Rheumatology Patient services




		Conditions, Treatments and Patient Services
		RHEUMATOLOGY The Multi-Disciplinary Musculoskeletal Service Conditions treated in rheumatology Inflammatory arthritis such as Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Reactive arthrtis Osteoporosis and fracture prevention Gout & other crystal arthritis Polymyalgia rheumatica & giant cell arthritis Other connective tissues diseases such as lupus & vasculitis Bone diseases such as Paget’s disease, osteomalacia Childhood arthritis Back pain Osteoarthritis Regional pain such as shoulder pain, knee pain, foot pain Soft tissue problems such as bursitis, tennis elbow, carpal tunnel syndrome When should you see a rheumatologist If musculoskeletal pains are not severe or disabling and last just a few days, it makes sense to give the problem a reasonable chance to be resolved. But sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your physician. Many types of rheumatic diseases are not easily identified in the early stages. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. It’s important to determine a correct diagnosis early so that appropriate treatment can begin early. Some musculoskeletal disorders respond best to treatment in the early stages of the disease. Because some rheumatic diseases are complex, one visit to a rheumatologist may not be enough to determine a diagnosis and course of treatment. These diseases often change or evolve over time. Rheumatologists work closely with patients to identify the problem and design an individualized treatment program. Rheumatology referrals Referrals to the rheumatology service will primarily come from your General Practitioner, who will need to undertake an assessment to decide whether referral to a rehumatologist is the most appropriate course of action in each individual case. Referrals may also be made by Physiotherapists, Fracture Clinics, Orthopaedics, Pain Management and many other medical services. The team The rheumatology team comprises of Consultant Rheumatologists, Doctors in specialist training (specialist registrars), Nurse Specialists, Physiotherapists and other health professionals. The team provides care based on multi-disciplinary holistic assessments of the individual care needs of people presenting with inflammatory and non inflammatory joint, muscle and bone diseases. Diagnostic service The department may also provide Musculoskeletal Ultrasonography and DEXA Scanning for diagnosis and assessment of various rheumatic conditions and Osteoporosis. Rheumatology clinics Inflammatory arthritis clinics for conditions such as Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Reactive arthritis etc Nurse specialist clinics for assessment of response and monitoring of therapy for these illnesses. Musculoskeletal clinics led by physiotherapists and supported by rheumatologists for evaluating back pain, regional pain, soft tissue conditions. Musculoskeletal triage Rheumatologists have pioneered the use of protocol based triage and ‘joined up working for the assessment of various musculoskeletal conditions working on the motto’ the appropriate health professional for the appropriate patient’. Rheumatologists work in close collaboration with senior Physiotherapists, Pain Management, Podiatry & other health professionals to offer the musculoskeletal clinics for patients presenting with non inflammatory musculoskeletal symptoms. Osteoporosis & fracture prevention clinics for evaluation of fractures due to osteoporosis and for secondary fracture prevention. Specialist clinics that may be available Polymyalgia rheumatica & giant cell (temporal) arteritis Lupus clinic for Connective Tissue Diseases such as Lupus , vasculitis Paediatric Rheumatology for children suffering with arthritis Combined pain clinic with the pain team Combined Foot/hand clinics Ultrasonography clinics The function of these clinics is to: · Diagnose and assess patients with various rheumatica diseases, · Arrange appropriate investigations including blod tests and radiological imaging · Control the pain and disability · Prescribe the appropriate treatment which may include a disease modifying drug such as Methotrexate or steroids · The treatment may require aspiration and drainage of swollen joints and injections with steroids · Monitor patients for any adverse effects and for degree of response to treatment. · Provide Patient Education and emphasise the self management of many of these long term conditions. · Provide Joint & soft tissue Injections for conditions such as shoulder, heel pain, tennis elbow, carpal tunnel syndrome,bursitis and tendonitis · Provide spinal injections for back pain & sciatica such as epidural injections and facet joint injections · Provide support for parents and carers of patients suffering with arthritis. · Promote the social and educational development and growth of children suffering with arthritis Multi-disciplinary clinics These provide opportunity for additional input in the care of various complex rheumatological conditions, using the full range of expertise available within the hospital. Musculoskeletal ultrasonography This is an emerging technology which allows radiation-free evaluation of patients with various musculoskeletal problems. For example it can detect early inflammation and damage from rheumatoid arthritis, small muscle (rotator cuff) tears in the shoulder and the degree of tendon inflammation in heel pain as well as presence of bursitis and joint fluid. Injections can also be undertaken with greater accuracacy using US assistance. Commonly used drug treatments The usual therapy for rheumatoid arthritis other inflammatory arthritis, connective tissue diseases such as lupus and vasculitis involves disease modifying agents such as Methotrexate, orally or by injections Sulphasalazine Leflunomide Hydroxychloroquine Mycophenolate Azathioprine Cyclophosphamide Other immunosuppressive agents Steroid treatment for many of the rheumatic conditions which again can be given orally, intra-muscular or Intravenous routes. Biologic agents . Patients with severe diseases may be treated with bioiologic therapy which includes Anti Tumor necrosis factor (TNF) agents such as Etanercept Infliximab Adalimumab Rituximab. – a B cell depleting agent Abatacept - Inhibitor of T cell co-stimulation Intravenous day-stay treatments The service also involves the administration of intravenous agents such as Pamidronate infusions, Iloprost, intravenous immunoglobulins. Joint injections Many patients with non inflammatory soft tissue conditions are treated with injections to the joints, tendon sheaths, and inflamed bursae. Special day procedures are also performed such as epidural injections as well as facet joint injections. Patient education is promoted through information leaflets produced by the Arthritis Research Campaign (ARC) as well information provided by different web sites such as the ARC and NRAS. Telephone helpline to provide patient support hrough the use of a dedicated helpline which can be accessed by all patients attending the Rheumatology Services. This provides an urgent response mechanism to any emergency that the patients may have. Departments also runs telephone clinics for patients who have difficulty in attending the Hospital. Research & Development and Teaching Is undertaken in most rheumatology units.This includes clinical audits of performance measures to ensure good patient outcomes.