Clinical Activity
Guy’s and St Thomas' Hospital NHS Foundation Trust
Clinical Lead for Rheumatology: Dr Terence Gibson
The majority of rheumatology activity is outpatient based. For 2008-09 the unit accommodated 2,416 new patient attendances and 8,546 follow up appointments. In addition, there were 729 day case events in 2008-09, mostly for infusions of biologics and bisphosphonates, and 592 in patient bed events. 2007-08 figures were similar, although demand for infusions has increased by 264%.
A key feature of clinical activity on the Guy’s site is the Arthritis Centre, a consultant led service focussing on the early diagnosis and management of patients with inflammatory arthritis, established in 2004 by Dr Bruce Kirkham and Professor Gabriel Panayi. The centre accommodates ~ 1700 visits per annum, including 120 new diagnoses of RA, and currently has ~ 250 patients receiving biologics at any one time. From a cohort of ~ 625 patients with RA, the centre delivers high quality care, as demonstrated by RA remission rates of 29%, with 15% of patients having low disease activity state (LDAS), 35% MDAS and 15% HDAS. 32% are taking methotrexate and 23% combination DMARDs.
A new RA remission clinic is being established by Prof Andrew Cope to help understand the relationship between clinical remission and immunological remission (or tolerance). A combined rheumatology/dermatology clinic specialises in the management of psoriasis/psoriatic arthritis (Dr Bruce Kirkham, Dr Sangita Agarwal, Professor Jonathan Barker) and a specialised clinic for ankylosing spondylitis is being set up (Dr Sangita Agarwal).
For further information on Rheumatology in the Guy's and St Thomas' Trust.
Clinical Lead for Lupus: Dr David D’Cruz
The Louise Coote Lupus Unit at St Thomas’ Hospital is a consultant led internationally recognised tertiary referral centre for complex autoimmune diseases. It is Europe’s first fully integrated lupus centre, linking the specialised care of lupus patients with teaching and research. The Unit delivers high quality clinical care, as evidenced by regular audit. Multi-disciplinary input from consultants in Nephrology, Haematology (including coagulation), Obstetrics and Clinical Nurse Specialists ensure that the multi-system spectrum of patients’ needs are met within the unit. There is a wide referral base: 73% of out-patients and 77% of in-patients come from all over the United Kingdom.
The Lupus Unit provides multidisciplinary care for patients with serious autoimmune connective tissue disorders including systemic lupus erythematosus, anti-phospholipid syndrome and the systemic vasculitides. There are sub-speciality clinics including a large renal clinic, pulmonary hypertension clinic, and a busy systemic vasculitis clinic. There is an internationally recognised pregnancy clinic where women with very complex autoimmune disorders are counselled and monitored during and after pregnancy, with very high rates of successful pregnancies. The Unit also delivers cytotoxic and biologic therapies including cyclophosphamide and rituximab. The Lupus Unit has successfully integrated clinical care, teaching and research and is the largest of its kind in Europe with 3000 patients. There is a heavy workload with 630 new patient and 4755 follow up appointments, 200 day cases and 140 in-patient admissions each year.
King’s College Hospital NHS Foundation Trust
Clinical Lead for Rheumatology: Dr Sophia Steer
The majority of rheumatology activity is outpatient based. For 2007-08 the unit accommodated 2,007 new patient attendances and 9,234 follow up appointments. In addition, there were 550 day case events for infusions of biologics. Outpatient activity at the Denmark Hill site includes services for patients with inflammatory arthritis, connective tissue disease, osteoarthritis, soft tissue rheumatism and metabolic bone disease. The inflammatory arthritis service has been developed by Professor David Scott. There are currently 600 patients with inflammatory arthritis attending a consultant-led, multidisciplinary service incorporating nurse-led clinics, early arthritis clinics, a spondyloarthritis clinic and a podiatry service. Approximately 125 patients are currently receiving biological therapy.
The connective tissue service is led by Dr Patrick Gordon and provides a multidisciplinary service for patients with serious autoimmune connective tissue disease including sub- specialist clinics for vasculitis and myositis. There are approx 400 lupus patients and 50 myositis patients under review. There are dedicated combined clinics with renal (Dr Katie Vinen), dermatology (Dr Daniel Creamer), and neurology (Dr Michael Rose) units. The service also delivers cytotoxic and biologic therapies including cyclophosphamide and rituximab.
The Clinical Academic Group has fostered close collaborations with local Musculoskeletal Clinical Assessment and Treatment Services (MCATS) and Primary Care, and is represented on the Lambeth and Southwark Primary Care Trusts’ Musculoskeletal Steering Group. These interactions greatly facilitate networks required to establish registers for people with Inflammatory Arthritis in South East London.
For further information on the Rheumatology Clinic in King's College Hospital NHS Trust.