This service is unique in the UK, offering an adolescent rheumatology service that provides diagnostic and therapeutic advice to patients with any rheumatic diseases that occur in adolescence in a one-stop multidisciplinary setting. We have a purpose-built adolescent unit for those patients that require inpatient care. There is also the ability to perform intra-articular injections under the cover of entonox and access to a dedicated daycare facility for young people. Each patient is allocated a 45 minute first appointment and 30 minutes for a follow up to facilitate a holistic approach.
The development of the Centre for Adolescent Rheumatology's website aimed at adolescents with arthritis and other rheumatic conditions
Autoimmune rheumatic diseases
This service aims to provide accurate diagnostic and long term management advice for patients with Systemic Lupus Erythematosus, Sjogren's Syndrome, Myositis, Vasculitis, Primary Anti-Phospholipid Antibody Syndrome and Overlap Syndromes. The regular rheumatology clinic staffs are supplemented by specialists in dermatology, nephrology, haematology, respiratory medicine, osteoporosis and oral surgeons from the Eastman Dental Hospital on different days of the month.
Carpal Tunnel Clinic
Patients with symptoms of carpal tunnel syndrome who need specific investigations, diagnosis and management can be referred to this service. There are consultants in rheumatology and hand surgery available to manage patients to the next stage. General practice referrals will be accepted directly into this service only if the referral is purely for the diagnosis and management of carpal tunnel syndrome.
Chronic Musculoskeletal Pain Clinic
This service works in close collaboration with two physiotherapists, four psychologists and the team of pain management consultants at The National Hospital for Neurology and Neurosurgery at Queen Square. The main objectives of this service are as follows. Firstly, to see patients with complex pain conditions, often refractory to treatment or which have a strong psychosocial component. Secondly, to provide reasonable explanations for the symptoms, which help the patients even when a definitive diagnosis and cure is not attainable. Thirdly, to advise on the likely prognosis of each patient and try to stop a recurring cycle of investigations and referrals to different specialists that frequently occurs with these patients. A particular function of the clinic is to act as an entry point to the pain management programme run by the psychologists and physiotherapists at Queen Square which helps patients adjust their lifestyles to cope with persistent pain.
Rheumatology Infusion Clinic
The Infusion Clinic sees approximately 100 patients’ a week with inflammatory arthritis (including rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis) who are being treated with biologic therapy and also osteoporosis and metabolic bone patients receiving bisphosphonate treatment. All treatment complies with NICE guidelines. There are substantial benefits for patients who have failed conventional treatments who are looked after by a dedicated expert team of nurses. Detailed information is recorded on each patient for audit purposes to ensure the optimal treatment of these patients.
Patients’ are also reviewed on an ad-hoc basis by the Specialist Registrars when they are unwell or flaring.
This monthly specialist advisory service is staffed by specialists in rheumatology, obstetric medicine and obstetrics with three main aims. Firstly, to provide pre-pregnancy counselling on the appropriate timing and risks of pregnancy and medications in patients with rheumatic disease. Secondly, to follow these patients through their pregnancies, help distinguish disease from pregnancy manifestations and advise on the safest therapeutic interventions where appropriate. Lastly, to follow patients for up to four months post-partum to ensure continuity of care and prompt treatment of any disease flares.
Osteoporosis and Metabolic Bone Disease clinics
The Osteoporosis and Metabolic Bone Disease clinics are run under the supervision of two consultants with one clinical nurse specialist who holds two monitoring nurse-led clinics including sc Denosumab injections. There is also daily infusion clinic for intravenous bisphosphonate therapy (pamidronate and zolendronic acid); and a fracture liaison service within the hospital. The Osteoporosis Clinic is mainly for patients with complicated or severe disease who are failing to improve with standard therapies, patients with secondary drug-induced osteoporosis such as corticosteroids, aromatase inhibitors or anti-androgens and younger patients with rickets/osteomalacia or osteoporosis related to inflammatory arthritis, inflammatory bowel disease, retro-viral disease and eating disorders. The Osteoporosis Clinic Team has strong relationships with other important departments within the NHS Trust such as orthopaedics, imaging, interventional radiology/neurosurgery (for percutaneous vertebroplasty, balloon kyphoplasty), chemical pathology, and physiotherapy. The Metabolic Bone Disease Clinic also offers expertise in the management of many rare conditions such as Paget disease, osteogenesis imperfecta (brittle bone disease) and provides a regional and national specialist clinical service for these patients.
Rapid Access for Early Inflammatory Arthritis
This service provides rapid access for patients with early (less than 6 months of symptoms) peripheral inflammatory arthritis to commence disease-modifying therapy - where appropriate - as rapidly as possible. There is increasing evidence to suggest that early intervention is crucial in preventing long term joint damage in patients with rheumatoid arthritis and psoriatic arthritis and direct referral to this service will help to bypass any potential delays in triage. The criteria for referral are two or more swollen joints in the hands or wrists and joint pain for less than 6 months. Consultant rheumatologists and clinical nurse specialists jointly manage the patients with the intention of rapidly achieving disease remission.
Rituximab for Rheumatoid Arthritis
The objective of this service is to make rituximab available to all patients with rheumatoid arthritis falling within the recommended indications (generally speaking failure of, or contraindication to, an anti-TNF agent). This service has the most extensive experience with this therapy internationally. Not all rheumatology units will be familiar with the use of rituximab and patients normally managed elsewhere are also welcome to be referred either for advice or provision of rituximab therapy if not available otherwise.
Upper limb clinic
This service is purely for the diagnosis, investigation and management of upper limb pain, including shoulder, elbow, wrist and hand symptomatology. Patients can be investigated further with in-house neurophysiology and radiology and there is a specialist hand surgeon available for advice and also immediate inclusion for surgery if appropriate. Injections can be given during the consultation. The extended scope practitioner is present to discuss work-related issues, give ergonomic advice and assess for further treatment by a physiotherapist.
Young adult rheumatology service
This clinic is designed primarily to facilitate the transition from the adolescent to the adult rheumatology service for those young people who are having difficulties as well as long term adult care for all patients with juvenile idiopathic arthritis (JIA). This ability to care for patients with JIA from ‘cradle to grave’ is unique and provides joined up clinical care and huge research opportunity.
There is also the capacity to see general rheumatological problems in patients of any age.