Inflammatory Arthritis: Types and Treatments

my name is Donna Will's and I'm the regional manager for the arthritis society in Manitoba Nunavut we are part of Prairie division which encompasses Alberta Saskatchewan and Manitoba our executive director is in Calgary and I help to oversee the Manitoba operations here as as the regional manager now on behalf of the arthritis society we are just so thrilled to welcome you to our inflammatory arthritis forum here in Brandon and I know that we have people not only from Brandon from but from all around the area as well so thank you very much for making the drive in today I believe that you will find the information shared with you to be very very valuable we have a special welcome to our brand and arthritis support group if you're with the support group move your head let's just see there we go yeah this group meets on a monthly basis to to learn to support each other and also to be there for the community for those that are newly diagnosed to be able to answer questions about resources that are available etc so if you weren't aware that there was a support group now you do know and those ladies are the ones you can ask them a little bit more about it there are 4.6 million Canadians with arthritis and over 200,000 of them are in Manitoba I'm new with the arthritis Society and I just started in December and some of those statistics were something that really shocked me I had no idea that basically you know just under one one-third of the provinces population has arthritis of some kind so that was shocking to me what was even more shocking is of those 200,000 that almost 60% of them are still in the workforce so what people quite often think of as you know you're gonna get it when you're older you know it's something that's gonna that's part of older your elder part of life it really isn't many people are still when the workforce they're trying to balance their their children and their work as well as their disease so that was quite a surprise for me when I learned that statistic and the fact that since the 1980s there were over 1,500 kids in Manitoba alone there were diagnosed some of them were only a you months old when they were diagnosed and again that was something that really really surprised me when I learned that if anybody is tech savvy at all out there we do have a Facebook page at arthritis Manitoba and we have a twitter handle at arthritis and B just in case you're into that okay we're ready to move on to the beginning of our program and we are starting with dr. David Robinson he will have time for your questions after his presentation so if there are some pads of paper on the table if you need to make a note of what your question is please go ahead and save them until the end dr. Robinson is a Rheumatologist and an associate professor of medicine at the university of manitoba he's the director of the arthritis center and head of the section of Rheumatology at Health Sciences Center he's the undergraduate and postgraduate program director for rheumatology and also a traveling consultant for the J a Hildy's northern medical unit I don't know when he has time to sleep dr. Robison focuses his practice on more severe arthritis severe forms of rheumatoid rheumatic there we go disease including rheumatoid arthritis and connective tissue diseases he also runs specialty clinics in vasculitis and scleroderma so help me welcome dr. Robinson to give his presentation today thanks for coming out shocked to see so many people here on a beautiful fall day it's sort of the like the last one tomorrow there's gonna be 12 feet of snow so we'll see how things go I'm I'm gonna just Philly you know what we're gonna talk about it and if it's and then everybody will get up and leave when they don't see what they want to talk about but we'll see how it goes we're gonna do an overview of inflammatory arthritis what is that in in particular and we're going to talk about various types and in particular gonna talk about rheumatoid arthritis which is the most common form of inflammatory arthritis and I've been asked to talk a little bit about psoriatic arthritis as well we're gonna talk about principles for managing arthritis in particular inflammatory disease and they apply to all the different forms don't tell anybody but we treat a lot of this stuff the same okay it's a secret we're gonna talk about some of the medications and then hopefully we'll have lots of time for some questions that you can ask and if I haven't covered your favorite topic by all means please please ask so Donna told you that more than four million Canadians have arthritis it really means the itis part means inflammation and arthro means joint so it's really inflammation of a joint and there's a hundred and twenty different kinds we have about 45 minutes let me do the math here I got about 20 seconds per type so let's get started hope you're paying attention I'm not gonna do that that would be mean what I'm going to talk about is a couple of forms and first I want to talk about what inflammatory arthritis isn't okay and what it isn't is osteo arthritis and osteoarthritis is the most common form of arthritis it makes up about two-thirds or three-quarters of the people who have arthritis and it's what we think about is wear and tear you know I was just in Winnipeg they had the Heritage Classic they had all the old alumni jets guys skating around and aching and creaking and moaning and groaning and of course they all have a little bit of wear and tear arthritis but there's actually many different causes and if you get frostbite and damage your fingers then eventually that can turn in osteoarthritis and it's really the final end point for all the different kinds of arthritis that we have so it's not just injuries because of course how do you injure your left fifth knuckle right and why does that one get bony and enlarged and so that's it's very common oops I lost a slide here what else isn't it it's oh what does the way look like okay see I can barely read my own slides so basically you get start with pain in the joint now it might be right in the joint itself or it might be referred from somewhere else we see lots of people who come in and they complained oh you know my knee hurts and we examine their knee in fact it's really their hips that's the problem when we examine it it's all usually worse with activity so if you're sitting there it feels a little bit better you get up and start shoveling things and then it hurts when you get up in the morning you might be a little bit stiff but you know five 10 15 minutes later it feels better okay and if you sit here for an hour and listen to me Yammer on and you get up you're gonna be stiff again we call that jelling phenomenon so every time you do that when you get up after sitting for a long time and you feel a little stiff you just go hey I know what that is that's gelling and then loss of function so if you've got arthritis in your lower extremities you might have trouble walking and if you've got it in your hands you might lose your grip strength and have to get somebody else to do all those Jarre openings so a knee joint can be involved with osteoarthritis if it's been injured or had something else happen to it but in fact there's some that are very very common so the last knuckles on your fingers are very common the middle knuckles the base of your thumb right down here this one here lots of people complain about the wrist but really it's way down here that it hurts and if you're doing anything with your thumb it causes problems hips and knees and then this great big toe here where everybody gets a big bunion and it really hurts lots of women get it because they wear fashionable Footwear and then they can't wear aníbal footwear anymore and then of course osteoarthritis in the lower back so here's some pictures of some folks yeah you can see this knee looks fairly straight and this one takes a little bit of a bend where it's not supposed to okay and that's because of some of the loss of cartilage in it you can see that here are these knuckles here and these fingers and if you put your fingers on those bony lumps they're really hard and they're bony and they're they're solid and sometimes they get a little red and they get they look a little inflamed most of the time they just sort of grumble along and then here's a fellow who has a bit of it looks almost like his knees a little enlarged and that's partly because he's lost some of the muscle around his calf and around his thigh here now the other thing that inflammatory arthritis isn't and this is very important is it's not what we call mechanical back pain so you know bike pain is really really common almost everybody gets back pain at some point in their life and some people have it chronically lasts for more than a couple of weeks or a couple of months and we talked about it being due to you know osteoarthritis of the spine but I'm gonna tell you a doctor secret okay if we took everybody at the age of 60 and x-rayed their spine at the age of 60 every single person will have changes of osteoarthritis on their x-ray and it won't relate to whether they have pain in their back or not okay so when you go into your doctor's office and they say oh you know I got a really sore back any x-rays your back and goes well mrs. Jones I know why your back is sore you've got osteoarthritis here but in fact it's not