Latest / MSKMag OutLoud / Rheumatology and Tendons - Certainly No SpA Day

Transcript

Rheumatology and Tendons - Certainly No SpA Day · MSKMag OutLoud

• 0:00
  SPEAKER_00: Rheumatology and tendons.
• 0:02
  SPEAKER_00: Certainly no spa day.
• 0:05
  SPEAKER_00: Written by me, Jack March, the rheumatology physio.
• 0:10
  SPEAKER_00: Most of the time,
• 0:11
  I talk about recognition of rheumatological diseases that have
• 0:14
  developed and
• 0:14
  SPEAKER_00: require onward referral.
• 0:16
  SPEAKER_00: It's become my shtick.
• 0:18
  SPEAKER_00: Reasonably,
• 0:19
  many people ask me about people they work with or have already
• 0:22
  been diagnosed or
• 0:23
  don't meet criteria for onward referral but have risk factor
• 0:26
  comorbidities.
• 0:28
  SPEAKER_00: Here,
• 0:28
  I will take you through these two scenarios and the adaptations
• 0:32
  and considerations
• 0:33
  we need to employ when we see people with existing
• 0:35
  auto-inflammatory disorders.
• 0:38
  SPEAKER_00: This isn't a problem, says you, the reader.
• 0:41
  If the person doesn't meet a threshold for onward referral to
• 0:44
  rheumatology,
• 0:45
  SPEAKER_00: then there is no problem.
• 0:46
  SPEAKER_00: They present with tendon-related issues and we manage them.
• 0:50
  is what someone would say if they were naive to the ways
• 0:52
  auto-inflammatory
• 0:53
  SPEAKER_00: conditions,
• 0:54
  SPEAKER_00: particularly spondyloarthritis,
• 0:55
  SPEAKER_00: affect tendons.
• 0:56
  SPEAKER_00: Let me spell out some problems.
• 0:59
  SPEAKER_00: Spondyloarthritis,
• 1:00
  SPEAKER_00: particularly peripheral or PSPAR,
• 1:02
  SPEAKER_00: can be triggered by tendon load spikes,
• 1:04
  SPEAKER_00: just like normal tendinopathy.
• 1:06
  Spondyloarthritis particularly affects high-load tendon
• 1:09
  entheses such as the
• 1:10
  SPEAKER_00: plantar fascia,
• 1:11
  SPEAKER_00: Achilles,
• 1:11
  SPEAKER_00: patella and lateral hip,
• 1:13
  SPEAKER_00: just like normal tendinopathy.
• 1:15
  Pete's bar affecting the emphasis of the high-low tendons
• 1:18
  presents clinically
• 1:19
  SPEAKER_00: almost indistinguishably from normal tendinopathy.
• 1:23
  Tendon research almost exclusively removes people with
• 1:27
  spondyloarthritis from their
• 1:28
  SPEAKER_00: cohorts to reduce confounding variables.
• 1:32
  I could go actually further,
• 1:34
  but I think I risk losing some of you to boredom.
• 1:37
  SPEAKER_00: The point is made,
• 1:37
  and these issues aren't the crucial component of what I want to
• 1:40
  write about in this
• 1:40
  SPEAKER_00: particular piece.
• 1:42
  SPEAKER_00: managing tendons on a background of auto-inflammatory pathology.
• 1:46
  SPEAKER_00: There are two main scenarios we need to consider,
• 1:48
  SPEAKER_00: and although they are similar in approach,
• 1:50
  SPEAKER_00: the outcomes are slightly different,
• 1:52
  SPEAKER_00: so we will look at them in detail.
• 1:54
  SPEAKER_00: These are 1.
• 1:56
  SPEAKER_00: Person with diagnosed spondyloarthritis.
• 1:59
  SPEAKER_00: 2.
• 1:59
  SPEAKER_00: Person with inflammatory comorbidity that increases risk of developing
• 2:03
  SPEAKER_00: spondyloarthritis,
• 2:04
  SPEAKER_00: namely psoriasis,
• 2:05
  SPEAKER_00: ulcerative colitis,
• 2:06
  SPEAKER_00: Crohn's disease,
• 2:07
  SPEAKER_00: uveitis,
• 2:08
  SPEAKER_00: iritis.