Our Rheumatology Service cares for people with a wide range of inflammatory joint conditions as well as vasculitis, osteoporosis and connective tissue diseases.
We have a specialist multi-disciplinary team for people with arthritis including doctors, nurses, physiotherapists, pharmacists and occupational therapists. We supervise the use of immunosuppressive drugs and biologic agents to control inflammatory arthritis and vasculitis.
Contact the Rheumatology Service on the details below to arrange a virtual clinic appointment.
For COVID19 Updates in the Western Trust and up to date advice from Department of Health and Public Agency click here.
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Information for Rheumatology Patients on Biologic Therapies in relation to COVID-19 Vaccine
We are delighted to announce that the Trust is now calling rheumatology patients on biologics therapy for vaccination against COVID-19. We are advising our patients to go forward for vaccination and are confident that the research done so far shows that the approved vaccines are both safe and effective. We know that many of you have been carefully isolating yourselves to prevent infection over the last number of months. Your rheumatology team has been working closely with the vaccination team to enable you to have priority access to the vaccine & we want to reassure you that your rheumatology treatment will not increase the risk of side effects from vaccination.
Our advice is based on national guidelines (Joint Committee on Vaccination and Immunisation JCVI and the British Society for Rheumatology) and our own review of the research.
From our knowledge of other vaccines, it is very likely that if you are taking certain medications you will not receive the full protective benefit from the vaccine (this is a process that takes about 2-4 weeks after getting the vaccine).
- One such drug is called Rituximab (Mabthera, Truxima infusions). We will be making special arrangements for people who are being treated with this drug so if you get a call for vaccination you should ensure that the vaccination team know that you are on this drug. If unsure, you can contact our staff (see below).
- Another is High Dose Steroid (Prednisolone more than 20mg/day). If you’re on a daily dose of 20mg/d or above please contact the rheumatology team for advice. As you know, you mustn’t suddenly stop regular steroid treatment without medical advice as this could lead to serious medical problems. If you’ve just had or are about to get a steroid injection please contact our rheumatology team for advice.
Another possible issue is that Methotrexate has been reported to reduce the effectiveness of other vaccines. Although there are no clear guidelines, it is possible that stopping the Methotrexate for two weeks could help your immune system to mount a stronger level of defense against future COVID-19 infections. However, if you do that it could also cause your condition to flare up. The science is not yet clear as to which option is preferable. If your condition is well controlled you can choose to pause your Methotrexate treatment for 2 weeks after receiving the vaccine. However, if your condition isn’t well controlled or you would prefer to keep taking the Methotrexate then please do so. Either way, you will need to keep on your guard against catching the infection through social distancing, wearing a mask etc.
Drugs that are not thought to have a significant effect on the vaccine response:
- Leflunomide, Sulfasalazine, Hydroxychloroquine
- All ‘anti-TNF’ drugs (adalimumab, etanercept, infliximab, certolizumab, golimumab)
- Tocilizumab, Ustekinumab, Secukinumab, Abatacept, Ixekizumab
- Baricitinib, Tofacitinib
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Information to help rheumatology patients considering advice from the Chief Medical Officer to ‘clinically extremely vulnerable (CEV) people’ on attending their workplace
Many of you will have received letters advising you to ‘shield’ early last year when the pandemic began. This was because we were worried that certain diseases/medications would put people at a much higher risk of severe complications from the COVID-19 virus. These instructions to ‘shield’ came to an end on 31 July 2020 but with the resurgence of the virus in the community the Chief Medical Officer for N.Ireland has issued a new letter which gives advice to ‘CEV’ people to help them decide whether or not it is safe for them to attend work. If you feel that continuing to attend work won’t be safe (either because you are at a particularly high risk or because your workplace arrangements aren’t ‘COVID-safe’), this official letter will provide you with the authority to claim Statutory Sick Pay for absence from work.
Although everyone on a biologic drug has an increased risk of infection, research on rheumatology patients who have been infected with COVID-19 suggests that for many of our patients the risk is not much higher than the general population. Our national rheumatology guidelines provide more detail about which patients are at a much higher risk of infection, and we hope that this advice will help you decide whether or not you continue to go to work.
Questions to ask yourself:
Am I over 70 years old?
Do I suffer from any of the following conditions as well as my arthritis/rheumatology condition?
