Andrea Bendrups is a General Physician and Rheumatologist who has been employed at RMH since 1981. For many years she held positions as a VMO in both General Medicine and Rheumatology and for a period of 10 years was also a VMO in general medicine to the recurrent miscarriage obstetric unit at the Royal Womens Hospital. She retired from private practice 9 years ago and shortly afterwards took up the position of Deputy Director of the RMH Clinical School, University of Melbourne, from which she just recently retired. She was a senior national examiner for the RACP and an external panellist to the Medical Board of Victoria, then AHPRA, for a period of about 10 years. Her current roles are as a panellist for Medical Panels for the Victorian Workcover Authority and sessional General Physician at the Royal Melbourne Hospital.
Rheumatology For General Physicians
Three topics will be reviewed:
- Immune checkpoint inhibitors which block cytotoxic T lymphocyte antigen 4 or the programmed death protein 1 axis are widely used in the treatment of many cancers. Immune related adverse events (irAEs) may result from the consequent activation of the immune system and often present with generalized symptoms including fatigue or fever or organ specific symptoms. The timing and range of presentations and their management will be discussed.
- There are several functionally important MSK complications of diabetes whose impact are often under-appreciated in the setting of more life-threatening co-morbidities. Both type I and type II diabetic patients are at increased risk of developing adhesive capsulitis of the shoulder, with prevalence of about 10% and 22%, respectively, and they have slower functional outcomes with usual treatments compared to their nondiabetic counterparts. Up to 36% of asymptomatic diabetics have tendinopathy (Achilles, rotator cuff or finger flexor tendon). Clinical and experimental studies show impaired tendon healing in diabetics but good treatment outcomes can be achieved with appropriate exercise programs and good glycaemic control.
- 30- 40% of patients in all studies of bDMARD use in rheumatoid arthritis fail to achieve or maintain treatment targets or develop AEs. Registry data reports 42-52% drug survival over 3-5 years. Optimising the dose of conventional DMARDs, in particular, MTX, has been shown to improve outcomes. Cycling within the same bDMARD drug class is most likely to work if cessation was due to an AE rather than lack of efficacy. Two registries show about 50% of patients cease their second bDMARD after 1 year, due to lack of efficiacy. A large European registry shows no overall increase in malignancy in bDMARD users. However there is an increased risk of melanoma and lung cancer diagnoses in the ARAD (Australian) registry. Corticosteroids remain the greatest risk factor for the development of infections in RA patients.