Service overview - Rheumatology

Our specialist doctors, called rheumatologists, run the unit and are experts in the field of musculoskeletal disorders (bones, joints, ligaments, tendons, muscles and nerves).

Their role is to diagnose conditions and recommend appropriate treatment, if necessary from the orthopaedic department. The rheumatologist may need to review you regularly, either in person or via one of the rheumatology team.

Alternatively, your condition may be one your GP can manage in the community. Many conditions are managed jointly between the GP and our hospital care teams.

Information for people receiving treatment for chronic rheumatic diseases during the COVID-19 outbreak

From consultant Rheumatologists at Broomfield Hospital, 9 April 2021

The Government has outlined its roadmap out of the lockdown, with a gradual easing of restrictions over the next few months that will apply to everyone. In addition, the vaccination programme continues to be rolled out to everyone, with prioritisation based on the advice from the Joint Committee on Vaccination and Immunisation (JCVI). This will help pave the way for restrictions to be safely lifted.

Although the advice to shield has ended, clinically extremely vulnerable people must continue to follow the rules that are in place for everyone.

https://www.gov.uk/guidance/covid-19-coronavirus-restrictions-what-you-can-and-cannot-do

1.If you are clinically extremely vulnerable

If you are clinically extremely vulnerable, you could be at higher risk of severe illness from coronavirus. You are no longer advised to shield, but you should continue to follow the guidance for people who are clinically extremely vulnerable and are advised to take additional precautions to protect yourself.

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Please refer to the risk assessment tool below to determine your clinical vulnerability status

The Government issued a letter to all clinically extremely vulnerable people on 17 March 2021. Accessible versions of the letter can also be viewed online.

https://www.gov.uk/government/publications/covid-19-letter-to-clinically-extremely-vulnerable-people

2. COVID-19 vaccination for patients being on immunosuppressive medication (listed in the risk assessment tool – point 6):

Three vaccines are authorised by Medicines and Healthcare products Regulatory Agency (MHRA) for use in the UK:

  • Pfizer/BioNTech

  • Oxford/AstraZeneca

  • Moderna 

All vaccines are recommended by the Joint Committee of Vaccination and Immunisation (JCVI) for immunosuppressed patients. Patients receiving rituximab treatment should ideally schedule their vaccination date at least a month or more before their infusion. Patients are not required to discontinue their immunosuppressive medications, detailed in the risk assessment tool, around the time of the above vaccinations.

Further advice about vaccination is available through these websites:

https://www.versusarthritis.org/covid-19-updates/vaccines-for-covid-19-your-questions-answered/

https://www.rheumatology.org.uk/practice-quality/covid-19-guidance

 

3. Covid-19 Vaccination of permanent household members of severely immunosuppressed patients

Eligible household contacts are being advised to call their registered GP practice to book a vaccination appointment and they will then be invited to attend the primary care network-led Local Vaccination Services (LVS) site.

Definition of severely immunosuppressed individuals is the definition of a clinically extremely vulnerable individual in the risk assessment tool below.

Definition of adult household contacts We are using the same principles to define household contacts in this context as those used in the Greenbook Chapter 19: Influenza “individuals who expect to share living accommodation on most days…and therefore, for whom continuing close contact is unavoidable.”

The JCVI advice covers individuals aged 16 years or over only. Those household contacts aged 16-17 years old will need to receive the Pfizer/BioNTech vaccine. Children are excluded.

4. Phlebotomy services during the Covid-19 outbreak

Mid Essex Phlebotomy Services has changed their services for appointment only service in response to Covid-19. Visit /blood-tests for more information and to register and book your appointment.

5. Frequency of blood test monitoring during the Covid outbreak during the Covid-19 outbreak

If you are under shared care we have communicated to your GP about any changes to blood test monitoring. Please contact your GP to enquire about these.

If you are on an immunosuppressive, but not under shared care yet, please continue blood monitoring as your rheumatologist has advised. You can contact our CNS helpline on 01245 514193 should you wish to clarify this further.

Useful information about coronavirus infection for those with rheumatological conditions is available here - https://www.versusarthritis.org/news/2020/april/coronavirus-covid-19-what-is-it-and-where-to-go-for-information/

 

6. Risk assessment tool for people receiving treatment for chronic rheumatic diseases in the context of the COVID-19 infection to determine whether they are clinically vulnerable or clinically extremely vulnerable

If you score 3 or more you are considered as clinically extremely vulnerable

If you score between 1 and 2 you are considered as clinically vulnerable

Risk factors

  • Long term (more than 4 weeks) Prednisolone dose 20 mg or above daily score 3
  • Long term (more than 4 weeks) Prednisolone dose between 5 and 19 mg daily score 2
  • Cyclophosphamide at any dose orally or IV within last six months score 3
  • One immunosuppressive medication (conventional* or biologic/monoclonal** or small molecule immunosuppressant***) score 1
  • Two or more immunosuppressive medication (conventional* or biologic/monoclonal** or small molecule immunosuppressant*** ) score 2
  • Aged more than 70 years regardless of health problems score 1
  • Aged less than 70 years AND other health problems**** score 1
  • Hydroxychloroquine, Sulfalsalazine alone or in combination score 0

*Conventional immunosuppressive medications include: Azathioprine, Leflunomide, Methotrexate, Mycophenolate (mycophenolate mofetil or mycophenolic acid), ciclosporin, Tacrolimus, Sirolimus. It does NOT include Hydroxychloroquine or Sulphasalazine, either alone or in combination.

