Nhs_choices Bthft Bradford Teaching HospitalsNHS Foundation Trust NHS Choices
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What we do

The Rheumatology service offers timely assessment and management of patients with rheumatological disorders.

We have extensive experience in the assessment and management of all rheumatological conditions, ranging from standard evidence based care to biological treatments for complex or severely ill patients. In addition we have an excellent research team headed by Dr Helliwell with multiple trials running. This allows patients access to new and innovative treatments.

Most of our patients are assessed and managed in our outpatient clinics. For those with complex disease or who are more unwell, we can offer assessment as an inpatient, usually on ward 6 at the Bradford Royal Infirmary, which we share with gastroenterology and renal medicine.

There is also a 12 bedded day case unit based in the Horton Wing at St Luke's Hospital, where complex treatments are administered under the care of our highly trained and experienced nurses and doctors. We have a rapid access review facility allowing us to see appropriate follow up patients, usually within 24-48 hours of them or their GP having made contact, usually via the rheumatology advice line or SystmOne (GPs). We also have an excellent dedicated physiotherapy, occupational and hydrotherapy service. We offer an advice line service for patients and carers.


The team

The service has a dedicated group of highly trained, motivated and experienced doctors, nurses and specialist nurses, physiotherapists and occupational therapists, working as a multidisciplinary team.

As a team we constantly strive towards improving the services we provide for our patients. Wherever possible, we provide patients with the necessary knowledge to make an informed decision about their own treatment. Questions are welcomed and are encouraged.

All consultants see general rheumatological problems including early inflammatory arthritis, spondyloarthropathies and connective tissues diseases. The team is made up of the following staff:

  • Dr Philip Helliwell - Consultant Rheumatologist FRCP, Senior Lecturer at Leeds University.  Special interest: Spondyloarthritidies (PsA and AS), biomechanical and foot disorders, sports medicine and Paget's disease

  • Dr Wendy Shingler - Consultant Rheumatologist, Rheumatology Specialist Lead, Clinical Governance Lead and Lead for Medical Student Teaching. Honorary Lecturer.  Specialist interest: Transition of Paediatric rheumatology patients
  • Dr Zoe Ash - Consultant Rheumatologist (Part time).  Interim Lead for Osteoporosis. Special Interest: Osteoporosis, Spondyloarthropathies.
  • Dr Ahmed Zayat - Locum Consultant Rheumatologist, covering for previous Dr MacIver patients.  Special interest: musculoskeletal ultrasound,

  • Dr Tariq Aslam - Locum Consultant Rheumatologist, covering previous Dr Das patients

  • Alan Pollard - Lead Nurse Specialist - General rheumatology
  • Sarah Redfern-Riley - Senior Nurse Specialist - General rheumatology and Transition of Paediatric Rheumatology patients
  • Samantha Johns - Senior Nurse Specialist - General rheumatology
  • Lynsey Hall - Nurse Specialist - General rheumatology
  • Catherine Short - Nurse Specialist - General rheumatology
  • Suzanne Mitchell - Sister on Daycase Unit - General rheumatology
  • Bev English - Research Nurse - General rheumatology
  • Janet Curran - Research Nurse - General rheumatology


Feedback, complaints and compliments

We are always happy to get feedback from patients, carers and GPs about our services. We are keen to act on feedback and improve our services wherever possible. Any complaints will be investigated thoroughly via the appropriate channels and are discussed with the whole team.

Contact us

¢ Pauline Oldfield - Secretary to Dr Helliwell and Dr Zayat: Tel. 01274 36 5227

¢ Linda Harris “ Secretary to Dr Shingler, Dr Ash and Dr Aslam: Tel. 01274 36 5389

¢ Kathy Evans “ Support Secretary

¢ Jennifer Rushton - Support Secretary

¢ Nazma Iqbal- Support Secretary

¢ Manju Mistry - General Support Clerk

¢ Jane Hurford “ General Support Clerk

There is also a telephone advice line service for patients already under our care. This is 01274 274 274, putting patients in contact with our Appointments team to book a telephone call back appointment typically within 24-72 hours (Monday to Friday). 

Please do not use this as an emergency service.  If you consider your problem to be an emergency then attend A&E or ask for an urgent GP appointment.

