Sandyford, Dublin 18
Rheumatology & Bone Health Service
The Rheumatology Service
The Rheumatology Service provides for management of Inflammatory Arthritis & Connective Tissue Disease and Vasculitis, Osteoarthritis & Metabolic Arthritis including Gout.
Specialist services include
(1) Ultrasound diagnostics & Ultrasound guided injections for regional joint disorders
(2) A Bone Health Unit for Orthopaedic and other patients at risk of Osteoporosis
(3) An Immunotherapy unit for patients with Inflammatory Arthritis, Connective Tissue Disease and Vasculitis
The Early Arthritis Clinic and Immunotherapy Unit
It is estimated that 2% of the Irish population will suffer from Inflammatory Arthritis. Inflammatory arthritis refers to a group of conditions such as Rheumatoid Arthritis, Psoriatic Arthritis, Reactive Arthritis and Ankylosing Spondylitis where the body’s own immune system attacks the joints causing inflammation (pain and swelling) which eventually leads to joint damage.
Rheumatoid Arthritis is recognised as the most common cause of potentially treatable disability in western countries. It is now known that the earlier patients are treated the sooner they will achieve disease control and prevent joint damage and disability.
The Beacon Early Arthritis Clinic offers a fast-track assessment of patients with suspected inflammatory arthritis, early re-assessments, a full multidisciplinary programme and access to all available therapies at the Immunotherapy Unit.
The following are features of Inflammatory Arthritis and may indicate that a patient should be assessed at the Beacon Early Arthritis Clinic:
• Symptoms present for more than 4 weeks: As some forms of inflammatory arthritis are self limiting a cut off of 4 weeks is generally recommended but if patients have significant disability, high levels of inflammation or auto-antibodies they should be referred earlier
• Early morning stiffness of more than 30 minutes is a feature of inflammatory arthritis; patients often report a good initial response to non-steroidal anti-inflammatory drugs.
• 3 or more swollen joints
• Tender / involved metacarpophalangeal joints
• Tender / involved metatarsophalangeal joints
In the early stages laboratory tests may be normal or only slightly elevated. Auto-antibody tests are helpful but can occur in other conditions and must be interpreted in the context of overall clinical evaluation.
• A raised ESR or CRP indicate a systemic inflammatory response
• Rheumatoid factor and anti-cyclic citrullinated peptide are useful in the early diagnosis of Rheumatoid Arthritis
• Antinuclear antibodies may indicate connective tissue disease
If referring to the Beacon Early Arthritis clinic we recommend sending the following tests on a patient in advance to expedite diagnosis and treatment:
Full blood count, ESR, Renal/Liver/Bone profile, Serum urate, CRP, Rheumatoid factor, Anti-CCP, Antinuclear antibody. All these tests can also be performed on the day of clinic assessment
In the early stages of Inflammatory Arthritis, plain x-rays are often unhelpful as the typical features of bone and joint damage will not be apparent. The clinic provides same day MRI and Ultrasound for early diagnosis of Inflammatory Arthritis if it is indicated.
Diagnosis will be made at the initial clinic assessment using clinical, laboratory and imaging assessments.
If immunotherapy is required all disease modifying agents will be initiated after a screening and education session. All licensed immunotherapies are managed through the Immunotherapy Unit. These therapies will include Etanercept, Adalimumab, Infliximab, Certilizumab, Abatacept, Rituximab, Tocilizumab, Golimumab, Intravenous Immunoglobulin and Cyclophosphamide.
Multidisciplinary Therapy and Shared Care:
Inflammatory arthritis management involves specialists in physiotherapy, occupational therapy and nutrition, all of which are available. The Beacon Early Arthritis Clinic advocates Shared care with your general practitioner (GP). We will advise on how often you will require monitoring blood tests and check ups with your GP.
Osteoarthritis & Metabolic Arthritis including Gout
Though less severe than Inflammatory arthritis, Osteoarthritis is a much more common disorder. Osteoarthritis refers to a group of disorders which result in damage to cartilage in joints (“wear and tear”). Common conditions include osteoarthritis of the hip, osteoarthritis of the knee, osteoarthritis of the hands and osteoarthritis of the neck and back. The process begins in the late 40s and in patients with early signs and strong family history, preventative measures are most effective at this early stage. Most patients will manage their osteoarthritis with a multidisciplinary approach. This will incorporate lifestyle changes such as weight loss, pacing of activities, joint protection, correction of joint alignment with orthotics and using walking aids such as a walking stick to offload a painful joint. Medical therapies consist of a combination of topical agents (eg. anti-inflammatory cream or capsaicin), analgesics (eg: paracetomol and codeine tablets), anti-inflammatory tablets, glucosamine and fish oil supplements and joint injections of hyaluronic acid or steroid. Most patients with osteoarthritis will not require joint replacement surgery
Common forms: Gout is the most common form of metabolic arthritis and results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints. When crystals form in the joints it causes recurring attacks of joint inflammation. Chronic gout can also lead to deposits of hard lumps of uric acid in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones. Gout is also strongly associated with the metabolic syndrome and patients diagnosed with gout will be offered assessment for metabolic syndrome.
Ultrasound Diagnostics and Interventions
Musculoskeletal Ultrasound is being increasingly used in the diagnosis of joint and soft tissue disorders. It can readily depict joint inflammation and damage and surrounding soft tissue inflammation while also allowing for accurate guided injection immediately following diagnosis. It is used in the early diagnosis of inflammatory arthritis being more sensitive than clinical examination in detecting joint inflammation.
Common soft tissue conditions diagnosed and injected using ultrasound include
• Shoulder tendonitis or rotator cuff tear
• Tennis or Golfer’s elbow
• Biceps tendonitis
• De Quervain’s tenosynovitis
• Carpal Tunnel Syndrome
• Flexor tenosynovitis (Trigger finger)
• Greater trochanter bursitis
• Quadriceps tendonitis
• Patellar tendonitis
• Achilles tendonitis
• Plantar fasciitis
• Morton’s neuroma.
Bone Health Service
One in three women and one in five men in Ireland will suffer an osteoporotic fracture in their lifetime. Patients presenting with bone fracture are an extremely high risk group for the diagnosis of osteoporosis. A Bone Health Service has been established in support of the Orthopaedic Trauma service providing a FRAX screening assessment including Bone Densitometry. This service is also available to all patients suspected of or diagnosed with Osteoporosis.
Patients diagnosed with osteoporosis will undergo full investigation for other predisposing medical conditions and a multidisciplinary treatment programme including medication, physiotherapy and nutrition will be prescribed.
RHEUMATOLOGY & BONE HEALTH SERVICE
IMPORTANT NOTICE: Please note you will need a referral letter from your GP to use any of
the services of UPMC Beacon Centre for Orthopaedics, except for the Physiotherapy department.