Hello, my name is John Isaacs,
I'm Professor of Clinical Rheumatology
at Newcastle University, and
my presentation is on modern therapy for
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.