always the osteoarthritis it might be the muscles that are sore it might be something else that's causing the problem and very often this kind of pain is due to the muscles themselves that are just unhappy and a little bit strained so this is what we call mechanical back pain and I'll tell you how that differs from the other form a little bit later so what is inflammatory arthritis well it's it's a forms of arthritis where there's significant inflammation I told you that the osteoarthritis those in knuckles they sometimes get a little warm they sometimes get a little red well in this case there's lots of inflammation going on and the joints can sometimes get very red and hot they can actually and what we can see is activation of your immune system so we can measure it in your blood that your whole immune system is active and causing problems and here's some knuckles that are big and swollen now if you put your fingers on these ones they're squishy like a grape because of all the fluid that's in them okay now I'm gonna give you a case you get to be the diagnosticians here and it's kind of a funny writing and it's not because they don't spell well it's just because it's an old case so he goes to bed and sleeps well but at about 2:00 o'clock in the morning is waked by the pain seizing either his great toe the heel or the ankle hmm the pain is like that of dislocated bones sometimes like the gnawing of a dog does anybody know what I'm talking about can you make a diagnosis such a quick and exquisite pain that is not able to bear the weight of the clothes so this is a description from doctors Thomas Sydenham who suffered from this himself and it was an attack of gout okay so gout is a form of inflammatory arthritis and you can see how red and hot these toes get and it's very difficult to walk on them when I stopped being working at the University I'm going to open a gout clinic and I'm gonna make all my money off of valet parking okay very smart so God is a form of inflammatory arthritis and it's caused by uric acid which is a normal product in our body but some people don't get rid of it very well and so it builds up and then it actually builds up around the joints and for reasons some reasons we know and some reasons we don't you get the sudden hot swelling of the joints and it usually gets better after five to seven days the problem with gout is that or after time it becomes more chronic it becomes more persistent and it can cause damage in the joints and so I don't have a lot of time to talk about go today but it can progress to a chronic destructive arthritis but most of the time it comes and it goes rheumatoid arthritis is very common is affects about one in every hundred people and it is a systemic inflammatory autoimmune disease so what I mean by that is is that it actually affects your whole body it is there's lots of signs of inflammation and it's autoimmune so your immune system which is supposed to spend its time fighting off the flu and bacteria and things like that becomes confused and it actually starts to attack your own joints and other organs more most commonly your joints like your fingers and Knuckles but also your lungs your skin in your eyes in some cases and it's associated with because it's an autoimmune disease making antibodies your immune system makes antibodies to some proteins in your own system that we can measure one of them is called rheumatoid factor and another one is called anti CCP now don't hurt arthritis effects 1% of the population and the peak onset isn't in 70 and eight-year-olds it's really in people who are still in their working years 40 30 to 50 year olds really is when it comes on twice as many women over men and we don't know why that is and we don't really know what the cause is we know that in some cases it runs in families a little bit but in a lot of cases there's no family history and we don't have a lot of clues as to whether there's a virus or something that triggers it but we do know that smoking can increase your risk and there's no known cure what does it feel like well it's a little bit different than osteoarthritis the joints are warm and swollen and any joint can be affected except for your back and those very last knuckles on your fingers you feel stiff in the morning when you get out of bed but it doesn't go away after 10 or 15 minutes it lasts for hours and some people say they never loosen up during the day so our classic is osteoarthritis goes away in 10 minutes rheumatoid arthritis takes an hour which means that all of my patients show up with 40 minutes of early morning stiffness right so just right in the middle decreased energy level and you can actually feel really sucked out with this in some patients even lose weight like they have some sort of a cancer okay I'm gonna take you to medical school here so this is one of the slides that I showed my medical students this is a cartoon of a joint and you can see here's one but not that kind of a joint okay but one bone here another bone here this is the cartilage that hard rubbery stuff at the end of the bones right when you're chewing on the chicken bone and this is the capsule that holds the two bones together and lining it is this very thin delicate tissue that we call synovium and its job is to nourish the cartilage and to provide oil for the joint that lubricates the joint this is what it looks like under the microscope there's normal synovium here very light delicate kind of tissue not a lot of cells in it and it becomes in rheumatoid arthritis it becomes thickened and becomes inflamed and what you can see is the difference between this and this you don't need to be a histology there's lots more cells and much more thickened and as that grows it actually eats into the cartilage and the bone so over here this sort of pink stuff here is cartilage and this stuff over here is bone and this is the synovium and you can see it eating into these and it causes destruction of the joints almost like a cancer that doesn't spread elsewhere but it eats away at the tissue and that causes damage to the joints that's very typical so you can see swelling on these knuckles here and over here and you can see these fingers have actually moved out of place where they should be this is a gentleman who I followed up north who had disease since he was a teenager and even though our best trials he really had difficulty responding to therapy so this is he's 50 years old in this picture he's 6 foot 3 inches tall and he weighs 112 pounds ok and so you can see the amount of damage that he has in his hands and the wasting that he has from his muscles fortunately people don't get like this anymore ok the other form of inflammatory arthritis is is a family of them that we call spondyloarthropathies if you say it enough you'll strain your tongue so these are types of arthritis and the main thing that sort of holds them all together is that you often get inflammation in the spine remember I talked to you about mechanical back pain we're now we're going to talk about inflammatory back pain which is a little bit different so these people get like the rheumatoid arthritis patients to get more than an hour a morning stiffness and this inflammation that's in the spine often leads to fusion of it I'll show you some pictures but it can be affect other joints as well and I'll fill you in as we go so the typical spondyloarthropathies a disease called ankylosing spondylitis you see it just gets harder and harder to pronounce after a while and again it mainly affects the spine in this case and here's what I'm talking about where I talk about fusions so this gentleman has had long-standing ankylosing spondylitis and you can see that he doesn't have the normal sway in his lower back that you or I do it's actually fused solid and stiff and the unfortunate part about ankylosing spondylitis is that as you fuse you tend to fuse in a in a bent-over position like a question mark so this gentleman has a hunched over position but he's actually unable to straighten up so that's as far up as he can look and you can imagine how disabling this could be in day-to-day life this is actually a surgical specimen of a hip joint taken from a patient and what's really different about ankylosing spondylitis and some of the spondyloarthropathies is that you get damaged to the joints but you also get bone formation so that the bones fuse so here is the thigh bone okay cut apart here it is cut in half here's the thigh bone here it goes like that this is the part of the pelvis that the thigh bone goes with it's a it's a ball and socket and where they're supposed to be spaced between the two it's completely filled with bone so this is a rigid solid bony hip that doesn't move at all which is why it's on a specimen table instead of in a patient okay now how do you know if you have one of these spondyloarthropathies or if you just have back pain well inflammatory back pain is a little bit different you know back pains ubiquitous which means everybody has it chronic back pain is common and we define that more than three months and 15% of all chronic back pain is inflammatory so we're talking about small numbers of people here and it's important to be able to distinguish one from the other so people who have mechanical back pain like I showed you before tend to be over the age of 40 when they show up so I run a clinic at the Health Science Center and every week