis Tendonopathies Fibromyalgia Nerve Entrapment (sciatica – Carpal Tunnel Syndrome) Back Pain – Fracture due to Osteoporosis, Osteoarthritis etc

8. How to see & Treat Everyone Rheumatologist Nurse Specialist Clerical GP Occupational Therapist Physiotherapist

9. How you can spot Inflammatiom INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone

10. How you can spot Inflammatiom INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone

11. INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone How you can spot Inflammatiom

12. INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone How you can spot Inflammatiom

13. INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone RA How you can spot Inflammatiom

14. INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone OA How you can spot Inflammatiom

15. INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynauds/PsoriasisNone How you can spot Inflammatiom

16. INFLAMMATORYNON INFLAMMATORY Speed of OnsetRapid (days / weeks)Gradual (years) ProgressionMay be RapidGradual (Years SwellingPuffy - TightNone or Boney (OA) Pattern of JointsVariableUsually Use Dependent Morning StiffnessMore Than 30 minutesLess Than 30 minutes Skin ChangesRashes/Raynaud/PsoriasisNone How you can spot Inflammatiom

21. What you can do to help Improve recognition of disease early Get patients to the Rheumatology Clinic Blood Tests (ESR, CRP) Antibody Tests (RF, CCP, ANA) Radiography and Ultrasound examinations

22. Radiography

23. Ultrasound

24. Our Team Rheumatologists Nurse Specialist Clerical Occupational Therapist Physiotherapist Musculoskeletal Triage Specialist

25. Our Services Musculoskeletal Triage Assessment Service Rheumatology Early Arthritis Service New and Return OPD Tallaght appointments Joint Injection Service NGH OPD Referral for Further Specialist services in Tallaght Hospital

26. referral Early Arthritis Clinic Early Arthritis Clinic Rheumatology OPD Rheumatology OPD Diagnose & Establish Multidisciplinary Care Pathway Diagnose & Establish Multidisciplinary Care Pathway Discharge MSK Triage Service Diagnose & Establish Multidisciplinary Care Pathway Diagnose & Establish Multidisciplinary Care Pathway Discharge with Plan Refer to Specialist Inflammatory Non-Inflammatory

27. Diagnosis Education / Literature DMARD Therapy Diagnosis Education / Literature DMARD Therapy Rheumatology CNS Clinic PhysiotherapyOccupation al Therapy Rheumatology CNS Clinic PhysiotherapyOccupation al Therapy Medics CNS / Medics Medics 0 6/52 3/12 6/12 9/12 12/12

28. Timely Diagnosis is Important Early Diagnosis < 6 months Reduced need for Medical Therapy Increased Rates of Remission Prevention of Permanent Joint Damage Functional Independence Prevention of consequences of long term inflammation