Rheumatology

Rheumatology is a branch of medicine that deals with disorders of the skeleton and the soft tissues that support it, that include, ligaments, tendons, muscles, synovium (joint lining) and cartiladge (gristle).

There are a wide variety of rheumatalogical conditions varying from soft tissue disorders such as tendonitis (inflammation of the tendon) to complex diseases effecting more than one bodily system.

We offer a consultant led service with a wide range of expertise; specialist clinics including osteoporosis, autoimmune disease, paediatric rheumatology and paediatric osteoporosis.

We endeavour to provide a holistic, patient centred modern Rheumatology service, working harmoniously/simultaneously with the physiotherapists, occupational therapists and GPs.

Our Rheumatologists are Dr Charles Li and Dr Cai Neville.

They specialise in the care of people with a wide range of inflammatory joint conditions. In addition to this, they run specialist interest clinics; Dr Charles Li has a clinical and academic interest in Paediatric Rheumatology, while Dr Cai Neville is the Osteoporosis Lead, and also runs a Paediatric Osteoporosis service.

Click here for more information about the consultants

Our nurse specialist, Natasha Pickard, offers a telephone advice line and nurse led clinics.

Several Clinical Assistants work for our consultants:

Dr. Tim Arnold works for Dr. Li on Thursday morning. He also works as a GP in Fairlands Medical practice and in the Orthopaedic/Musculoskeletal MPTT (multi-professional triage team) service.

Dr. Simon Beck works for Dr. Neville on Monday mornings. He also works for Novartis as medical advisor.

Dr. Suzie Cooper works for Dr. Li on Monday mornings in Haslemere. She also works in the Orthopaedic/Musculoskeletal MPTT (multi-professional triage team) service, and as a GP locum around Surrey.

Our consultants also run Wisley Ward, one of the inpatient wards in the Royal Surrey. The ward looks after both medical and rheumatological patients. This is staffed by a team of junior doctors, some of whom also help in out patient clinics, under supervision.

The phone number for the Rheumatology telephone advice line is 01483 571122 ext 4672.

This is an answer machine service, so please leave your name, hospital number and contact telephone number and you will be contacted within 48hrs.

If you have an urgent enquiry please contact your GP or in an emergency go to Accident and Emergency.

You will be seen by a member of the Rheumatology team. This may be a junior doctor or a Clinical Assistant on behalf of the consultant. You should bring an up to date list of your medications, along with a urine sample, particularly at initial consultation. You may be sent for X-Rays or blood tests after your consultation, and should be prepared for this.

You may need to be reviewed regularly by a member of the rheumatology team and/or your condition may be one that your own GP can manage in the community.

We work very closely with your GP to ensure your treatment is well managed. A letter goes to your GP after each consultation detailing any investigations performed and a management plan.

Depending on your diagnosis, you may be commenced on ‘Disease Modifying Anti-Rheumatic Drugs’, otherwise known as DMARDs. You will be given information about these drugs at your appointment, and should expect to have monitoring of these drugs, often done in the community by your GP.

You may be asked to attend the Medical Day Unit. This is situated on level A of the hospital. Patients attend there to receive infusions (e.g. Aclasta, Infliximab) and joint injections.

If you need a joint injection, this will usually this will be arranged with the consultant on a Wednesday morning. Please be advised that you may be in the department for up to 6hrs. Following this, you will need to rest the joint for 24hrs. Please ensure that you have made arrangements for somebody to collect you, as you will not be able to drive.

Contact number for Medical Day Unit is 01483 571122 Ext. 2424.

1. Should I have the ‘Flu  and/or pneumonia jab?

These are both safe for you to have, and we would recommend both the ‘Flu and pneumonia vaccine in patients with rheumatological conditions, particularly if you are on disease modifying drugs (e.g. methotrexate).

2. What do I do with my medication during my operation?

Usually it is safe to continue all DMARDs during the time of an operation. It should have no impact on healing or infection rate. The exceptions to this are steroids and anti-TNF drugs (etanercept/ adulimumab /infiximab). Steroids should be taken at the minimum dose possible, to avoid infection/delayed healing. Do NOT stop steroids or reduce dose without consultation with your GP or consultant. Injectable anti-TNFs should be stopped for 2 weeks before and restarted when the wound is healed with no sign of infection (usually 1-2 weeks). With infliximab, sugery should be timed to be between infusions (i.e. 4 weeks after an infusion).

3. I have an infection/am on antibiotics, do I stop my medication?

DMARDs are usually continued in mild-moderate infections. If you have a severe infection, bad enough to necessitate hospital admission, sometimes DMARDs are stopped at the discretion of your doctors. Anti-TNF drugs should always be stopped at any sign of infection and re-started once infection cleared/antibiotics finished. Steroids should NEVER be stopped during infection, and the dose may sometimes be increased.

4. I think I am having a side effect of my medication, what should I do?

If the situation is an emergency, contact your GP or go to A&E. Consult your drug information leaflet. If the situation is not an emergency, leave a message on the advice line, and our specialist nurse will get back to you.

5. I am having a flare of my arthritis, what shall I do?

Using maximum pain relief regularly, such as paracetamol and anti inflammatory drugs if prescribed. Ask your GP if you need something stronger. Resting the joint or joints and using ice/heat packs can be helpful. If this does not improve things over the next few days contact either your GP or the telephone advice line.

6. How do I find out the results of my tests?

These will be discussed at your next appointment, and a copy will be sent to your GP and quite often to you at home. Due to the data protection act, these will not be discussed over the telephone.

7. Can I have vaccinations while I am on medication for my condition?

You should avoid live vaccines such as oral polio and yellow fever while on any of the immunosuppressive drugs such as Methotrexate, Azathiaprine, Leflunomide, Humira, Enbrel and Infliximab. It would be wise to discuss vaccinations with your GP well in advance of any travel arrangements, if you may require these vaccines. 

8. Can I have a steroid injection prior to my holiday?

If you are waiting for your treatment to work, or your disease is active, we may decide to give you a steroid injection to settle the joints in the interim. However, steroids on a regular basis have significant side effects and we do not routinely administer these prior to special occasions. If you do require an injection please discuss with the nurse specialist via the advice line.

9. I have an appointment in the Medical Day Unit for a joint injection, how long will I need to rest for following this?

Usually this will be arranged with the consultant on a Wednesday morning in MDU. Please be advised that you may be in the department for up to 6hrs. Following this, you will need to rest the joint for 24hrs. Please ensure that you have made arrangements for somebody to collect you, as you will not be able to drive.

Contact number for medical day unit is 01483 571122 Ext. 2424

Protocol for the administration of Leflunomide

Protocol for the administration of Mycophenolate Mofetil

Protocol for the administration of Intramuscular Gold

Protocol for the administration of Ciclosporin

Protocol for the administration of Azathioprine

Protocol for the administration of Sulphasalazine

Protocol for the administration of D-Penicillamine

Protocol for the administration of Methotrexate