1 / 13

Inflammatory Rheumatic Diseases in the Elderly

Inflammatory Rheumatic Diseases in the Elderly. Bhaskar Dasgupta MD, FRCP Consultant Rheumatologist, Honorary Professor, Essex University Southend University Hospital Email: bhaskar.dasgupta@southend.nhs.uk. Polymyalgia rheumatica One of commonest inflammatory disease of the elderly

alban
Download Presentation

Inflammatory Rheumatic Diseases in the Elderly

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Inflammatory Rheumatic Diseases in the Elderly Bhaskar Dasgupta MD, FRCP Consultant Rheumatologist, Honorary Professor, Essex University Southend University Hospital Email: bhaskar.dasgupta@southend.nhs.uk

  2. Polymyalgia rheumatica One of commonest inflammatory disease of the elderly Commonest indication for long term steroid therapy in the community Wide variation of practice Diagnostic uncertainty Many causes of prox pain & stiffness Systemic symptoms APR – many causes Association with GCA Steroid response

  3. Healthcare burden of PMR GPRD database Incidence in England 8.4 per 10,000 person-years Prevalence > 50 years estimated at 739 per 100,000, with higher prevalence in females Associated with a significant incremental cost of $2,233 at the 10th percentile of costs and $27,712 at the 90th percentile Mainly for co-morbid CVS conditions, hospital stays , Imaging More likely to have: a history of myocardial infarction (odds ratio [OR]: 1.78, 95% CI: 1.13, 2.82) peripheral vascular diseases (OR: 2.21, 95% CI: 1.37, 3.60) cerebrovascular diseases (OR: 1.60, 95% CI: 1.08, 2.39) Dasgupta et al Handbook of Disease Burden Springer Science 2010 Chapter 233

  4. Large Vessel Arteritis • Giant cell arteritis - Common in the West, uncommon in India • Takayasu’s aorto-arteritis - Has predilection for certain geographical areas I.e. Japan, South-East Asia, India, South America, milder form in North America

  5. Importance of GCA • Commonest of the vasculitides • Neuro-ophthalmic complications • One of the commonest causes of acute blindness • Need for careful disease assessment to maintain an acceptable balance between risks and benefits of steroid therapy

  6. Classification criteria GCA • 1. Age at disease onset  50 years • 2. New headache -- New onset of or new type of localised pain in the head • 3. Temporal artery abnormality • 4.Elevated erythrocyte sedimentation rate  50 mm/hour • 5. Abnormal artery biopsy----Biopsy specimen with the artery showing vasculitis characterised by prominence of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells. • For purposes of classification, a patient with vasculitis shall be said to have giant cell (temporal) arteritis if at least 3 of these 5 criteria are present.

  7. Epidemiology of PMR and GCA • Age and sex are risk factors • Increasing incidence through successive decades • Female:Male = 2.5-3:1 • Common in Caucasians of Northern European origin • Rare in Asians and Afro-caribbeans

  8. Epidemiology contd • Variable incidence 9.3 -27/100,000 >50yrs • Suggestion of cyclical pattern • Association with environmental agents: adenovirus, RSV, Mycoplasma,parvovirus B19, chlamydia pneumoniae, HPIV • Chlamydia found by PCR in TA biopsies • ‘Actinic’ hypothesis

  9. Current state of practice • BSR/BHPR have published guidelines on the diagnosis and management of PMR and GCA • Guidelines have been adopted by the Royal College of Physicians • However there is still little hard data on diagnosis, course, outcomes and complications of PMR and GCA • Newly formed organisation PMRGCAUK has as its objective supporting research and increasing awareness of these conditions • Many unanswered questions remain

  10. Questions • What is the incidence of PMR and GCA in South East Essex? • What is the prevalence of PMR and GCA in SE Essex? • How are PMR and GCA managed in SE Essex? • What are the outcomes and complications of PMR and GCA in SE Essex? • What is the provision of services for these conditions?

  11. Plan • To develop a Registry for the diagnoses of PMR and GCA across SE Essex • Circulate definitions of PMR and GCA across all GP practices • Implement educational training programmes for recognition of these conditions • Develop a standardised data-gathering template for these conditions • Notification of all new PMR and GCA to central registry

  12. PMR and GCA registry • How are PMR and GCA diagnosed? • How are PMR and GCA investigated? • How are PMR and GCA managed? • Incidence of complications • Time trends • Seasonal trends • Geographical and socio-economic variation

  13. Collaboration • Between • Southend University Hospital • NHS SE Essex • ?Essex University • Work with RDS for a grant application • PMRGCAUK • Develop web-based data gathering?

More Related