Advice is available regarding the disease, disease flares and medication. If necessary, an appointment to see a member of the Rheumatology team can be arranged.

GPs are encouraged to use the advice service via SystmOne. For existing patients please send us a task; for new patients please use the e-consult pathway via system one.

Calls to the rheumatology advice line are not appropriate in the case of

1. A request to change your appointments (If you want to change your appointment please ring 01274 274274.)

2. A request for a repeat prescription (If you need a repeat prescription or more blood forms please ring 01274 36 5779.)


Translators and interpreters

Most of our clinicians can only ask questions and examine patients using English, although some of our Consultants are fluent in Urdu and Punjabi. If patients are not fluent a translator may be needed (either in person or with a video link). These translators are bound by rules of confidentiality.
Either the GP or the patient's relatives may let us know of the patient's needs. Relevant contact details will also be provided on the appointment letter.
It should be noted that although relatives can be very helpful as translators, we often need to use medical vocabulary which needs a trained translator. People are also often uncomfortable discussing all aspects of their medical history with a relative.
Translators and interpreters are available for the majority of languages and can be arranged for each appointment. A period of 24hours notice is recommended.

Referral pathways

Ideally patients should be referred via the Electronic Booking Service (EBS). If patients are urgent we can transfer them to an urgent slot from here. We currently accept paper referrals for urgent patients if EBS cannot be used appropriately. It is helpful if a share on SystmOne is set up, for patients that agree, prior to attending their appointment.
For patients where GP's are very concerned, including suspected GCA, our on call Specialist Trainee can be contacted via switchboard Mon-Fri 9am-5pm. Rapid review within 24-48hrs can be arranged for appropriate patients
Details of our referral pathways and specialty specific information including DMARD monitoring guidelines can be found on the Bradford Trust Internet site.

First appointment

- Patients will see a Consultant, Junior doctor or Nurse specialist when they attend clinic. Questions will be asked about their problems and often a full examination will take place.
- We have both male and female clinicians in the department. If a patient prefers to see a female consultant this should be made clear when the patient is referred. We will endeavour to accommodate this request but it cannot be guaranteed.
- Patients should bring a list of medications, and a urine sample if possible

Cancellations

If you have a request to change your appointment please ring 01274 274274. It is very helpful to give as much notice as possible if patients cannot attend their appointments as this allows the slot to be offered to someone else. Due to the waiting lists being long it may be some time before another appointment can be offered. If there is clinical concern patients contact the advice line and GP's can contact us via SystmOne.

Medications

Patients should bring a list of their current medications to each appointment they attend

Gout Management

Guidelines for Management of Gout

Acute Gout treatment

1. Rest affected joints

2. NSAIDs (if no CI) +/- PPI cover

3. If renal impairment consider Colchicine 500mcg bd-qds

4. If not on Allopurinol do not initiate during an acute flare (see below)

5. Opiates analgesia can be used alongside above treatment for pain relieve

6. If able intra articular steroid injection can be considered (if no risk of septic arthritis).  PO or IM steroids can also be considered if NSAID or Colchicine CI/side effects


Start treatment if has any of the below:

¢ After 2nd attack

¢ >1 attack per year

¢ Presence of uric acid stones

¢ Presence of tophi

¢ Patients who need to continue with diuretics


What to start: 1st line

1. Allopurinol 50-100mg as starting dose, increasing by 50-100mg per month dependent on urate levels

2. Start 2 weeks after acute Gout flare has settled

3. Aiming for serum urate level to be in the lower half of the normal range

4. Max Allopurinol dose 900mg. Rheumatology referral to be considered if insufficient response with Allopurinol 600mg.

5. When adjusting Allopurinol take into account renal function, as renal impairment can increase risk of toxity and Allopurinol dose may be limited in patients with renal impairment because of this.