I get another doctor who's 45 years old walking and going oh my back is killing I just know it's usually sudden onset so you can point when it happened I was raking leaves I was shoveling snow I picked up my grandkid I did something like this and my back went out it's made better by rest and interestingly although we give you things like Advil and naproxen and a leave and all the rest it's the first thing out of our hands it almost never works so the effect of those drugs on mechanical back pain is really limited so inflammatory back pain often happens in teenagers and young people so in their in their teens in their 20s so very early it's hard to pinpoint when it starts when they tell you when there's something I don't know you know it's not just because they're teenagers it's worse when they sit around and with rest and particularly at night and it improves with activity so the more active these people are the better they feel they have morning stiffness more than 30 minutes or an hour and some patients respond extremely well to these anti-inflammatories so that you can it can sometimes be used to help diagnose it not all of them but some of them okay so another form of spondyloarthropathies that is fairly common is one that goes along with psoriasis so it's called psoriatic arthritis psoriasis is a skin disease that is fairly common in the population and about 10% of the patients who have psoriasis will have some joint involvement along with it unlike rheumatoid arthritis it's about the same number of men as women this is the prevalence this is how many people there are about four and a thousand to one in a hundred depending on what groups of folks you look at and most of the patients develop the psoriasis before the arthritis so we get a lot of referrals from the dermatology community saying this patient who has psoriasis has now got some joint pains as this psoriatic arthritis about 20% and get at the same time and then some of them present us with arthritis and we say hmm and then a couple of years later they might develop the skin disease these are the common locations for psoriasis you know the scalp or on the face the trunk and around the bellybutton in the in the buttocks the backs of the elbows and the knees are very common and the nails can be affected as well and this is a typical picture of psoriasis of scaly raised often itchy kind of skin rash now sorry attic arthritis is a little different than rheumatoid arthritis it can be quite variable sometimes it looks just like rheumatoid arthritis sometimes it looks just like ankylosing spondylitis and sometimes it looks like something in between and you can get erosions and loss of bone like I showed you in rheumatoid arthritis where you actually have damage and you can see here's a finger joint and you can see the nice round normal bone here and you can see how it's been eaten away on this one okay so very a lot of damage there what's different is that I like ankylosing spondylitis you can make new bone and so you can actually fuse joints usually later on so sometimes we see a mix of these findings in the same person and that gives us a clue as to what we're dealing with so sorry attic arthritis can affect the spine but also lots of the peripheral joints and and so here's some person you can tell that they have psoriatic arthritis because they have a skin rash on their hands that's always very helpful when we're making a diagnosis and they can affect the these last knuckles here and they can affect all these knuckles as well as these ones and the risks and just about anything now another funny sort of thing that happens in psoriatic arthritis is something called dactyl itis or what we like to call sausage toes so instead of just the joint becoming inflamed the whole digit becomes inflamed so here's a little piggy that looks fairly normal okay and then if you look at this one here it's a little bit swollen and then this one is completely looks like a breakfast sausage okay and again you can tell there's a little bit of psoriasis on there I'm not sure what a breakfast is but that's okay but these are typical of psoriasis year and the nails are affected in psoriatic arthritis so sometimes it can be something very minimal like these you can see these little tiny pits we call these pitting and sometimes it can be lifting so this is the fancy word for this is a neat goal Isis where the nail tends to lift off its bed a little bit and then sometimes they can look very damaged in these kinds of cases again you can see the red and scaly skin changes here next to it and the and the nails are fairly damaged sometimes it's difficult to tell those apart from fungal infections in the nail and sometimes we have to send cultures to know whether what's actually causing it now some psoriatic arthritis patients have the worst arthritis that we've we can really see they have very very destructive joints and so you can tell if you look at this finger here the bones have been eroded away so much that there's really just the tissues left behind and this can actually be telescoped out and all the rest I had one of my patients who was twiddling her thumb the other day like this it was very unsettling the didn't bother though what's on there also a very odd about this disease is you can see how badly damaged this finger is but look how normal these two fingers look they're completely unaffected which is a very unique feature of this disease you can have inflammation in the eye and this is usually painful and red and it usually requires an urgent assessment by an eye specialist with lots of topical steroids and usually some therapy some systemic therapy as well some pills and you can have something called enthuse itis which always makes me feel like I'm lisping when I say in the Vitis but it's really where the tendons and ligaments insert into bone you can see that they have these little fibers that that anchor into the bone and that's where you get some inflammation so when we look at it clinically it's where the tendons insert into the into the heel bone here your achilles tendon or at the bottom of your foot or even where all your trunk muscles attaching to your into your pelvis can become inflamed and you know we think about when tendons get sore is like a tendinitis or sometimes the tendinosis and really that's where the that's a problem that happens in the middle of the tendon whereas this is really at the attachment to the bone okay so psoriatic arthritis can affect the spine like ankylosing spondylitis and you can see these big bony lumps here on the sides of the spine that are fused it together and we can sometimes see these take a long time to form we can sometimes see early changes with an MRI so if your doctors thinking that you might have psoriatic arthritis or a spawn Laura but they may send you for an MRI this is an MRI of the sacroiliac joint so now we're looking down on top of it and you can actually see here's where the joint is and the sacroiliac joint is where the spine the middle part of your pelvis meets the wings of your pelvis okay and there you can see these little white spots are where there's inflammation within the bone there and there's eating away of the bone as well now unlike rheumatoid arthritis we don't have any special tests that we can do to tell us that you have psoriatic arthritis we have to do it based on our on how you present and what your history is and what physical findings you have so like most of my most of the time people present with an arthritis in my clinic I say okay this is what I think you have I reserve the right to change my mind in the next year so okay because sometimes I do there are no Auto antibodies or special tasks soups no auto anybody's especially tests there may be signs of inflammation in the blood but that's not very specific if you get a cold you get signs of inflammation in your blood and there is a genetic test that sometimes is associated with it but this genetic test is present in 10% of the population so it's not particularly helpful in making a diagnosis now that you know everything that I know about arthritis let's move on to management okay I hope you're paying attention because there was a there's a test coming later I might be making that up all right so we want to do four things no matter who we're treating and what we're doing with rheumatoid with arthritis okay no matter what kind they have one is we want to make the patient feel better we want to relieve their pain and the inflammation I think that's probably on the patients list too as might guess we want to maintain and improve their joint range of motion so range of motion is how much you can actually move your joint through any given range okay through any movement and your joints are very much like my mother used to say about my face you know she said if you keep making that face it's gonna stay that way so when your joints are sore if you leave them in the same place for a long period of time you very quickly lose the ability to do that okay we want to prevent further joint destruction from all that inflammation and we want to limit this until you're 300 years old most people are pretty happy to go into a wheelchair when they're 300 I haven't had anybody complained about that yet now non-drug treatment is really important for all arthritis but it's really the first line of treatment for osteoarthritis okay you can go into your