Thursday, 28 May 2015

Reflections from British Society for Rheumatology Conference 2015



Reflections from the British Society for Rheumatology Conference 2015, Manchester UK

      I had the privilege of attending the recent British Society for Rheumatology AGM in Manchester, UK from the 28th -30th April. It was a privilege as this was the first time in 5 years that I was able to attend the whole conference. In years past, I had the responsibility of looking after the ward and department. So, this year was my turn to attend and I was looking forward to the attending UK's premier rheumatology gathering.
    As soon as the train passed Stockport, the weather changed from the Berkshire sunshine to the Lancashire grey and wet. I had forgotten to bring my raincoat and umbrella! Soon I was at the conference centre, all warm and dosed up with caffeine from the exhibition booths.

Manchester Central - venue for BSR 2015
          It was nice meeting up with colleagues from far and wide, sharing and discussing all things in and out of rheumatology. One of the first delegates I met was Martin Lau @ImpactSports9 . It was good to meet him in person, our previous contact was on twitter.

With Martin Lau @ImpactSports9

          The BSR 2015 app was helpful in planning the day at the conference. After poster viewing on the first morning, I attended the session on optimising service to RA patients. A very relevant session in the current NHS climate where the challenge is to deliver the best service with finite resources.


         After lunch, the next session was aptly named Jewels in the Crown. The keynote address was from Sir Mark Walport who gave an excellent review of how future healthcare will be shaped.


          This was followed by the prestigious Heberden Round which was delivered by Prof. David D'Cruz. The lecture was titled Lupus and the art of clinical medicine. The lecture kept to the high standards and tradition of William Heberden (1710 –1801), a distinguished physician.



          There was a lot of new information on the use of technology including apps and software that could be used in clinical practice. More work needs to be done to see how applicable these technologies will be. The day ended with a session on the use of such technologies and if they may break boundaries in RA care.



        The second day started with poster viewing and then the session on essentials in rheumatology. This was a session on disease assessment and management. A very practical and useful session.


        A quick dose of coffee was then followed by viewing of posters on the spondyloarthropathies. Lots on new initiatives in the area which is really exciting. The next three sessions were focused on infection,  autoimmunity and the role of the microbiome in inflammatory arthritis.



       In the afternoon, it was the turn of the second of the Heberden presentations. The Herberden Oration was presented by Prof. David Scott. A tremendous presentation on the excellent work through the years to improve RA outcomes.


         The day was finished on the high at the Conference dinner held at Old Trafford, the home to Manchester United. I took the pre-dinner stadium tour and got the see the Theatre of Dreams in a little more detail. The highlight was visiting the home team changing room and walking down to tunnel leading to the arena. We were entertained by an after dinner speech by ex-Red Devil star, Norman Whiteside.

The Theatre of Dreams

With Norman Whiteside
             The final day of the conference started with poster viewing. The next few sessions were very clinical, focusing on clinical guidelines, management and use of biologic treatments.



        Finally, to round up the conference, I chaired the Spondyloarthritis Special Interest Group Meeting. This was the last session at the conference and I was encouraged that 80 attended! We even had the main auditorium for the meeting. The speakers did an excellent job updating us on topics relevant to the area of spondyloarthritis.

          I came away from the meeting with new information that will be shared with the team as we deliver our service to patients. It was a well organised meeting and an opportunity to share and exchange information with fellow rheumatologists. I look forward to BSR Glasgow 2016.





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Sunday, 1 February 2015

The Rheumatology Voice - increasing arthritis awareness



Increasing Arthritis Awareness

Initiatives in 2014 to increase Arthritis Awareness


            The NHS landscape changed with the creation of the Health and Social Care Act 2012. This means the greater need for collaboration between GPs, specialists and patients. Together, the aim is for new care pathways that deliver benefit to patients. In arthritis, key to the success of the care pathway is the early recognition of arthritis. This is done by increasing awareness of arthritis.

The benefits of increased awareness include earlier recognition, diagnosis, referral and treatment of a potentially painful and disabling condition. Earlier diagnosis and treatment will lead to better outcomes.

All of this work would not have been possible without the help of members of my rheumatology unit and the teams involved in the many events in 2014.  This includes patient groups who have been very supportive of the drive to increase arthritis awareness.

            Over 2014, my department hosted GP events that focused on topics that included early inflammatory arthritis, polymyalgia rheumatica, osteoporosis, gout and the spondyloarthropathies. This was geared for colleagues in primary care, to increase awareness and improve referral to specialists. It is important to approach this from the perspective of GPs. A recent posting by Paula Wright in the BMJ has been helpful http://careers.bmj.com/careers/advice/advice-overview.html

            In May, I chaired an Inflammatory Back Pain (IBP) seminar for GPs, nurses and physiotherapists. This is to increase awareness of IBP which is a feature of ankylosing spondylitis (AS). The message is that not all back is the same. Early detection of AS will improve long term outcomes.