6. When initiating treatment use appropriate prophylatic cover

        i) Cochicine 500micrograms bd for upto 6 months (if no contraindications) or

        ii) NSAID or Coxib can be used if no contraindications but for a max of 6 weeks with appropriate PPI cover as necessary or

        iii) 120mg IM Depomedrone (max every 8-12 weeks usually only 2 needed)

7. Patient should be warned that there is a possibility of flare of Gout when initiating treatment and to continue Allopurinol and treat any flares


Once Allopurinol initiated and target serum urate level achieved:

1. Monitor serum urate level twice a year aiming to maintain serum urate level

2. If has Gout flares, DO NOT stop the allopurinol and treat symptomatically with

    i) Colchicine (if no contraindication) 500 micrograms bd-qds (max qds “ often will cause diarrhoea at this frequency, usually tds         tolerated)

    ii) NSAID/Coxib (if no contraindication)

    iii) PO steroids/intra-articular steroid or IM steroid

    iv) Septic arthritis remains important differential of acute monoarthritis


If unable to achieve target serum urate level with Allopurinol alone:

1. Uricosuric agents may need to considered and can be used alone or added to Allopurinol - will need specialist input

2. Febuxustat -

        i) metabolised by the liver so no dose adjustments in renal impairment

        ii) NICE recommends its use for those patients who are intolerant to Allopurinol or when Allopurinol contraindicated

        iii) The most common side effects are diarrhoea, nausea, headache, liver function test abnormalities and rash

        iv) Not recommended in IHD or congestive heart failure

        v) Starting dose 80mg, increasing as necessary to 120mg od after 1 month, aiming for serum urate level in lower half of the normal             range

        vi) prophylactic treatment with Colchicine (for at least 6 months) or NSAIDs/Coxibs (6 weeks) or IM depo as above


Other pharmaceutical considerations

¢ Analgesic doses of Aspirin (600-2400mg) interferes with uric acid excretion, low dose aspirin considered ok

¢ Losartan produces a uricosuric effect typically decreasing serum uric acid levels by 20% to 25% so should be considered in those patients who have Gout and where an antihypertensive required

¢ Amlodipine also has uricosuric properties to be considered where antihypertensive required

¢ If raised cholesterol add in Fenofibrates, which again have uricosuric properties

¢ Stopping diuretic treatment where able


Lifestyle modifications

¢ Reducing and managing cardiovascular risk factors: as Gout is part of the metabolic syndrome

¢ Maintaining hydration particularly in those patients with hx of renal stones

¢ Advice regarding alcohol Beer>Spirits>Port>Wine (14 units maximum recommended amount per week)

¢ Weight loss

¢ Low purine, increase low fat dairy


Patient education is essential

¢ Advice on lifestyle changes

¢ Usually lifelong treatment

¢ Do not to stop treatment if flares

In refractory Gout we (rheumatology service) would be very happy to see the patient for further assessment and management.


PMR Guidelines

 PMR Guidelines

Hot Swollen Joint Guidelines

Hot Swollen Joint Guidelines

DMARD/Biologic Monitoring Guidelines

DMARD / Biologic Monitoring Guidelines - click on link below

dmard___biologic_monitoring_guidelines-20160930125026

Getting here and contacting us

For those with complex disease or who are more unwell, we can offer assessment as an inpatient, this is usually on Ward 6 at Bradford Royal Infirmary.

There is also a 12-bed day case unit in the Horton Wing at St Luke's Hospital.

Key contacts are:

Pauline Oldfield            Secretary to Dr Helliwell and Dr Zayat; (01274 365227)
Linda Harris                  Secretary to Dr Shingler, Dr Ash and Dr Nadesalingam / Aslam; (01274 365389
Jennifer Rushton          Support Secretary       
Kathy Evans                 Support Secretary
Nazma Iqbal                 Support Secretary
Beverley Loryman        Support Secretary

There is also a telephone advice line service for patients already under our care.  This is 01274 274274.Advice is available regarding the patient's rheumatological condition and associated medications.  If necessary, an appointment to see a member of the Rheumatology team can be arranged.GPs are encouraged to use the advise service via SystmOne.  

For existing patients please send us a task and for new patients please use the e-consult pathway via system one.Booking a rheumatology advice line call back is not appropriate for:        
    1. A request to change your appointments (please discuss this directly on 01274 274274).        
    2. A request for a repeat prescription (if you need a repeat prescription or more blood forms please ring 01274 365779).

Locations

Please view a location for further information, including opening and visiting times.

Horton Wing Ward 6