**Biologic/monocolonal includes: Rituximab within last 12 months; all anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab and biosimilar variants of all of these); Tociluzimab; Abatacept; Belimumab; Anakinra; Seukinumab; Ixekizumab; Ustekinumab; Sarilumumab; Canakinumab

***Small molecules includes: baracitinib, tofacitinib, apremilast

****Other health problems include: Heart attack (myocardial infarction), chronic heart failure, hypertension, ischaemic heart disease, chronic lung disease, interstitial lung disease, pulmonary arterial hypertension, peripheral vascular disease (blocked arteries in your limbs), stroke (cerebrovascular accident) or TIA (transient ischaemic attack), dementia, connective tissue disease, peptic ulcer disease, chronic liver disease (not short-lived abnormalities of blood test),Diabetes Mellitus, chronic kidney disease (on or being considered for dialysis, post-kidney transplant), cancer, AIDS (not just HIV positive)

7. Continue to follow safety guidelines

Current guidlines for protecting your self and others How to stop the spread of coronavirus (COVID-19) - GOV.UK (www.gov.uk)

Getting tested and isolating if you or a household member has symptoms of COVID-19 Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection - GOV.UK (www.gov.uk)

 

AttendAnywhere video consultations for patients

AttendAnywhere logo

We have introduced video appointments to help us carry on seeing patients during the current coronavirus pandemic.

Many of our services are now using this resource. Please click here to read more and to watch a short video, which will help you understand how these video appointments will work.

Basildon Hospital - Rheumatology services

Rheumatology Day Unit, Basildon University Hospital,
Nethermayne, Basildon, Essex, SS16 5NL


Contact

Telephone: 01268 524900 ext 3397 / 8359 / 2267 / 2391
Rheumatology helpline: 01268 598461

Opening times:

Monday – Friday, 9am – 5pm


Who the service is for

Adults with rheumatic conditions.


About the service

The Rheumatology Department offers assessment and treatment for rheumatic conditions including:

Inflammatory arthritis - rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and other inflammatory arthritis
Osteoarthritis
Connective tissue diseases - SLE (Lupus), Sjorgren's syndrome, systemic sclerosis, myositis, PMR, GCA and other vasculitis and auto-immune disorders
Metabolic bone disease – osteoporosis, male osteoporosis, young osteoporosis, eating disorders, Paget's disease and osteogenesis imperfecta
Regional musculoskeletal problems and Fibromyalgia

The service offers the following procedures:

diagnostic procedures such as muscle biopsies and lip biopsies
joint injections, including image guided injections for joints such as hip and Caudal epidural injection
intravenous treatments - biologics, cytotoxic, IV bisphosphonates
outpatient clinics for biologic screening, DMARD monitoring
electromyography (EMG) and nerve conduction velocity (NCV) services (on specialist referral)
musculoskeletal ultrasound

Outpatient clinics are held at Basildon and Orsett Hospitals, and include:

early arthritis clinic
connective tissue diseases clinic
'one stop' osteoporosis clinic, including DEXA scan
combined paediatrics/rheumatology clinic
musculoskeletal ultrasound
EMG clinic
injection clinics

The Rheumatology Department is involved in many research studies and patients may be offered the opportunity to participate if they are eligible.

Broomfield Hospital - Rheumatology services

Rheumatology is one of the medical specialties which deals diseases related to the musculoskeletal system, including arthritis and other related diseases and disorders of the joints, muscles  tendons and bones.
 
Other parts of the body such as the muscles, the skin, the eyes, the lungs, blood vessels and kidneys may also be affected by some of these conditions.

Adults with inflammatory arthritis and Vasculitis are seen and treated in clinic. Large cohort of patients on Biologic Therapies Paediatric and Adolescent patients are seen in paediatric MDT setting. We have close co-operation with Royal Free, UCL and Great Ormond Street Hospital for management of these patients


Contacts

Tel: 01245 515231

01245 514415


Services

Each of the four consultants sees patients with general bone and joint conditions such as Osteoarthritis and Rheumatoid Arthritis at weekly outpatient clinics at Broomfield, St Michael’s and St Peter’s.

Each of the four consultants sees patients with general bone and joint conditions such as Osteoarthritis 

Rheumatoid Arthritis Each consultant sub specialises in particular disorders as follows:

All Rheumatology referrals should be directed to: 

Department of Rheumatology
Broomfield Hospital, Court road, Chelmsford, Essex CM1 7ET

Urgent referrals can be faxed to the department on 01245 513970

DEXA scanner and is located at :
 
Broomfield Hospital,
Court road
Chelmsford
Essex CM1 7ET
Contact : 01245 514106

Specialist clinics include:

Paediatric rheumatology.
Electrodiagnosis (EMG) clinics.
Osteoporosis clinics.
Sports medicine and Soft tissue Rheumatism clinic. 

The Rheumatology Team provides a broad base of expertise in rheumatic disorders in close liaison with the Physiotherapy and Occupational Therapy departments. Specialist diagnostic and monitoring services are available for patients with all forms of rheumatic disease including the following conditions:

Connective tissue disease.
Osteoarthritis.
Inflammatory arthritis.
Osteoporosis.
Spinal diseases.
Soft tissue lesions.
Crystal induced arthropathy.
Infective bone/joint disease.
Orthopaedic medical conditions.

Southend Hospital - Rheumatology services

Our rheumatology team is responsible for the diagnosis and treatment of conditions which cause pain, stiffness and swelling of bones, muscles and joints such as arthritis and rheumatism.

Our services and clinics include:

general
musculoskeletal
injection clinic
suspected PMR (Polymyalgia rheumatica, or painful muscles - a condition which can come on suddenly and which is often treated with steroids)


Contact us

To change an appointment please call 01702 385244.    

For general rheumatologic queries: if you are suffering a flare-up of your condition or require additional medication advice please call our secretaries on either 01702 385254 or 01702 385252.

We do not have the facility to support walk-in requests in the department. If you require urgent assistance please contact your GP or call 111, the NHS non-emergency number.