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On the front foot to assess Rheumatoid arthritis

Vital research into Rheumatoid Arthritis at TQEH will help patients get better treatment.

A/Prof Catherine Hill (left) and Ms Sue Lester assess an x-ray of Arthritis in feet joints.

Have you ever thought of Rheumatoid arthritis as a life-threatening disease? Unfortunately it is. But over the last decade dedicated research has enabled a revolution in the management of this condition.

"Rheumatoid arthritis causes continual inflammation of the joints and studies have shown that if untreated or poorly treated, people do sadly die at a much earlier age, particularly of cardiovascular diseases," said Dr Maureen Rischmueller, Rheumatology Department Director at The Queen Elizabeth Hospital.

"The continued inflammation throughout the whole body has a negative effect on blood vessels, increasing peoples' risk of heart attack and stroke," she said.

Rheumatoid arthritis is not only life threatening, it's extremely debilitating. The continual inflammation invades the bones and cartilage around joints causing them to dislocate and fuse. Over time this leads to reduced mobility and day to day activities like dressing, showering, toileting and walking become very difficult or impossible.

"Through research, we now understand the importance of early diagnosis and treatment to prevent both disability and other serious complications such as lung and heart problems. With early and ongoing management of Rheumatoid arthritis, people can expect to live a normal life."

However, research at The Queen Elizabeth Hospital, in collaboration with Rheumatologists at the Royal Adelaide Hospital, has recently found that the most common measuring tools used to evaluate the effects of treatment regimes in clinical practice are unsuccessful at detecting continued presence of Rheumatoid arthritis in a significant number of patients.

"There are a lot of different elements which you need to carefully assess in Rheumatoid arthritis patients to see if their current treatment is working. In order to streamline this process, a number of composite scores, such as the DAS28, CDAI and SDAI, have been developed and tested by rheumatologists around the world. These scores are used to assess if patients are in remission, which is the aim, or if they have low, moderate or high disease activity, which informs the treatment plan they need."

These composite scores largely neglect counting sore and swollen joints in the feet. TQEH's team therefore suspected that some patients with Rheumatoid arthritis in the ankles and feet might be falsely assessed as being in remission, and therefore not be given the treatment needed to prevent permanent damage and disability. The study at TQEH was designed to compare the accuracy of the DAS28, CDAI and SDAI to other more stringent criteria for Rheumatoid arthritis disease remission.

"The study found that 20-30% patients classified as being in remission by the DAS28 actually had active arthritis in about four joints in their feet. They weren't getting the right treatment and their arthritis was still having a negative effect on their quality of life," said Sue Lester, a Chief Medical Scientist working on the project.

"This research is very important because many doctors and Rheumatologists have been confidently using this score thinking they are doing right by their patients, when in actual fact they aren't," said Ms Lester.

TQEH Rheumatologist A/Professor Catherine Hill said "this research has informed local and international clinicians that they need to use a more comprehensive, sensitive tool to evaluate their patients."

The importance of TQEH rheumatology teams’ findings was reflected by their article making headlines in both national and international Rheumatology Updates and Websites. The teams' important findings and recommendations will lead to improved use of medications to improve patients’ quality of life, and help them live more happily and healthily for longer.

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