Arthritis Cases for Practical Management in Primary Care with Associate Professor Frederick Joshua

In this podcast, Associate Professor Fred Joshua, a dedicated physician specializing in rheumatic diseases, presents insightful clinical cases focused on inflammatory diseases. His expertise encompasses rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, reinforced by his research and pioneering work with rheumatological ultrasound in Australia. As the President-elect of the Australian Society for Ultrasound in Medicine and a prominent educational figure at Macquarie University, Associate Professor Joshua emphasizes the importance of comprehensive assessment and management of rheumatic diseases to improve patient outcomes.

The session begins with an introduction to inflammatory diseases, featuring a case study of a 32-year-old woman experiencing joint pain and swelling alongside fatigue over three months. Through a detailed examination, he guides the audience in differentiating various types of arthritis based on clinical assessment, serological testing, and imaging techniques like ultrasound. He stresses that elevation of inflammatory markers, such as ESR and CRP, does not always correlate with visible joint damage on X-rays, reminding practitioners that ultrasound can provide valuable insights into joint health.

Professor Joshua deepens the discussion by comparing the diagnostic criteria for rheumatoid arthritis, psoriatic arthritis, and lupus. He elucidates the nuances of each condition, such as the omission of psoriasis as a requirement for diagnosing psoriatic arthritis under new CASPAR criteria and the need for positive ANA results for lupus. This segment underscores the importance of understanding disease-specific presentations, serological markers, and imaging modalities to guide appropriate treatment strategies.

Moving on to treatment options, Associate Professor Joshua elaborates on the use of DMARDs (disease-modifying antirheumatic drugs) and corticosteroids, emphasizing their roles in symptom relief and slowing disease progression. He discusses the rationale behind prescribing prednisone for short-term flare management, detailing its efficacy despite potential long-term side effects. Methods of monitoring patients on methotrexate, including necessary pre-screening tests, are also presented, reinforcing the framework for patient safety and effective disease management.

An interactive portion of the lecture sees Professor Joshua addressing challenges encountered in treatment pathways, such as transitioning from DMARDs to biologics when conventional therapies fail. He highlights recent advancements in biologic therapies that target specific immune pathways involved in rheumatoid arthritis and psoriatic arthritis. The lecture covers the roles of TNF inhibitors, IL-6 blockers, and JAK inhibitors, detailing their mechanisms of action and associated risks. The discussion emphasizes evidence-based approaches and the need for multidisciplinary care involving rheumatologists, physiotherapists, mental health professionals, and primary care providers to optimize treatment outcomes and manage comorbidities.

The final cases presented illustrate complex presentations of inflammatory disease in patients with psoriatic arthritis, reinforcing the interconnectedness of rheumatic conditions with systemic health issues like metabolic syndrome, cardiovascular risk, and overall patient well-being. Professor Joshua advocates for proactive management strategies, including lifestyle modifications and interdisciplinary coordination, to address the multifaceted needs of patients with rheumatic diseases.

In summary, the lecture not only highlights the essential diagnostic and therapeutic approaches for rheumatological conditions but also calls for integrated care models to improve the quality of life for patients living with...