Welcome to Dumfries - information for locums

Staff

Referrals

Who to refer to in Orthopaedics etc

Letters

Clinic letters are in the form

Copies of all letters to GPs are sent to patients

Assessments

All patients fill in a questionairre at each clinic (of the Pincus type). This includes an MHAQ and visual analogue scores for pain, fatigue and general health. We record swollen and tender joint counts (28 joint counts) for rheumatoid type arthritis at each visit and DAS28 scores for those on or being considered for biologics. Patients with ankylosing spondylitis have BASDAI recorded as well as the usual assessments.

Regimes

Our starting treatment for new onset rheumatoid and rheumatoid-like PISA is methotrexate 10 mg weekly with folic acid 5 mg weekly, though we use combination therapy (either O’Dell or COBRA regimes) in those at high risk of damage/disability. I suppose this is those I would like to give biologics to first line, but cannot. I rarely give doses of methotrexate over 25mg/week and have only a handful of patients on parenteral methotrexate. Our commonest other DMARDs would be leflunamide and sulfasalazine. Gps do the blood monitoring.

We use anti-TNF as per the BSR/NICE guidance, with adalimumab and etancerpt used more than infliximab, because of difficulty delivering the IV infusions regularly. Rituximab is reserved for TNF failures.

The nurse specialist concentrates on inflammatory arthritis. If you diagnose new IA, refer to her and she will arrange the PT/OT/podiatry assessments for you and review the patientherself after 4 and 12 weeks. She will alter or increase the DMARDs then if the RA is not fully controlled. We are trying to avoid duplication so the medical review can be 5-6 months.