doctor's office and be told I have osteoarthritis and you say wow give me that magic pill there is no magic pill for osteoarthritis all of these things are very important we don't have a lot of time to go through them but you know energy conservation where you plan and pace and prior eyes what you do education like we're doing today exercise weight reduction physiotherapy and occupational therapy can sometimes be very helpful so it's something that you really need to talk about all the medications that we use for osteoarthritis are really pain relievers to help you do all of these things these are also important for inflammatory arthritis but medications become much more important so we use Tylenol or acetaminophen we use anti-inflammatories and sometimes dr. Robinson takes a big rusty needle and sticks it into somebody's joint and those can be sometimes helpful they make people feel better but in the inflammatory arthritis they don't really stop any of the joint damage from happening okay so people can continue on and end up with that this is one of my favorite slides the Nobel Prize in Physiology or medicine in 1950 does anybody know what they got what these gentlemen got that for the god of her using cortisone and rheumatoid arthritis patients it was the very first time and the very first thing any sort of cortisone was used any disease and people got out of wheelchairs and they walked and they climbed stairs it was a miracle drug okay absolute miracle drug however after a couple of years it became known that there was lots of side effects to cortisone and prednisone and now my patients call it the miracle drug from hell so cortisone or corticosteroids that's prednisone sometimes we use a drug called depo medrol and sometimes we inject those things in people's joints are very good at reducing the inflammation of inflammatory arthritis if you take a it's like taking a wet blanket and putting it on a campfire okay it just puts it right out right away but there are lots of side effects and most of the drugs that you take on a day to day basis a few percentage of people will get side effects from them but with cortisone everybody gets the side effects eventually it's very reliable that way so we want to limit the use of these to either very low doses over long periods of time or as a bridge to safer acting drugs so for inflammatory arthritis those safer acting drugs are what we call disease modifying the a R stands for antirheumatic drugs or DMARDs is how we pronounce this and these are the the typical names that you might see there's methotrexate is the most commonly used one you may have heard of people getting gold injections in the past well I don't think I have anyone in my practice on gold injections anymore very lots of side effects to gold injections but we use other medications like hydroxychloroquine and sulfasalazine there's a brand new one that you might have seen called tofacitinib or xeljanz which is advertised as well and these relieve pain and inflammation they slow down the rate of joint damage and they're safer than prednisone for long-term use sounds good to me there's some problems they're very slow to work they take weeks to months to sort of kick in there's sometimes some nasty side effects they're safer than prednisone but there are some people who get side effects with them so they can make a sick to your stomach they can make your liver inflamed they can make your blood counts go low and you won't have any symptoms to tell you that your liver is unhappy so you got to go for blood tests on a regular basis when you have these drugs and this is probably the worst part is is that they're very individual who they work for so we often have to do a trial and error process to find the drug or the combination and drugs that works for a given patient and each of those trials takes three to four months to sort out so it becomes a very long process in some cases to make people feel better some people get better with the first trial which is good but some people need combinations and all the rest for patients who don't respond to the traditional drugs that we use in the last now 15 years we have had a real revolution in treatment and there's a group of drugs called biologics biologic is Greek for expensive okay and these are large protein molecules that are targeted to specifically block key molecules and inflammation so we've taken the knowledge that we've gained about how inflammation works and what molecules drive particular pathways and now we can target a very specific way to block that they're given intravenously or as an injection under the skin because they're big proteins you just digest them in your stomach if you took them by mouth so they have to be given by a needle and they're very expensive they're anywhere from twenty to forty thousand dollars per year for the ones that we use for arthritis there are some biologics that are used for other diseases that are as much as four hundred thousand dollars a year and they're not used very much but these are very expensive and because they're not a cure people have to keep taking them over and over and over again right so they're limited to patients who have failed the usual chemistry and when you look they grow them up in yeast and bacteria and things like that so it looks like you're in a brewery when you go to these places there's big you know canisters like they're brewing the stuff and the and the organism makes the protein and then we isolate it and we give it to patients the most common ones that we use for both rheumatoid arthritis and psoriatic arthritis are called TNF inhibitors or TNF stands for tumor necrosis factor and you've probably seen ads for these on TV certainly from the states there's infliximab but Remicade there's now generic like Remicade form eat an acceptor Enbrel Humira symphony and Cinzia and some of these are given intravenously and some of them are given under the skin or subcutaneously and TNF is a very critical inflammation molecule in both rheumatoid arthritis and the spondyloarthropathies like psoriatic arthritis and when we block it it results in decreased inflammation and decreased damage and some people have a very good effect and but a few people have what I like to call a hallelujah effect where we give them this drug and they're dancing pirouettes and doing much better but again they take one two sort of three months to sort of work and to try out to see how they're going to work so here's a couple of examples so here's Phil Mickelson who has psoriatic arthritis and his golf career was pretty much on the ropes when he developed the psoriatic arthritis he started on one of these biologics and he has done remarkably well and goes on to win more tournaments and this is LeAnn Rimes who I didn't know from a hole in the ground before I put this talk together but apparently she has really bad psoriasis can you see it I can't see it but it apparently is well cared for by one of these drugs so there are some problems with TNF inhibitors you know one of my mentors once told me that you always when a new drug comes out on the market always use it in the first two years because after that it develops side-effects so there's infections about 10% of people get nuisance infections sometimes sign is sometimes bladder infections about 5% will develop more serious infections like infections in their joints or those sorts of things that require hospitalization and if you on one of these and your doctor gives you antibiotics for sinuses or for bronchitis or for pneumonia it's really important not to take your biologic until you've finished your antibiotics because it's not because they don't like each other it's just that the infection can get away from you if you're if you're sick enough to need antibiotics you can't take any live vaccines like the shingles vaccine or yellow fever when you're on these drugs and so we often have that question asked us particularly about the shingles vaccine one one infection in fact I skipped this line that is an issue with the TNF inhibitors is that if you had exposure to TB when you were a kid it can hang out in your body for the rest of your life and until you die of a heart attack at ninety or something and never caused your problems but if we give you one of these drugs that can actually wake it up so that's called sleeping TB and it can reactivate it and so before you start them you should always have screening for it we do it with the skin test and with a chest x-ray and these TNF inhibitors always work best if we combine them with one of the other more traditional disease modifying drugs there are other biologics that we use particularly for rheumatoid arthritis one of them is rituximab another one is called Orencia or a bad acept and then another one is called act Emre and these are alternatives to all of those TNF inhibitors we often use them more as a second line or if people who have specific reasons to be on them sorry otic arthritis I want to say a word about it just because it's a little bit different is sort of differentiated we used to treat it very much like rheumatoid arthritis and it's a little bit different we do use all of the other things like physio and occupational therapy and anti-inflammatories and corticosteroids because we're treating really both the skin and the joints we often work in combination with the dermatologists and so these patients are