Rheumatoid Arthritis Revisited

  • By Judith Sullivan
  • 31 Mar, 2017
  • 07 Feb, 2016
    Author/blogger Reggie Simpson

It's been in the news of late

What do the following famous names have in common?

Pierre-Auguste Renoir, renowned French artist

Claire King, British TV actress starring in Emmerdale, Bad Girls

Dr Christiaan Barnard, who performed the first human-to-human heart transplant

Kathleen Turner, US Hollywood star (Body Heat, Romancing the Stone)

They all suffered or are suffering from Rheumatoid Arthritis (RA).

February 2, 2016 was Rheumatoid Arthritis Day - a day to promote education and awareness launched by the Rheumatoid Patient Foundation, a non-profit organization based in the United States. Its mission is to improve the lives of people with RA and to raise greater public awareness, develop resources to support patients with effective healthcare decisions, advocate for quality healthcare and fair government policies, and contribute to scientific research in finding a cure.

It’s worth having a look at their website and online resources:

http://rheum4us.org/rheumatoid-arthritis-awareness-day/

In all about 1.3 million Americans — 75 percent of them women — know the pain of rheumatoid arthritis, or RA.

Closer to home, the charity National Rheumatoid Arthritis Society (NRAS), which counts the Rt Hon Theresa May MP, Home Secretary and Minister for Women and Equality as a patron, provides information for RA sufferers, their families, friends and carers and healthcare professionals in the UK. This includes information on the condition, how to manage it, and living with the condition so as to have the best quality of life possible.

690,000 people in the UK (1%) have rheumatoid arthritis costing the NHS approximately £560 million per year. The National Audit Office estimate that the total cost of RA to the UK economy is £4.8 billion per year.

  World Arthritis Day (WAD) 12 October 2016

We may be debating about remaining in the EU, but there are European organizations and initiatives that focus attention on education, research and lobbying in the EU on RA and wider arthritic conditions and their detrimental effects on health and wellbeing.

WAD was established in 1996 as a global initiative bringing people together to raise awareness of issues affecting people with rheumatic and musculoskeletal diseases. WAD is celebrated every year on 12 October and is supported by a year-round global campaign to raise awareness, influence public policy and provide a vast network of support for all those touched by arthritis, be it osteoarthritis (OA) or arthritis in any form. The initiative is driven by EULAR (The European League Against Rheumatism) based in Switzerland. See http://www.eular.org/  to learn more. The organisation also has a useful leaflet on 10 things you should know about rheumatic diseases:

http://www.eular.org/myUploadData/files/10%20things%20on%20RD.pdf

What is the difference between RA and osteoarthritis (OA) and other forms of arthritis  

Arthritis is an umbrella term used to describe inflammation of the joints. However, there are different kinds of arthritis. Although RA and OA both affect the joints, they’re very different forms of the same broader condition.

RA is an autoimmune disease, which means your body attacks itself.  In people with RA, the body interprets the synovium , the soft lining around the joints, as a threat similar to a virus or bacteria and attacks it. This attack causes fluid to accumulate within the joint. The fluid build-up causes swelling, pain, stiffness, and inflammation around your joints.

OA, the most common form of arthritis, is a degenerative joint disease. People with OA experience a breakdown of the cartilage that cushions the joints. The wearing down of cartilage causes your bones to rub against each other exposing small nerves, which causes pain. OA does not involve an autoimmune process like RA does, but mild inflammation also occurs.

Both types of arthritis are more common in women than men as evidenced in the American statistics.  RA and OA are more prevalent in older adults, but RA can run in families and develop at any age, often showing as a low-grade temperature, muscle aches and/or fatigue.

People who are overweight, smoke, suffer from joint deformities, diabetes, or gout are more likely to develop OA.  Equally, sporting stars past and current have been diagnosed with OA, such as golfer Tiger Woods.

Symptoms could include morning stiffness and severe fatigue, as well as sore joints.

At Betafeet Podiatry we ask you for your medical history, and among the questions are whether you suffer from RA and/or arthritis. Not every patient understands what these mean unless they have been diagnosed with one or the other.

You may also wish to refer back to a website blog I posted in December 2015 on RA:

http://www.betafeetpodiatry.co.uk/rheumatoid-arthritis1

.

Hopefully, these resource tools will give you a better understanding about RA and arthritis generally. You should speak to your GP if you have any concerns about chronic or recent joint pain so that proper referral pathways to podiatric or other healthcare can be made, such as the Beta Health Clinic in Hemel, you may also benefit from other holistic treatments for RA from visiting  www.betahealth.co.uk .   


By Judith Sullivan 18 Jul, 2017
Andre was an associate podiatrist at Betafeet for five months.  His contributions to the practice were considerable.  Sadly we lost him to a higher professional and personal calling.

After a stellar educational background and career, Andre joined babylon Healthcare Services, UK based, with a view to helping them set up and deliver the first digital healthcare pilot services to the NHS.   Digital healthcare is a cluster of new and emerging applications and technologies that exploit digital, mobile and cloud platforms for treating and supporting patients. Digital Healthcare is being applied to a  wide range of social and health problems, ranging from monitoring patients in intensive care, general wards, in convalescence or at home – to helping doctors make better and more accurate diagnoses, improving drugs prescription and referral decisions for clinical treatment.

Rwanda then beckoned.

Since joining babylon Rwanda in April 2016, Andre has been instrumental in successfully setting up and launching Africa's fastest growing digital healthcare service.  According to Lindsey McConaghy, babylon's PR manager, 'Rwanda has a population of around 12 million but doctor numbers are in the hundreds. There’s an imbalance between supply and demand'.  

Digital Healthcare is not without its sceptics nor controversies - at what point do you let an app do the diagnosis?  Will GPs embrace technology in this way?

Here is Andre's report about his experiences in Rwanda:  

Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.

This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.

As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.

Now you are probably wondering what this has to do with podiatry?

Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.

As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.

The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.

How did all this lead me to Africa, I hear you say?

In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.

This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.

Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care. 

'Footnote'

It is with this experience I now look to move on to my next adventure focusing on Aboriginals and the utilisation of technology in the prevention of major non communicable disease such as diabetes.

Final comment from Reggie Simpson and Betafeet Podiatry

 We wish Andre the very best in his future and thank him for this interesting blog account.  We look forward to his next blog focused on his work with the Aboriginal population.  

By Judith Sullivan 12 Jun, 2017
By Reggie Simpson
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