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The Back Pain Maze

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By Dr Irwin Lim, Rheumatologist

You’re going to hear a lot about this from me in the next couple of weeks.

It starts now.

DTYBOI Logo

http://www.dontturnyourbackonit.com.au

A consumer awareness campaign to drive awareness and earlier diagnosis of Ankylosing Spondylitis (spondyloarthritis).

This week, GPs are being mailed information regarding this. The Back Pain maze is highlighted.

I hope you find this visual as striking as me. What do you think?

Back Pain Maze

http://www.dontturnyourbackonit.com.au

 
 
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
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Did you know these weighty facts about Psoriatic Arthritis?

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Hobart: view from our apartment

Hobart: view from our apartment

By Dr Irwin Lim, Rheumatologist

2 weekends ago, 11 from our clinic were in Hobart attending the Australian Rheumatology Association’s Annual Scientific Meeting.

It’s always an enjoyable meeting where familiar faces and a general sense of camaraderie abound.

There was a great session updating us on Psoriatic Arthritis (PsA). There is a lot of scientific buzz around psoriasis and psoriatic arthritis, with a range of interesting and useful-looking medication therapies in the pipeline.

What I want to highlight however is a range of facts I gleaned from the talk by Professor Christopher Ritchlin. He hails from Rochester, USA and is a world expert.

His talk focussed on the link between obesity and psoriatic arthritis. Here are some interesting tidbits:

  • Using a definition of body mass index (BMI) >30 kg/sq.m, around 37% of those suffering with PsA are obese while 29% with psoriasis are obese.
  • Obesity seems to be a state of non-resolving inflammation. Adipocytes (fat cells) release chemicals called cytokines which seem to draw immune cells into the adipose tissues from the blood stream. This in turn leads to an increase in pro-inflammatory cytokines, driving the inflammatory process.
  • Having a higher BMI seems to also lead to a higher incidence of Psoriatic Arthritis. BMI > 35 leads to a relative risk of between 1.48 – 2.7 of developing PsA.
  • PsA seem to be an independent risk factor for cardiovascular risks. This means that having PsA increases your risk of heart attacks or strokes over and above the standard risk factors of high lipids or high blood pressure, diabetes, etc.
  • Rheumatoid arthritis (RA) is known to increase cardiovascular risks significantly. The CVS risk of PsA is thought to be similar to that of RA.
  • Metabolic Syndrome (the combination of insulin resistance, obesity, dyslipidemia and hypertension) is found in twice as many patients with PsA compared to RA.
  • Obese patients are significantly less likely to achieve a state of Minimal Disease Activity.
  • Importantly, weight loss actually improves the ability to control disease activity. In a study involving 138 obese PsA patients starting TNF-inhibitor therapy, those patients who managed to lose >10% of weight at 6 months, were 4.8 times more likely to achieve a Minimal Disease Activity state. Therefore, weight loss enhances the response to TNF inhibitor therapy.

It’s easy to link excess weight to back, knee and lower limb pain. Patients understand the physics of carrying this extra baggage and it’s biomechanical load on these areas. I think it’s widespread knowledge that obesity predisposes to cardiovascular risks. But in many, this information still does not seem enough to engender lifestyle change.

Maybe, we rheumatologists need to spend more time explaining how weight affects the actual disease process in PsA. Maybe we need to highlight that reducing weight improves response to treatment.

So much attention is placed on therapeutics and rightfully so, given the disease process needs to be controlled. But we just don’t seem to address obesity effectively in our patients with rheumatic disease.

We can do better. We need to do better.

What do you think I could say or do to help this process?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Low dose Methotrexate: Myths & Realities

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By Dr Irwin Lim, Rheumatologist

My rheumatology colleagues, Phil Robinson (follow him at @philipcrobinson) and Claire Barrett, are passionate about tackling the misinformation regarding methotrexate.

This misinformation comes from doctors, patients, “helpful” relatives & friends, nurses and pharmacists.

I had already written about this a number of times, and you can read my posts on Methotrexate by clicking this link.

In an effort to try to educate people about low dose methotrexate and to dispel the myths which circulate. we wrote an article that has been published this month in Australian Pharmacist called: “The Safety and Handling of Low Dose Methotrexate: Myths and Realities”.

Phil is highlighting it on his blog (http://arthritiskare.com) as I am, on this blog.

Please help us spread the message. Tweet this, Share it, Email it. Thank you.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Our workflow for newly diagnosed Rheumatoid

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By Dr Irwin Lim, Rheumatologist

This is a quick follow up to the last post, as a response to requests to see our flowchart for a newly diagnosed rheumatoid arthritis patient.

How much disease education is too much?

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By Dr Irwin Lim, Rheumatologist

Our clinic’s been developing more and more resources for patient education.

A person given a serious diagnosis of a chronic, life-changing disease such as rheumatoid arthritis (RA) or ankylosing spondylitis (AS) needs to be supported.

We believe that treatment decisions, especially difficult ones, become a little easier to make and agree on, if the persons involved have understanding and insight into their diseases.

So, front up, from the point of diagnosis, information needs to flow.

But, is too much information a problem?

There’s so much to consider.

Different people want different amounts. People process info differently. Some like to read, some don’t. Some prefer video or audio. Some just want to be told.

While it’s easy to assume healthcare providers can just tailor what education they provide to the individuals, it’s not so easy in a real life setting.

We have protocols and pathways that we tend to default to. To be efficient. To not forget stuff we would like to get done.

I thought I’d share what I would do for a typical new RA diagnosis.

In the consultation room, my patient will receive a folder containing a variety of printed sheets about the disease and possible treatments. It includes a simple workflow diagram showing the treatment path we will likely follow. A plan of attack, so to speak.

Folder

Disease sheets

 

After they’ve left my room, my patient will get an introductory email from our rheumatology care coordinator, Flora, with appropriate weblinks:

RCC 1st email

The patient is also booked in for a face-to-face session with Flora to run through key concepts and to help the person navigate the health maze.

And of course, there is phone access, email contact and follow up appointments.

My worry is that we’re providing too much in too short a time. Does too much lead to turn off?

There must be ways to improve this information dissemination, such as closer links to patient support groups. In a reasonably cost/time effective way.

I’d love to hear your ideas.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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