often on lots of topical agents either topical steroids or other medications along with ultraviolet light possibly for the to try and control the skin if we get really lucky and we start somebody on methotrexate or one of the TNF inhibitors it works for both their skin and their arthritis really well and they don't have to do very much of that we do use the disease modifying drugs for the skin and the arthritis and the typical disease modifying drugs work really well for things like elbows and fingers and ankles but they don't work for the spine inflammation so if you have spine inflammation we often have to use the biologics in order to control that so it's a it is actually important that we make a different of the right diagnosis in patients in order to make them better because the that spine tends to fuse up over time and patients who have spine involvement the exercises that we get people to do are very important so that if you do fuse up you fuse up in a straight position rather than looking like a question mark because it's much more functional there was a one of my mentors in medical school who retired shortly after I started practice had very bad ankylosing spondylitis and he was stiff as a board but he was straight up and we always had to raise the bed to about five and a half feet so that he could listen to the heart when we were the again so you can see all of these are really focusing on trying to get the person to lean back and to rotate and keep that spine nice and straight there are some new therapies for psoriatic arthritis that are out there that are specifically for psoriatic arthritis which again makes us having to not treat everything the same a little more important one of them is called a prem alast and the easy word for this is otezla it's a pill that you take twice daily and it does have some side effects like nausea and diarrhea but it's easier on things like your liver and your blood counts than methotrexate and some of the other pill forms of treatment that we use and it has a lower cost than the biologics it's not covered yet in Manitoba the government's looking at it they're thinking about it they're very slow to decide these things but we can sometimes get a hold of it if we need it there's another drug called stellaris to Kingdom F in it it's approved for psoriasis so it has to be ordered by a dermatologist or I have to go begging on my knees to the government to let them approve it and it works very well for psoriasis and probably a little less well for the arthritis but there are some people who respond very well from the earth rightist point of view to this and then very very recently approved was another drug called second mm one of my colleagues calls these biologics all the unpronounceable --zz I think that's sort of a good descriptor and it's an injection that's given monthly its newly approved and and we haven't actually used it in anybody yet but we'll be trying it at some point in time and now I think that's the end so I want to give you some time to ask some questions about what you need to know that's great so the question is really about something called endo flex I have a whole hour-long talk that's entitled secrets your doctor is keeping from you okay and I keep I keep a file at work of the various things that people bring in that they have either seen or tried or that sort of thing and it varies quite a bit so so those kinds of products fall under the under the category of what we call unproven therapies sometimes there's the hint of truth in the base in how they're based so they might say that there's something to do with stem cells and sure enough people are looking at stem cells as therapy for all sorts of diseases but the way that they're actually using it doesn't make any sense sometimes it's as simple as the same kind of treatment that's in a 535 like a menthol or capsaicin which is a pepper a topical peppers hot pepper spray kind of thing that you can put on that helps with pain but most of the time these things are not very effective they're certainly not going to be very effective for inflammatory arthritis and they won't prevent any joint damage they are usually harmless okay they usually don't interfere it's a good idea to tell your doctor if you're taking them in case there is an interaction with something that you're on and the oh you found it Wow okay Wow this is like this is like instantaneous stuff it's like I have a producer in the side so inste Flex is glucosamine MSM bark extract ginger root extract buzz wiliest Cerreta extract turmeric cayenne and hyaluronic acid so that's very interesting actually so glucosamine is there was actually a nice study done on glucosamine a number of times people's the makers of glucosamine tablets in Europe have in fact it's a it's a you have to get a prescription for it in Europe and they showed lots of reduction in joint pain in osteoarthritis with Cohoes mean now the problem is is that if you're selling this stuff and you're doing the research at the same time it's a little bit dicey right you sort of have the the way that you set up the experiment as often in your favor that sort of thing so about probably 15 years ago now we did a very nice study where we took people who had been taking glucosamine and said I take glucosamine and it works for me we said great so we took a couple of hundred of those people and we let them continue their glucosamine or we put them on an identical looking placebo or sugar pill and we followed them up over six months and we couldn't tell the difference the number the amount of pain people had afterwards the number of flares of their arthritis that they had were exactly the same I couldn't draw the lines overlapping any any better and then the NIH did a big study on glucosamine and they couldn't show a difference in hip or knee arthritis as well so in the in the controlled studies that been done with things like clothes I mean it doesn't seem to work very well nowhere at all on the other hand it's relatively harmless it costs a little bit of money you got to take a whole bunch of pills during the day in order to do it which is all the downsides but if it works for you I usually take credit for it okay so I usually tell people that if they're really if they can afford it and it doesn't interfere with their other drugs that - go ahead try it and if it works then that's terrific you know if you feel much better than you can try withdrawing it and see whether you can get away without it right go from there so the question is whether the the low blood counts would affect your iron so low iron can cause anemia or low red blood cell counts and these medications in really severe cases can cause low blood red blood cell counts they mostly cause low white blood cell counts if they're going to do something but they can make your red cell counts go down they're unrelated so it doesn't make your iron go down it doesn't affect how much iron you get but sometimes your doctor is looking at your hemoglobin and it might be a little bit low and they're saying well is this your drug or is this because you don't have any iron enough iron on board there's some good measures that we can do in the blood to see how your iron stores are and if they're low then we can put you on a supplement for awhile yeah yeah so lots of people ask about massage therapy and whether it's of help sometimes what happens is when your joints are really inflamed and irritated the muscles that are around the joints they get very tense and they get very when they get very tight and they cause more pain and so there's really not a lot that's downside apart from the fact that you often have to pay for them for forgetting massage therapy it's important if you have spinal arthritis particularly if you have rheumatoid arthritis or psoriatic arthritis that affects your spine that you let your massage therapist know that they're all aware that sometimes you know every once in a while somebody's head pops off but you know the so they'll treat it a little bit more carefully but there's a that they can sometimes be very helpful you can also do some stretching yourself for some of those muscles and and they stretch much better if the muscles are nice and warm so if you're going to try doing your range of motion exercises or your stretching exercises it's a good idea to either do them right after you've done some form of exercise like walking around or doing things or for your neck you can put a heating pad on it for 10 minutes or so before you try doing the stretching just to warm the muscles up yeah so so is it best use heat or ice for inflammation basically if things are hot it's best to put ice on them but not everybody has read the textbook and so some people actually find that when they use a little bit of heat on on a sore joint that it feels better and it may be that there's more damage than inflammation but the rule of thumb is that for inflammation putting some ice on it for 20 minutes at a time and you take like a bag of peas and throw them in the freezer they'll be all frozen right and you can put it on it molds nicely to the joint and you can throw it back in the freezer you have to put a little X on the bag so you know which one you've been using as the thing don't cook those Peas but if if the ice doesn't seem to do very much or it irritates it then certainly trying some heat is a reasonable option as well there