Rheumatology

We deal with the diagnosis and management of acute and chronic inflammatory conditions. We also deal with neck/back pain, soft tissue problems and shoulder disorders, although initial referral for management of these conditions is usually to the Locomotor Service.

Other conditions that we manage include osteoarthritis, gout, bone disorders such as osteoporosis, osteomalacia and Paget’s disease.

Treatments are mainly based in the outpatients department and on the medical day unit. We work closely with physiotherapists and occupational therapists within the hospital and the Primary Care Trust.

Acute and chronic inflammatory conditions
These include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica, and systemic autoimmune disorders such as systemic lupus erythematosus (SLE), antiphospholipid syndrome, Sjogren’s syndrome, scleroderma, inflammatory myopathies and vasculitis.

Most conditions are assessed in the rheumatology outpatient clinics. In clinic, patients have the opportunity to discuss other coping strategies to improve their health including exercise and alternative therapies, hydrotherapy, occupational therapy and podiatry.

The need for social service intervention is also discussed and if necessary an immediate referral to the appropriate health professional is made.

Patients over 18 years of age and who have the below immune mediated inflammatory disorders, are considered high risk from coronavirus and are prioritised for Covid 19 treatment:

• people who have received a B cell depleting therapy (anti-CD20 drug for example rituximab, ocrelizumab, ofatumab, obinutuzumab) in the last 12 months
• people who have been treated with cyclophosphamide (IV or oral), biologic medicines or small molecule JAK-inhibitors (except anti-CD20 depleting monoclonal antibodies) in the last 6 months
• people who have been treated with corticosteroids (equivalent to greater than 10mg per day of prednisolone) in the last 28 days
• people who are on current treatment with mycophenolate mofetil, oral tacrolimus, azathioprine/mercaptopurine (for major organ involvement such as kidney, liver and/or interstitial lung disease), methotrexate (for interstitial lung disease) and/or ciclosporin
• people who exhibit at least one of: (a) uncontrolled or clinically active disease (that has required a recent increase in dose or initiation of new immunosuppressive drug or IM steroid injection or course of oral steroids within the 3 months prior to positive PCR); and/or (b) major organ involvement such as significant kidney, liver or lung inflammation or significantly impaired renal, liver and/or lung function)

For patients with any of the above risk factors: The NHS offers treatments to people with coronavirus (COVID-19) to prevent those at highest risk becoming seriously ill.

The below link provides further information on what to do next and how to register your positive Covid19 result. It also provides further information on Covid19 treatments and guidance on how to access it.

https://www.nhs.uk/conditions/coronavirus-covid-19/self-care-and-treatments-for-coronavirus/treatments-for-coronavirus/