Rheumatology Service

• Rheumatology primarily deals with management of patients with inflammatory and auto-immune musculoskeletal and multi-system disorders.

• The Rheumatology Department in NHS Tayside are a multi-disciplinary team comprising medical staff, specialist nurses, a specialist pharmacist and specialist AHPs. We conduct in-person out-patient clinics at Ninewells Hospital, Perth Royal Infirmary and Arbroath Infirmary.
• For Staffnet users more information is available on our departmental website. 

Our staff members include:

Consultants	Specialty Registrars	Specialty Doctor	Specialist Nurses
Dr Suzy Silburn Dr Su-Yin Tan Dr Vinod Kumar Dr Smita Bhat Dr Andrea Strang	Dr Sean Murphy Dr Fiona Richardson	Dr Rosi Thomson	Donna Daugherty  Jacqui Patterson Amanda Petrie

Specialist Pharmacist: Lee-Ann McDermott

Referrals from other Health Boards.
Please consider carefully if you choose to refer your patient to the Rheumatology service in Tayside. We predominantly see patients who live within Tayside but also receive referrals from other Health Boards.
We adhere to the Tayside formulary as well as shared care agreements. If you choose to refer your patients to our service, please note that we would expect you to adhere to the Tayside shared care agreements, prescribing and monitoring. If this is difficult please refer to the local rheumatology service.

• Tayside Rheumatology Referral Guide
• Emergency: These conditions should always prompt admission to hospital, or at least discussion with the on call rheumatologist (weekdays 9am – 5pm), on call physician (during OOH period) or, in the case of septic arthritis, orthopaedic surgeon:
  • Septic arthritis - Any patient with an acutely painful, red, swollen joint who is systemically unwell or where there is a suspicion of septic arthritis.
  • Systemic vasculitis - A systemically unwell patient with features of vasculitis such as weight loss, purpuric rash, haemoptysis, neuropathy etc
  • Giant Cell Arteritis - Please follow the separate GCA referral pathway and guidance

• Urgent (Urgent SCI-Gateway referral ): Inflammatory arthritis, Ankylosing Spondylitis, suspected Connective Tissue Disease with organ involvement
• Routine (Routine SCI-Gateway referral): Suspected Connective Tissue Disease without organ involvement, Gout, Polymyalgia Rheumatica

• For further guidance details, see pathways linked at the bottom of the page.

• Rheumatology has little specific management to offer patients with non-inflammatory conditions other than confirmation of diagnosis.
• If there is a diagnostic difficulty or particular reason why a Rheumatology review would be helpful then we can review these patients, but it will likely be a once-off appointment.
• We do not have sufficient resource to routinely see and diagnose conditions such as osteoarthritis. Patients such as this can be managed with conservative measures such as analgesia and physiotherapy.
• Conditions that do not require a referral include (links to primary care guidance where available):
  
  • Osteoarthritis 
  • Fibromyalgia
  • Localised mechanical joint or soft tissue pain 
  • Joint hypermobility syndrome/hypermobile Ehlers Dahnlos syndrome
  • Raised plasma viscosity with no inflammatory symptoms 
  • Non-specific low positive autoantibodies found incidentally

This allows us to vet effectively and prioritise the patients who require urgent rheumatology review:

• Clinical history
• Examination findings
• FBC and CRP, plus relevant immunology. If there is a strong concern, referrals can be sent to us prior to immunology results returning.
  • Anti-CCP antibody where there is concern about inflammatory arthritis
  • CTD screen where there is a query over an autoimmune connective tissue disease
  • MPO/PR-3 where there is concern about small vessel vasculitis
• Hand and foot x-rays for suspected inflammatory arthritis
• Clinical impression and question for rheumatology

• Our preferred method of referral is via SCI-Gateway with the referral prioritised as Urgent or Routine.
• Discussion can be had via the on-call page (via switchboard).
• Please be aware that the person carrying the page may well be in clinic so there may not be an immediate response.
• Please do not refer using typed paper letters. These can result in a significant delay.

• Advice can be sought via SCI-Gateway. Responses will be sent within 24 hours. This is our preferred option as it allows time to give a considered opinion and creates an electronic record visible to all from any site.
• Discussion can be had via the on-call page (via switchboard). This is not our preferred route as it is usually useful for us to review blood results, imaging and previous letters before formulating advice and this is difficult to do thoroughly whilst on the phone.

• Medication dose and monitoring; DMARDs & Biologics - NHS Tayside primary care monitoring guidance (Disclaimer: This information is only available if you are on an NHS network)
• Useful patient information leaflets on various Rheumatological conditions can be found at the Versus Arthritis website.
• Glucocorticoid fracture risk assessment and management NHS Tayside 
• We have a page on our Rheumatology website with lots of useful resources