are some therapies that can sometimes help with mechanical back pain you know there's those inversion tables where you hang upside down for a little while and and that stretches things out and most of what the chiropractor does when he's actually manipulating people's backs is to do the exact same thing so there's lots of little joints in your spine and what they're doing is they're not putting them into line but they're actually doing very much like when you crack your knuckles you get that little crack and you're in the in the knuckle and it separates the joints a little bit and it actually relaxes the muscles around that area so so something that moves it around in a gentle fashion may be of some benefit from a symptom point of view so the question is whether arthritis affects hearing there is an association with hearing loss that goes along with gray hair and glasses there are some rare forms of arthritis that can affect the bones in the inner ear and the nerves that are there those are often things little and they have strange names like relapsing polycon Rytas and and granulomatosis with polyangiitis but the typical forms like osteoarthritis and rheumatoid arthritis and the spondyloarthropathies don't usually affect that again it's um it's one of those things where as as you get older and you may accumulate some osteoarthritis you may also accumulate some other problems like hearing hearing deficits my this picks up well from here I'll do some drumming later yeah so medical marijuana is a very hot topic these days and and we know that the the receptors in the brain that marijuana attach or some of the components of marijuana that they attach to can certainly relieve pain the problem is is that the science around it isn't as robust isn't as good as it is with some of the other medications we've used and what's really lacking is science around what marijuana to use so if you sign up and get a license to have medical marijuana it's a little bit different so let's say for example that I diagnosed you with high blood pressure and and I say okay I have probably 25 different drugs that I can use to treat your high blood pressure with and multiple doses of those and so I look at you look at your medical history and I say okay I want to give you X Y Z it's own so many milligrams and we'll see how this works and you take it to the pharmacy and they give you that in the medical marijuana world what happens is is that I say okay yeah you've got bad arthritis so you need some medical marijuana I'll sign your form and then you go to the pharmacy and I'll have the pink ones please okay so it's you actually talked to the pharmacist to the marijuana distributor and they will tell you what they think is going to work based on not a lot of science and and trials that we've sorted out so our experience has been a little bit mixed some people find some good relief with it most of the people who have tried medical marijuana have been using marijuana before they come to see me and ask about it the and in some cases it has allowed them to get off of heavy-duty narcotics for example and to continue working and do very well so those are the really good cases in other cases it has really made no difference and a lot of people find that they don't like the effect because they get a little bit stoned and they don't feel the that it's that there is alert as they could be when they're on it so there's there's two things one is this that you can now get cannabis oil and its various it varies quite a bit there's really two different ingredients there's something called cannabidiol and there's THC and it's the THC that makes you you know feel really stoned and the cannabidiol that has more of the effect I think on the pain side and you can get anywhere from almost pure cannabidiol to almost pure THC in these products there's also a synthetic form called NAB alone that we can prescribe and that tends to make people feel quite stoned actually so the one that's easy to prescribe is a little bit less well tolerated so it's a bit of a it's a bit of an open question and I think it's going to be a real change in the game become spring when it all becomes legal in recreational marijuana usage and how we actually manage that around patients but it's a very good question thank you yeah so sorry otic arthritis tends to cause more fusion in the spine than it does erosion and damage so sometimes in the early stages we can see in the sacroiliac joints we can see loss of bone and erosions and then what happens over time is those actually fuse and you end up with more bone formation so you end up losing range of motion it's so it's a little bit tricky but not particularly like erosions where rheumatoid arthritis it can actually eat away all the bones in your spine certainly in your neck as well I don't know about you but I learned a lot today did you yeah I know I love the way dr. Robinson presents he makes sure that we understand what he's talking about I didn't walk away going what was that what didn't he made sure that we understood everything we needed to understand I think it's a great gift that he has to be able to share his knowledge in a way that we can all understand now we're going to share a little bit more about the arthritis society we are one of the resources that are there for you and I'm gonna tell you a little bit more about the arthritis society and help people who are living with arthritis come can live well and using the resources that we have to offer and plus we also have an event that's going to be coming to Brandon that we're going to be telling you about as well so again our sponsors are our major sponsor is Celgene and we have dr. Tracy Jason and Ellen chin from Celgene here today to to view and see what was going on today but they were the major sponsors and they were one of the main reasons that you were able to attend this free of charge today so let's please say thank you and our to secondary sponsors are rolling spokes and Safeway so be so as you see they have tables over at the side bless who is one of the co-owners of rolling spokes you may have seen him on West Man communications he actually taped an interview last week to help to promote this particular event so maybe you did see him and doesn't worry very grateful to him for doing that for us and pharmacy at Safeway and Sobeys has been very supportive not only Brandon but in Winnipeg as well and supporting all of our education making sure everybody has the opportunity to participate in it I don't know okay new toy I'm not quite sure how it works yet that's right well okay good good good so a little bit about the arthritis Society you may not know but it's been around since 1948 and it has invested in one hundred and ninety million dollars into research and that investment has trained rheumatologists it's helped to develop new drugs such as the biologics have heard about today to be able to help with the symptoms and of course they are always working towards trying to find a cure and we raise funds and drive different ways in order to be able to fund that research but the Arthritis study is the main research sunder our mission is to provide leadership and funding for research advocacy and solutions and to help you live well with arthritis little more about what we do so we excite we talk button to be invested in in research project projects we raise awareness you may have heard me talking at the beginning about the fact that there have been over 1,500 children in the province that have been diagnosed since the 80s with juvenile arthritis how many people know that children get arthritis so that's part of our job is to raise awareness we raise awareness with the teachers so that they know that this is a possibility and how can they integrate this child's challenges within their classroom children quite often or they deal with bullying when they have j-a because you can't see that they have juvenile arthritis so they get teased by their classmates at search or when they can't to do something so we try to make sure the teachers understand what's going on and we also go into the classrooms we do some childhood reading and one of them one of the books we read is called pain is like a grouchy bear I bet you some of you actually you know know what that means I know that I do we also offer education services not only for individuals but for groups as well we'll go in and talk to staff groups or sometimes we'll go to medical students or massage therapy students so they understand what it's like to live with arthritis and a different way they may have to look at or think about when they have a patient who has arthritis of course we have online so those of you that are tech-savvy we have great resources on our website but we also do things like this education and in-person and we also try to connect people we want to make sure that there's a lot of resources around you and talked about our brand and support group which meets the is it the first Tuesday of the month second Tuesday of the month at the tell me I'm sorry I can't remember no no Town Center next to the food court at one o'clock 1:30 and second Tuesday of every month and this is a very active group that's always bringing in new education and things to be able to learn about but they're also there for each other and that's really important and I'm now going to hand it over to Allison Allison Kirkland is our