1. Dr A Moorthy MB, MRCP(UK) Rheum,FRCP Edin CONSULTANT RHEUAMTOLOGIST Have You got the - S Factor ?......

16. A key element in successful patient care in RA is early recognition of the disease. Public awareness of the clinical presentation and potential consequences of a RA is still poor and many patients wait too long before presenting their symptoms to medical professionals (Westhovens et al., Belgian 2005 data, unpublished).

18. Understanding of the disease

22. Patient Education & Awareness on Arthritis Dr Sonia Panchal Dr A Moorthy Dr A Samanta

23. GP Visits (N=56)

24. GP Visits With your symptoms, how many times did you visit your GP before a referral was made to Rheumatology? (N=110)

25. Rheumatology Referral (N=110)

26. Prescription Exemption (N=56)

33. First, aim at remission induction as soon as possible using intensive initial treatment strategies secondly, once that objective is reached, treat to target based on disease monitoring and prompt treatment adaptation in the case of derailing

35. diagnosis

43. Understanding of the disease

45. Current Anti-TNF-  agents Adalimumab Human IgG1 Human Infliximab Mouse IgG1 Etanercept Human p75 Human IgG1

46. Rheumatoid Arthritis treatment targets Osteoclast Bone Complement Adapted from Arend WP, Dayer JM. Arthritis Rheum . 1990;33:305 – 15 Established Treatment Targets B cell T cell Antigen- presenting cells Synoviocytes Pannus Articular cartilage Chondrocytes Macrophage HLA -DR other cytokines IFN-  & Production of collagenase and other neutral proteases TNF  IL-1 Rheumatoid Factors, anti-CCP Immune complexes Neutrophil Mast cell

48. Tight control ……

51. There is also a need to educate medical professionals in order to facilitate the diagnostic process in the early disease phase. In several countries carefully trained patient-partners are put at the frontline of medical education, offering students and postgraduate professionals the unique opportunity of sharing patient experiences and hands on training in musculoskeletal examination.

53. TRAINING THE FUTURE RHEUMATOLOGY WORKFORCE

68. Confused……

69. Thank you ……