With the team at the Back Pain Seminar


            In July, there was public engagement with the ‘Don’t Turn Your Back On It’ campaign. This initiative was supported by the National Ankylosing Spondylitis Society (NASS). The team spoke to many people in Reading Town Centre on inflammatory back pain. There were acrobats to highlight the event on the day.

With Sue Hicks, Specialist Physiotherapist in Reading Town Centre


            In October, the Reading Fibromyalgia Society held their first anniversary celebration at Prospect Park Hospital in Reading. I and other members of the Rheumatology Team were able to support this. The event was attended by Alok Sharma, MP for Reading West and also by Cllr. Sarah Hacker, Reading Deputy Mayor. See their blogs on this event:

http://www.aloksharma.co.uk/content/sharma-speaks-reading-fibromyalgia-support-group-anniversary

http://www.getreading.co.uk/news/local-news/reading-fibromyalgia-support-group-marks-8135939

http://cllrsarahhacker.blogspot.co.uk/

            In November, two seminars were held to increase awareness of arthritis. A public seminar was organised by the Royal Berkshire Hospital for members on early arthritis and rheumatoid arthritis. The event was also attended by the National Rheumatoid Arthritis Society (NRAS) http://www.nras.org.uk/
With the NRAS at the Trust Public Seminar on rheumatoid arthritis

            In the same month, there was a GP teaching event on topics such as early referral to specialists, what to look out for, how to manage arthritis in primary care. There was also a practical session on how to perform the disease activity score 28 (DAS28), an outcome measure used in rheumatoid arthritis. We were supported by our local arthritis charity, Arthritis Matters for this event http://www.arthritismattersreading.co.uk/


GP Teaching event to increase awareness of arthritis

            November was a busy month as it was also the month that the National Ankylosing Spondylitis Society (NASS) organised the parliamentary event to raise awareness of the need to increase access to physiotherapy. This is the next step of the NASS As It Is campaign http://nass.co.uk/news/as-it-is---next-steps-in-the-campaign/?keywords=as+it+is


With Debbie Cook, NASS Director
At the NASS event with the team from Portsmouth

            In 2015, more such events are planned to continue the drive to increase awareness of arthritis. Rheumatology needs a voice and together, our efforts no matter how small or big, will go towards improving patient access and care. This is A Joint Venture.

@synovialjoints

Views are my own. These are opinions, not specific medical advice and cannot replace the need to see your physician for review of your individual medical condition.



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Sunday, 23 November 2014

As it Is - Back to Action at the Houses of Parliament


As It Is - Back to Action at the Houses of Parliament

In the last decade, great advance has been made in treatment of ankylosing spondylitis (AS). This has been focused on therapies such as the biologics eg. Anti-TNF. One of the cornerstones in treatment of AS remain exercise and physiotherapy. This spans the treatment pathway for AS as recommended by ASAS/EULAR.

Studies have shown that exercise in AS improves function (Passalent, 2011) (van Tubergen & Hidding, 2002). A Cochrane review suggest that an individual home-based or supervised exercise program is better than no intervention (Dagfinrud, Kvien, & Hagen, 2005). Supervised group physiotherapy is better than home exercises and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone. The benefit of group therapy may be due to both the motivation and opportunity for exercise that it provides. Both these factors are important in improving function is AS (Brophy et al., 2013). In a small study, high intensity exercise improved disease activity and reduced cardiovascular risk factors in patients with active axial SpA (Sveaas et al., 2014).

The evidence from the many studies have form the recommendations for the management of AS (Zochling, van der Heijde, Burgos-Vargas, et al., 2006). Exercise and physiotherapy forms the non-pharmacological treatments for AS  (Zochling, van der Heijde, Dougados, & Braun, 2006).

As it is, I was back at the Houses of Parliament on November 18th November 2014, to highlight the need for better access to physiotherapy for patients with AS. The event organized by NASS was hosted by Huw Irranca-Davies MP.


With the team from Portsmouth, L-R: Roger, me and physiotherapists Emma, Claire and Ronnie


With the NASS Team, Hedley Hamilton, Laura G and Laura R


With Debbie Cook, Director of  NASS


With Gillian Eames, Sebastian, Paul Curry and wife. Paul shared his story of AS.

