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.
Appointments and referrals
Who can refer
GPs and other secondary care services.
How to refer
To refer a patient into Homerton’s Rheumatology service GPs will need to do this through 'advice and refer' (A&R) using the advice and guidance (A&G) pathway on eRS. Directly bookable services for Rheumatology will be closed from Tuesday 24 October 2023.
Please refer to the GP handbook and A&R quick guide on how to make an A&R request and for some frequently asked questions. For any non-clinical queries relating to Advice & Refer please contact Vanita Patel .
The Trust has created a GP educational video for adult Rheumatology referrals, below, as part of the pilot for advice and refer, which includes a demonstration of assessing the hand and wrist for synovial joint swelling.
This service is suitable for patients above 16 years of age.
Patient Information about referrals
Conditions, diagnosis and specialist treatments
Please refer to the Directory of Services on e-RS for further details. The quick guide and video also provide further information on this.
0:00 Understanding Rheumatology Referrals
0:28 Possible Inflammatory Arthritis (IA) Part 1
1:15 Demonstration of examining Hands / Wrists for synovial swelling
5:57 Possible Inflammatory Arthritis (IA) Part 2
8:18 Possible Connective Tissue Disease
10:20 Osteoporosis Management
11:25 Possible Ankylosing Spondylitis
12:59 Chronic Pain Syndromes (Fibromyalgia)
14:30 Hypermobility / Ehlers-Danlos Syndrome
15:50 Advice and Refer
If you have any clinical queries for the video and in general, please email Homerton Rheumatology admin at email@example.com
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.
Coronavirus (COVID-19) Medication Advice for Rheumatology Patients
If you have Rheumatoid Arthritis, Psoriatic Arthritis or Ankylosing Spondylitis and are on biologic drugs (including Baricitinib and Tofacitinib)
1. You should stop these drugs immediately if you develop any fever (feeling shivery), sore throat or cough
2. Methotrexate and Leflunomide should only be stopped if you are unwell with a fever. You will need special treatment to remove Leflunomide from your body if you are unwell enough to need to come to hospital.
If you have Lupus (SLE) and are on Azathioprine or Mycophenolate it is important not to stop these unless you are clearly unwell (have fever) and have been advised to do so by a medical professional-Please contact us.
Sulphasalazine and Hydroxychloroquine are not immunosuppressant drugs and can be continued even if you are unwell.
For patients on NSAIDs (Ibuprofen, Naproxen, Etoricoxib), these are now known not to make COVID-19 infection worse and you can continue to take these even if you become unwell..
This advice may change as new information becomes available.
You may also find advice at https://www.versusarthritis.org
To change or cancel an appointment please contact the outpatients department on 020 8510 5544.
Rheumatology patient helpline:
Mondays to Fridays 9am to 5pm
tel: 020 8510 7612
Specialist nurses (after 2.30pm)
020 8510 7200
Monday to Friday 9am - 5pm
tel: 020 8510 7612
admin email: firstname.lastname@example.org