new education and services coordinator who is joined us at the arthritis Society and just a few months ago and she's got some great information to share with you and I'll come back at the end to wrap everything up thank you very much for coming out this afternoon so my name is Allison Kirkland as she mentioned I'm education and services coordinator with the arthritis Society from Manitoba and Nunavut so I I tell people I'm the person that gets to spend the money I'm responsible for the programs we offer putting together forums like this the resources that we have available to you answering questions when you call into the office I'm I'm the gal that you get and we have in an effort to better use the funds that people donate we've made some changes and how we're structured and whatnot so a little bit of what I'm going to talk about too is volunteering because my my position is really an amalgamation of three other positions and a lot of my responsibilities our hope is to have volunteers out out in the communities delivering our programs sharing our resources offering the support groups like the brand and support group are a huge boon for the Arthritis society and really help us raise awareness and and for advocacy so why do we want to do this I love this quote this picture here the person you see speaking this is from our family day a few weeks ago October 2nd Sunday October 2nd we held an event called family day and it is for the children with arthritis and their families it's an educational opportunity it's an opportunity for these families and the kids with arthritis to connect and and do some things in an environment where everybody is like them instead of being the odd man out and speaking here is dr. Kirsten Gare Holt who is the head of pediatric rheumatology at Health Sciences and she's wonderful wonderful speaker and one of the things she's mentioning here is it's easy to miss what you're not looking for so something that's been mentioned a few times today is that we have 4.6 million Canadians that are diagnosed with arthritis we have over 200,000 in Manitoba currently there's about 600 in the province 600 kids in the province that have arthritis and that that equates to about one child per school in the province at HSC in their pediatric department there they're treating about a hundred and eighty alone so there are a lot of people from infants to older adults that are dealing with arthritis and unfortunately a lot of the people that are coping with arthritis have waited a long time to get around to dealing with it a lot of times we feel aches and pains as we're getting older and we just put it off to aging or something we did during the day and we don't go and get things diagnosed maybe as soon as we should so it's really important to raise awareness for people to be conscious of what could be and so that's a large part of what the Arthritis society does is we are really trying to wait raise awareness and we're trying to increase advocacy so part of the reason we want to do that is we want you to go to your doctor we want the people in your life you know you're here probably because you've already been to your doctor you've been diagnosed you you're doing your you know you're seeking treatment you're getting treatment but there's 60% of the people that have arthritis are under the age of 65 it's leading cause of disability in cam and arthritis is something that if you diagnose it early it can be treated earlier which means it can slow or stop the progression you're still going to have our threat us but treatment is going to affect how your disease progresses and the sooner you can do it the better so it's really important to get early diagnosis it's um really important to get diagnosis by a physician in this stage a day and age with the internet a lot of people are going online and and we do have a symptom checker on our website but it is fairly specific but a lot of people are self diagnosing but unless you're going to a doctor you're not getting a definitive diagnosis I don't know if you're aware of this but there's a hundred and nineteen presently we're aware of there being a hundred and nineteen different types of arthritis so you know about osteo you know about rheumatoid we talked about psoriatic arthritis we've talked about ankylosing spondylitis here today with dr. Robinson but there's things like lupus fibromyalgia things like that they're there multiple varieties of arthritis and you need to know what type you have to be able to treat it appropriately and they're a broad variety of treatments and for that you need to go talk to your doctor but your doctor is not the only member of your treatment team so that's another part of our education our resources our awareness and our advocacy is helping you and the people in your life and if you choose to come and volunteer us for us and help us spread our mission you're letting people know that your treatment team is your doctor it is your pharmacist pharmacist is a really crucial part of your treatment team because your rheumatologist of you seeing rheumatologist knows a lot about rheumatological treatments the drugs being used for that but you know I've had instances where I've had phone calls from people who said you know I'm I'm not sure what to do because my doctor says I can't take medication for the pain or my cardiologist says I can't take medication for the pain because it's in or going to interfere with the drugs that I'm taking for my heart problems and somebody like your pharmacist is going to help you navigate some of those issues occupational therapists helping you figure out how to be more functional in your day to day life physiotherapist massage therapist even psychologists and social workers if you have arthritis and you've had it for a while you're aware that fatigue is a huge problem but you're also aware that depression is a huge part of dealing with a chronic illness and dealing with chronic pain and it's something that you shouldn't be dealing with on your own so again really good to seek the professionals so the other thing to think about and we we brought this up several times and I frankly don't think it can be stated enough is that arthritis hits people of all ages from infants to older adults using myself for an example I started showing signs of arthritis when I was eight years old part of what the arthritis does our three society does with that money that's looking into research it took 11 years for me to be diagnosed and the reason it took 11 years is because research had to catch up with me they couldn't definitively diagnose it until I had been suffering it from 11 years but the other things that we we have and we do we have will voytovitch who was our spokesman for arthritis awareness month in September and will is he was and is again a very active man very fit outgoing professional he's a father of two children and he was hit hard by arthritis coming up on his 40th birthday he he's somebody who suddenly couldn't get dressed without his wife's help his young son going to hockey practice he had to ask other parents to tie his son skates and this is a man who is not even 40 yet he used to be an athlete he was a former U of M bison and he he was embarrassed he was depressed he hid it from everybody but when he found the right doctor and he got the right combination of treatments it made a world of difference for him his life has turned around and he's expressed that he feels exactly like he did before arthritis he knows that he's gonna have to continue being treated to feel that way but it's it's a fabulous thing we have people this lovely blonde young woman here in the picture this is Krystal karakov she's 31 years of age she's been on disability since 2009 she first developed arthritis when she was 5 years old at 31 years of age she's had both of her hips replaced she's had both of her knees replaced she's waiting have both of her shoulders replaced she's in constant pain but we're at a place where we've been able to help her still be at least somewhat functional and give her some hope for the future and both of these people are really key excellent volunteers for the arthritis Society for all her challenges Krystal to care cough she she is on our divisional Advisory Board she's been part of our walked fight arthritis a part of our steering committee for that she is the impetus behind our teens support program because she would like to help teens that are struggling with the challenges of arthritis so really crucial part of our team and that's part of the reason volunteers are so important is to be able to spread their stories to connect with people to relate with people as well as to educate so in terms of finding answers when you're looking for answers there's a variety of options that the arthritis Society can provide we have forums like you're attending right now we have education programs we offer a variety of programs we have the chronic pain management workshop we have a workshop on understanding our raitis on overcoming fatigue so we have all these options in person but again this is where volunteers become really important we're based in Winnipeg so it's kind of hard for us to deliver these programs in places like Brandon and the surrounding areas so if you're thinking that you have something to share and you have some time I would loved to see you come and talk to me about the possibility of