ILOs

• understand the role of members of the multidisciplinary team, especially physiotherapy and occupational therapy for patient management in RA & OA.
• understand how arthritis impacts day to day function for patients.
• Appreciate different types of joint replacements and prostheses used by orthopaedic surgeons.
• Know the different pathological processes in osteoarthritis and inflammatory arthritis

Rheumatoid Arthritis: Patient Perspective

• First noticed symptoms back in 2007 when she was 27, nothing up to that point. But then woke up one morning and couldn’t move head to right or left, or bend her arm that day. Phoned GP, went to see her, GP seemed to think that she’d twisted her neck etc. Recommended her to see chiropractor. Was due to get married in July 2008.
• Went to chiropractor for over a year, trying to get self sorted out. Spoke to sister who had juvenile chronic arthritis.
• Two years after initial symptoms, rheumatologist spoke to her. Patient had pitting in her nails. Got referred to rheumatology, and got her diagnosis in 2009.
• Patient had stiffness in morning, had constant pain, exhausting. So exhausting for her to be in pain all the time. Was always very wary about using painkillers and medication etc. Because some medications gave her side effects, she became very wary of using painkillers etc.
• This patient always had psoriasis since she was a 7 year old girl. It would always come out most when she was stressed etc.
• Her sister had passed away and before she went, she advised the patient not to take methotrexate or cyclosporin, and this left a scar on her. In hospital, she was very concerned about taking these drugs.
• Patient started to develop problems in other joints - like knees - would flare overnight. Would struggle to walk, struggle to go to work. She was very resilient, would go into work with crutches etc.
• Methotrexate worked very well for the patient in 2014. Took it for a year. She wanted to stop it though because she was about to go for fertility treatment… desperate to start a family…
• IVF didn’t work… she stopped with the idea of having a family… decided to go back onto methotrexate, this time injections. But it didn’t work. She started getting terrible chest infections that she needed antibiotics for.
• Decided to adopt a baby boy…
• She’s now on biologic therapy and living life, she’s got her energy back, can make movements she never used to be able to make before…
• But still, activities like hill-walking and cycling… she can’t do. She doesn’t want the arthritis to limit her, but she still needs to be realistic.
• Managing expectations and taking the positives from the hand she’s been dealt → her key advice.