1. Dr. Fahim Khan MBBS,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@gmail.com.

2. 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

4. Osteoarthritis

5. Osteoarthritis knees

6. RHEUMATOID ARTHRITIS

7. Psoriatic arthritis with DIP joint involvement

8. PSORIATIC ARTHRITIS

9. Gout

10. Gout

12. Lyme Disease

13. Osteoporosis

14. Fibromyalgia

16. Malar Rash SLE

17. Vasculitis

18. Raynauds---Systemic sclerosis

19. DERMATOMYOSITIS

20. GCA ► headache

21. 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

22. Rheumatoid Arthritis SYMPTOMS ► 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

23. Pain, swelling and stiffness

24. RHEUMATOID HAND BOUTTONAIRES DEFORMITY SWAN NECK DEFORMITY

26. RHEUMATOID ARTHRITIS MRI WRIST COLOUR DOPPLERS SYNOVITIS

27. Damage from Rheumatoid Arthritis Joint erosions with deformities/poor quality of life skin ulcers(leg ulcers) 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

29. Rheumatoid Arthritis complications

30. Can we prevent this damage?

31. 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

32. Current TNF Blockers in RA TNF THERAPY

33. CURRENT APPROACH TO Rheumatoid 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

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