Episode Details

Panel Discussion with Associate Professor Frederick Joshua, Professor Sam Adie and Dr Mustafa Alttahir.

In this episode, we welcome Associate Professor Samir Viswanathan to moderate a panel discussion with experts Associate Professor Frederick Joshua, Professor Sam Adie and Dr Mustafa Alttahir on the complex world of inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, and lupus. The conversation begins with an exploration of diagnostic markers and the role they play in primary care, revealing that while 70-80% of rheumatoid arthritis patients present with biological markers, the diagnostics become murkier with conditions like psoriatic arthritis. The discussion sheds light on the limitations of blood tests and emphasizes that understanding patient history is equally critical in forming a diagnosis.

We then shift gears to discuss the management of treatment protocols for patients undergoing surgery while on DMARDs and biological agents. The experts share their insights on how and when to halt these medications pre-operatively, underscoring the general guideline of stopping conventional drugs like methotrexate a week before surgery, while biological drugs may require a longer cessation period. The discussion balances medical protocols with practical implications, noting that surgical infection rates are low, allowing for a more seamless transition to restarting medications post-operation.

Addressing pain management strategies, the panel engages in a candid dialogue about the analgesic ladder for arthritis-related pain and the rising concerns about opioid usage. The conversation challenges the prevailing negative perception of anti-inflammatories, countering the fear that they may adversely affect kidney function. The expert panelists argue for rational use of anti-inflammatories, advocating for them as viable alternatives to opioids, especially given recent findings highlighting their efficacy. This discussion culminates in upcoming research aimed at exploring opioid-sparing strategies for pain relief in hospital settings.

As the conversation progresses, the importance of patient-reported outcomes is emphasized, especially when it comes to managing vague symptoms and the potential anxiety that positive autoimmune markers can instigate. The panelists highlight the necessity for shared decision-making and individualized monitoring, advising that patients with mild symptoms may not require immediate referral, while those exhibiting discernible dysfunction or systemic complications should be prioritized for specialized care.

The dialogue inevitably leads to specific queries regarding steroid injections in various joints and the criteria for their administration. With a statistic of one in 400 for infection risk, the panel reassures listeners of the relative safety of knee injections compared to surgical options, outlining circumstances under which to consider such treatments. This part of the discussion highlights practical guidance for physicians on managing patient expectations and the nuances involved in guiding treatment options based on observed joint conditions and patient history.

This session not only sheds light on the intricacies and evolving landscape of treating arthritis and related autoimmune conditions but also reinforces the importance of collaboration among medical experts to improve patient outcomes.

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