Special Episode 15. Rheumatic Fever with Dr Alex Tai
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Recent research has found that Aboriginal and or Torres Strait Islander people are ten times more likely and Pacific Islander people 82 times more likely to have an episode of ARF than other ethnicities.
Although more than 9000 people are on RHD registers across Australia currently very little is known about the epidemiology of ARF and RHD in southern regions of Australia despite an estimated 57% of the Aboriginal and Torres Strait Islander population living in these regions. Importantly on 31st July this year, acute rheumatic fever and rheumatic heart disease became routine notifiable conditions in Victoria with only Tasmania and the ACT left to enact this important policy.
A new case of ARF is recognised to be 10 times more common in an individual with a past episode of ARF than an individual from the same community without prior ARF underscoring how important disease notification is for secondary prevention. Presently 80 % of people diagnosed with ARF have no prior diagnosis registered.
It was a real honour to welcome back expert infectious diseases specialist Alex Tai who has been passionate about education and bringing forth new issues of an infectious nature for our understanding. It gives me great pleasure to welcome Alex back to Everyday Medicine to discuss this important topic further.
References:
Dr Alex Tai - Gippsland Region Public Health Unit - Monash University. - Baw Baw Physicianshttps://www.bawbawphysicians.com.au › ...Dr Alex Tai - Infectious Diseases Physician
Dr Alex Tai - LinkedIn
Notification of Rheumatic Heart Disease and Acute Rhematic Fever. https://www.health.vic.gov.au/health-advisories/notification-of-rheumatic-heart-disease-and-acute-rhematic-fever
National Treatment Guidelines - www.rhdaustralia.org.au/arf-rhd-guidelines
Episode 104. Rheumatology in the community with Dr Mirza Baig (Part 1)
Musculoskeletal disorders are a common cause of long-term disability and are estimated to make up about 15% of the workload of general practitioners. Joint pain specifically is also extremely common, especially as one ages. In one national survey, one third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint followed by shoulder and hip pain.
Musculoskeletal disorders are a common cause of long-term disability and are estimated to make up about 15% of the workload of general practitioners. Joint pain specifically is also extremely common, especially as one ages. In one national survey, one third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint followed by shoulder and hip pain.
Epidemiological studies suggest that there is a large reservoir of patients with significant musculoskeletal disorders who do not consult with health services at all, contributing to community malaise and common problems such as soft tissue pain, back pain and minor arthritides that may often go untreated in the community.
When such patients do present in primary practice the practitioner must remain alert to the possibility such presentations could also reflect an emerging more serious rheumatic or nonrheumatic condition.
The practice of rheumatologic medicine embraces a wide range of conditions making this field of medicine incredibly interesting. Apart from “wear and tear” -osteoarthritis which is the most common type of arthritis there are inflammatory autoimmune conditions to consider such as rheumatoid, ankylosis spondylitis and lupus for example, crystal arthropathies and then the very large group of strains, sprains, other injuries and fibromyalgia which can all be expected as clinical problems to be managed in primary practice.
Doctor Mirza Baig is a general physician with an interest in rheumatological diseases and has a busy medical practice extending across metropolitan and rural communities. It was a great privilege to have this conversation with Mirza across two episodes embracing a practical approach to inflammatory and noninflammatory joint disease and joint counselling as well as practical tips for the management of fibromyalgia. Please welcome Dr Mirza Baig.
References:
Dr Mirza Baig : www.sjog.org.au
fibromyalgiaausralia.org.au
www.ncbi.nlm.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 79. Investigations in Rheumatology with Dr Andrew Teichtahl
In this episode we explore investigations in rheumatology - What is helpful and what is not?A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
In this episode we explore investigations in rheumatology - What is helpful and what is not?
A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
www.racp.edu.au Investigations: In Medicine-Rheumatology-RACP
www.ncbi.nlm.nih.gov : Common Laboratory Tests for Rheumatological Disorders, ED Gupta 2009
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 78. New Agents in Rheumatology with Dr Andrew Teichtahl
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
Some of these products are designed to interfere with cytokine function or production and include:
· TNF inhibitors
· TNF receptor fusion proteins
· IL6 inhibitors
· IL-17 inhibitors
· IL-12/23 inhibitors
· T-cell modulators
· B cell modulators
In addition, the development of small molecules as Janus kinase inhibitors has opened up new channels for inflammatory modulation.
It was a great privilege to welcome rheumatologist Dr Andrew Teichtahl to this podcast to help us understand how to apply this new age of science to the practice of rheumatology. Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911251/ New era of treatment with biologics in rheumatology – is it time to shift paradigms in treatment with biologics? Anna Felis-Giemza
www.nature.com/articles/nrrheum.2009.197, Are new agents needed to treat RA ?
https://arthritis-research.biomedcentral.com/articles/10.1186/1478-6354-13-S1-S5 Advances in rheumatology: new targeted therapeutics
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.