A survey in 2013 by NASS showed that 60% of people in UK with AS do not have regular access to  physiotherapy. The evidence supports the role of physiotherapy and exercise as key to managing the condition. Physiotherapy remains one of the cornerstones of treatment for AS and is provided by 90 physiotherapy branches. Improved access to the right care for patients with AS including physiotherapy will ensure that patient remain physically active and in work where possible.

#AS_It_Is

@synovialjoints

Views are my own. These are opinions, not specific medical advice and cannot replace the need to see your physician for review of your individual medical condition.


References

Brophy, S., Cooksey, R., Davies, H., Dennis, M. S., Zhou, S.-M., & Siebert, S. (2013). The effect of physical activity and motivation on function in ankylosing spondylitis: a cohort study. Seminars in Arthritis and Rheumatism, 42(6), 619–26. doi:10.1016/j.semarthrit.2012.09.007

Dagfinrud, H., Kvien, T. K., & Hagen, K. B. (2005). The cochrane review of physiotherapy interventions for ankylosing spondylitis. Journal of Rheumatology. doi:10.1002/14651858.CD002822.pub3

Passalent, L. A. (2011). Physiotherapy for ankylosing spondylitis: evidence and application. Current Opinion in Rheumatology, 23, 142–147. doi:10.1097/BOR.0b013e328342273a

Sveaas, S. H., Berg, I. J., Provan, S. A., Semb, A. G., Hagen, K. B., Vøllestad, N., … Dagfinrud, H. (2014). Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study. PloS One, 9(9), e108688. doi:10.1371/journal.pone.0108688

Van Tubergen, A., & Hidding, A. (2002). Spa and exercise treatment in ankylosing spondylitis: fact or fancy? Best Practice & Research. Clinical Rheumatology, 16, 653–666. doi:10.1016/S1521-6942(02)90240-8

Zochling, J., van der Heijde, D., Burgos-Vargas, R., Collantes, E., Davis, J. C., Dijkmans, B., … Braun, J. (2006). ASAS/EULAR recommendations for the management of ankylosing spondylitis. Annals of the Rheumatic Diseases, 65(4), 442–52. doi:10.1136/ard.2005.041137

Zochling, J., van der Heijde, D., Dougados, M., & Braun, J. (2006). Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Annals of the Rheumatic Diseases, 65(4), 423–32. doi:10.1136/ard.2005.041129





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Tuesday, 23 September 2014

Going Head over Heels for inflammatory back pain



Reading goes Head over Heels for inflammatory back pain

 Increasing awareness of inflammatory low back pain in Reading


On Saturday 19th July 2014 I spent the day in Reading Town Center promoting awareness of inflammatory back pain to the public. Reading is the first site nationally for the Don't Turn Your Back on It campaign. This is a campaign backed by the National Ankylosing Spondylitis Society (NASS).

Speaking to public on inflammatory back pain.
The children of parents were attracted to the 'dinosaur' spine.

The Don't Turn Your Back On It campaign came to Broad Street, Reading to help people suffering from chronic lower back pain to identify if the cause of their pain. Identifying inflammatory low back pain is the key to early diagnosis of ankylosing spondylitis (AS). Currently there is a still an average delay of 8.5 years from symptom onset to diagnosis of AS. With increase public awareness, this should help reduce delay in patients seeing their GPs for onward referral to a Rheumatologist for a diagnosis of AS.

A group of acrobats performed at the event to bring attention to the issue. This got the crowd thinking and talking about back pain seeing the acrobats bending and flexing their spines. We talked to hundreds of people and were interested to hear their individual stories.

Acrobats performing in the middle of Reading Town Center (Broad Street).

 It was a wonderful performance from the acrobats on a wonderful Saturday afternoon.
The rain stayed away despite the forecast of heavy showers!

Information leaflets on inflammatory back pain were handed out by the team on the day. This included Claire Harris, physiotherapy advisor at NASS and Chair of AStretch. Sally Dickinson from NASS was also on the stand along with NASS trustee Peter Wheatley-Price. I was also supported by Susan Hicks, specialist physiotherapist from the Royal Berkshire Hospital. 

The team on the day promoting awareness of inflammatory back pain in Reading.


The campaign hopes to help people suffering from chronic lower back pain  for more than 3 months and encouraged them to  visit the campaign website. Here they can complete a short symptom checker to assess if their back pain may be inflammatory. They are advised that the results can then be discussed with their GP. Further information about the campaign, types and causes of back pain and educational resources offering insights into the lives of people living with chronic back pain are also available on the website. 

 @synovialjoints



Views are my own. These are opinions and not consultations. It cannot replace the need to see your physician for review of your individual medical condition.
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