(精选)Rheumatology教学课件.pptVIP

Do not put off referring a patient with persistent synovitis to a specialist if the bloods and x-rays are normal- these tests can be normal in early RA If symptoms have been present already for more than 3 months, reactive arthritis is unlikely and further delay affects outcome, so refer immediately Single joint pain – not NICE guidance Should be referred to Rheumatology if inflammatory Early morning stiffness 30 minutes, or Boggy swelling suggesting synovitis, or Raised inflammatory markers eg PV/CRP Any of these features is significant Psoriatic arthritis often presents with a mono-arthritis- personal or FH of Psoriasis? Disease modifying agents(NICE CG79) Offer a combination of disease-modifying anti-rheumatic drugs (DMARDs) in people with newly diagnosed active RA, (including methotrexate and at least one other DMARD, plus short-term glucocorticoids) as soon as possible, ideally within 3?months of the onset of persistent symptoms. Start DMARD monotherapy in people with newly diagnosed RA for whom combination DMARD therapy is not appropriate. Disease modifying agents(NICE CG79) Cautiously reduce drug doses to levels that maintain disease control in people with recent-onset RA receiving combination DMARD therapy in whom disease has been controlled ie those who have gone into remissison. In people with recent-onset active RA measure: - C-reactive protein (CRP) - key components of disease activity Do this monthly until disease controlled to level agreed with the person with RA Monitoring disease (NICE CG79) This implies treating to a target Disease Activity Score (DAS28)- composite outcome measure of tender joints, swollen joints, patient’s global assesment of their condition, and CRP Please measure CRP rather than PV with monitoring bloods Target should be agreed with the patient at the start of treatment by the rheumatologist People’s expectations are low and they are often grateful for any reduction in symptoms DAS28 Greater than 5.1 – high disea