volunteering increasing those programs but we're also looking for people to represent us at at health Fair's to let people know about the resources we have to share our resources we do we have stuff that you can get in person you can call us on the phone but you can also go online and almost all of the resources that the arthritis Society has if you are tech savvy or you're sharing with somebody who might be and it's not your thing they can go to our three dos CA and we just we have a huge amount of stuff on our website we have everything from downloadable publications of all the resources that we have and if you haven't checked out that back table please do get si an idea what you can get in person but you can also find online and the website can be a little daunting to navigate if you haven't done it before but there's lots of great options so I'm just going to briefly touch on some of the places you can go on our website so just learning about arthritis for people that are fairly newly diagnosed or maybe you're not that newly diagnosed but you'd like to learn more you can navigate this blue bar down the side of the page it's going to help you navigate throughout the website so we have pages where you can come and click on the side about arthritis and you're gonna have some generic information on arthritis but on this slide here at the bottom we have a list of the more common arthritis --es and if you click on them it'll expand and it'll give you all sorts of information on the illness itself or on the type of arthritis itself it'll give the frequently asked questions it'll talk about treatments what you can expect symptoms things like that I mentioned earlier the symptom checker so this is a really it's it takes you through you can go click and answer really easy questions and it takes you through fairly quick e quickly to help you again we want you to get a definitive diagnosis from your physician but this might help you know whether it's worth your while to make that appointment and and get in so it's really useful it's also good for helping you prepare for your doctor's appointments to come up with your questions and that's something else that we do have on the site is we have information that and we have also have the hard copies we have information that will help you determine the questions that you need to ask to help you with those doctor appointments because he it can be tough you think about all the stuff that you want to know and then you go into the doctor's office and it's all gone so we we have resources that help you with those some of the other things that we have so not everybody can make it out to workshop or we're not maybe able to deliver it everywhere that we would like to so some of our workshops are actually online and one of our best and most popular workshops in-person and online is our chronic pain management workshop so it's an actual program that you can go through online it's simple it's very much like dr. Robinson everything is put out there in easy-to-understand terms and it's a really excellent it covers techniques for managing pain it talks about the things that are connected to pain such as stress anxiety depression how to break that pain cycle things like that so we have programs and things like that online programs that you can do and day to day stuff helping you manage your arthritis in the day to day there's information on that if you have osteo and joint replacement is maybe on your horizon we have pretty much everything you need to know about joint replacement surgery and leading up to it preparing for it what questions to ask your doctor about it so all the stuff that we have we're always looking for people to find ways to get involved it's really important to us and volunteers are a really key part of what we do we can't do what we do without volunteers and we have a huge amount of volunteer options we have people that help us out in the office we have people that give presentations we have people that are on our advisory board our walk committee and Donna's going to talk a little bit more about that in just a moment you can just in talking to people raise awareness tell them if they're if they have questions tell them they can go to our website or call our 1-800 number and just a quick note if you call the 1-800 number I don't know what magic causes it to have but you get routed to the office in your province yes so if you call from anywhere in Manitoba you call that 1-800 number even though it's a national number you will get our office in Winnipeg so good to know easy to find and you can participate and again I'm going to let Donna talk to you a little bit more about participation however if I have in any way shape or form or just being here today has inspired you to possibly want to volunteer or at least know more about it you can certainly come and talk to me afterwards Thanks so while Alison does education I'm the money girl I've always tried to find ways to find funding and if it's through corporate sponsors it's through individual givers it's through foundations and it's through events so we get no funding from the government whatsoever so we're always looking for ways to raise funds so that we can provide the education provide the resources provide funds back to research that's so very important as you've heard today how much research has managed to accomplish in the last 50 years so there's a variety of ways in which people can get involved with all of that we are very very excited that we are bringing the walk to fight arthritis to Brandon we have just recently booked with the riverbank Discovery Center and that's going to be our location if on June of the 4th the walk to fight arthritis is a national event it means on that same day on June 4th all the way across the country are thousands of people who are walking to fight arthritis so it's a huge community community all across Canada that is all coming together to do this you some of you may have been aware of the Jingle Bell walk run which is an event that's been produced here a run here for the last actually not sure how many years but I know it's been around for a while and it was decided that we wouldn't be doing that event and the numbers of people participating we're going down etc it was time to refresh and do something different so we're going to be starting with the walk to fight arthritis which is a very exciting event when it's when you think about how many people all across the country are doing it all together all for the same cause it's very empowering and so there are a few things that how we need to make this happen one of them had was finding a location so we're all good and we're all set with that I'm going to be looking for people to be on the organizing committee it's very important to have people that are local be on the organizing committee who know you know the businesses and the people and the connections so I'm gonna be looking for people to do that if you or somebody you know might be interested in being on the organized committee please let me know afterwards the other thing I'm going to be looking for is I'm going to be hiring on contract professional event manager so if anybody knows of a professional event manager you think might be interested in helping to run this event for us I will have a contract that starts in the new year and you can send them my way as well and we can we can talk about it again it would be great to have a local event manager be able to run this event for us in Winnipeg we have about 500 people participate there's walks across the country sometimes they only have 25 people participate depending on the size of the of the city that it's being held at but it's all about coming together for a great cause for people and 90% of the people that attend either have arthritis or their loved one has arthritis friends and family so it's very much a community event that happens I'm just gonna wrap up and say we are so grateful that you're able to join us today I'm really hoping that there was something that you got out of it that you're able to take away just even if it's a one or two nuggets of information that you're able to walk away with a better understanding or even that you can share with how's this better understanding you know that would be fantastic because you've now become our our advocates you'll go out into the community and talk about it we really are very very grateful that you're able to join us today and really hoping that in June I will see you at the walk defy Darth right although I'm not sure if I'll be here I might be in Winnipeg but overall they royal you that we'll see you there at the walk defied arthritis and thank you so much for sharing your time with us and I hope to see you again someday if there are any questions please Allison and I will be around please don't hesitate to approach us and again we still have Sobeys as so be Safeway and rollin folks over at the side if you didn't get a chance to talk to them or we have our information table at the back as well with lots of different information just in case you haven't had a chance to see that yet today again thank you you

Channel: Arthritis Society

Views: 441,125

Rating: 4.68957 out of 5

Keywords: arthritis, rheumatology, osteoarthritis, inflammatory arthritis, gout, pain, treatment, Canada

Id: 7abUCT0hnYY

Length: 84min 23sec (5063 seconds)

Published: Fri Nov 11 2016