Modern management of rheumatoid arthritis - with a focus on biologic therapies

Published on May 31, 2020   40 min

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Hello, my name is John Isaacs, I'm Professor of Clinical Rheumatology at Newcastle University, and my presentation is on modern therapy for rheumatoid arthritis.
There's been a revolution in rheumatoid arthritis outcomes over the last 30 years, in the image on the left is a typical rheumatoid arthritis patient from the 1990s when I started seeing rheumatoid arthritis patients, and on the right is how I would expect my patients to look today, you can see the big difference.
To understand what's going on, I wanted to talk a little bit about rheumatoid arthritis pathology. In this cartoon, the left hand side shows a normal joint, and the right hand side shows the equivalent joint in a person with rheumatoid arthritis. You can see there are two bones there and they're joined by the brown joint capsule, the yellow is the articular cartilage (the gristle), and the really important thing we're going to talk about is the synovium, or the pink line. In health you can see this membrane is quite thin, in rheumatoid it becomes a very bulky proliferating tissue, and you can see that proliferating tissue is actually invading into the cartilage and bone. In fact when we do imaging such as X-rays, MRI-scans or CT-scans, we look for erosions which are holes in the bone, as you can see indicated by the arrow, this is effectively an image of that invading synovium.
The next slide shows what you would see if you looked into a joint. On the left hand side (using an arthroscope), in a normal joint you can't see the synovial membrane, it's so thin that it's transparent and you're looking at the blood vessels underlying the synovial membrane. On the right, you can see an inflamed joint, and what you can see in this joint is that because of the proliferating bulky synovium it's now forming polyploid processes protruding into the joint. Below that you can see a more chronic picture, there's lots of fibrin and a very messy interior to that joint.

Modern management of rheumatoid arthritis - with a focus on biologic therapies

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