- Diabetes
- Lung disease (COPD, Asthma, Fibrosis)
- Heart disease (Angina, Heart attacks, previous Bypass or Coronary artery stent)
- Hypertension (High blood pressure) or ‘Pulmonary Hypertension’
- Significant Kidney disease
Am I on steroid medication?
- Dose of over 20mg/day of Prednisolone
- Dose 5 to 20mg/d of Prednisolone AND taking a biologic drug
If the answer to any of the above questions is yes, you should consider yourself to be at a higher risk of serious infection with COVID-19 and you should seriously consider staying away from the workplace until the risks are lower. If you have recently been vaccinated against COVID-19, you will need to wait for 3-4 weeks after the vaccination before you can expect that your risk of suffering a serious infection will have reduced.
Is my arthritis badly flared?
If yes, then taking time off work can help you to manage. During this COVID-19 pandemic your doctors will be more reluctant to give you a course of steroids to get you over the flare.
If you have any further queries about this, please contact either your GP or our rheumatology team using the following contact details:
Email: info.rheumatology@westerntrust.hscni.net or our
Helpline number 028 7161 1173
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Day Ward/ Infusion Unit
Patients who normally attend the day ward/ infusion unit for rheumatology treatments. Please note that it is likely that the infusion unit/day ward area will be closing in the near future as the hospital adapts to cope with the coronavirus threat. We cannot put our patients at risk by asking them to attend the hospital during this outbreak. We will attempt to support our patients using the telephone helpline 028 7161 1173 but this should not be used before consulting the advice on the rheumatology web page on the Trust website. This webpage will be updated regularly with general advice e.g. whether or not to stop treatments due to the infection risk as the information evolves.
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Outpatients
Patients who normally attend outpatients will be finding that their appointment has been postponed. The rheumatology team will try and contact people by phone to check on how they are doing, and a very small number of patients with urgent problems will be seen in person. Please note that you may get advice from a doctor who is not your regular rheumatologist during this crisis period. Most of the rheumatology team will be sidelined to deal with the medical crisis due to the coronavirus. Patients with specific queries can use the email address info.rheumatology@westerntrust.hscni.net
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Medication
Patients who are on medication for their arthritis can check here for general advice on whether or not to continue their medication in the face of the general threat of coronavirus infection (click here). The current expert advice does not recommend us to stop treatments for arthritis, but that may change. The usual advice applies i.e. stopping immune suppressive therapy when you know you have an infection.
There has been a number of stories on social media regarding NSAID. The Department of Health’s Circular from the Chief Medical Officer states “There appears to be no evidence that NSAIDs increase the chance of acquiring Covid-19. In view of the current lack of clarity the Commission on Human Medicines (an advisory body of MHRA) and NICE have been asked to review the evidence.
It is therefore suggested that, in the interim, for patients, who have confirmed Covid-19 or believe they have Covid-19, that they use paracetamol in preference to NSAIDs.
Those currently on NSAIDs for other medical reasons (e.g. arthritis) should not stop them.”This advice will be updated as further information becomes available.
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Blood Monitoring
Many GP practices are not going to be able to continue monitoring blood tests during this period, and for most people there is a greater risk from attending your practice for a routine blood check than just continuing with the medication. We are trying to communicate with GPs and Pharmacists to instruct them to relax the rules for blood checks. At present if you have been on the disease modifying medication e.g. methotrexate, salazopyrin, leflunomide etc, blood monitoring can be extended to 6 monthly rather than 3 monthly as long as they have been stable. Your GP may wish alternative arrangements for yourself if they are not stable. However, if you are only on the medication less than 3 months, then monthly monitoring is still required. If your treatment is suspended, there is a major possibility that your arthritis will flare and we will have few options to help.
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Urgent Appointments
GPs will still be able to phone the rheumatology team to request urgent appointments. We will give advice and in a small number of cases we may be able to arrange a clinic visit. Patients should only attend the hospital if they are free of symptoms (fever, cough, shortness of breath etc.) AND have not been in contact with someone infected by the coronavirus in the previous 14 days. Any staff unexpectedly exposed to a person infected virus will be quarantined for 14 days and may themselves fall ill.
Locations where this service is delivered
Contacts
Rheumatology Service
02871611173
info.rheumatology@westerntrust.hscni.net