The information here is aimed at GPs who are caring for patients with Rheumatological conditions.
How can I make an urgent referral?
Although urgent referrals can be made via the EBS system it is often better to speak to one of the consultants directly as they may be able to arrange to see the patient outside normal clinic hours and if necessary can see the patient the same day. Consultants can be reached via their secretaries on the above numbers or by bleep via the main hospital switchboard on 01709 820000. Referrals can be faxed to 01709 304276.
Looking for advice and guidance?
Consultants and the Rheumatology Specialist Registrar are all happy to give advice over the phone. You can contact them via the rheumatology secretaries or by bleep via the main hospital switchboard. Advice and guidance facilities are available on the EBS system but often this will lead to further information and discussion.
Caring for Patients on Biologic therapies and other Immunosuppressants
Biologics currently used include:
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Rituximab (MabThera)
- Adalimumab (Humira)
- Abatacept (Orencia)
Immunosuppressants currently used include:
- Mycophenolate mofetil
Infection rates are potentially increased in patients taking the above medication particularly the biologics and cyclophosphamide. It is important that such patients are seen urgently if they are suspected of having an infection and treated with full dose antibiotics if they are thought to have a bacterial infection. A full blood count should be checked to ensure that they haven’t developed a leucopaenia. The biologic / immunosuppressant should be withdrawn until the infection has resolved. If in doubt please contact a rheumatologist.
Please contact the department if a patient has been exposed to varicella zoster so that we can check their immunity status and if appropriate arrange the administration of varicella zoster immunoglobulin. Should a patient develop shingles or chickenpox, please start the patient on aciclovir, withdraw the immunosuppressant and contact us. In some situations the patient may be admitted for intravenous anti viral therapy.
Patients on the above medication should be offered an annual flu vaccine and be given pneumococcal vaccination as per the BNF. Patients on immunosuppressants should not be given a live vaccine including MMR and yellow fever.
Patients having surgery
Please let us know if patients on biologic therapies or cyclophosphamide are due to have surgery so that we can liaise with the surgical team. These therapies should be stopped before surgery and not restarted until the patient’s wounds have healed. Medications such as methotrexate do not need to be stopped. If in doubt please contact the rheumatology team.
Patients should not become pregnant whilst taking the majority of immunosuppressants (azathioprine, sulfasalazine and hydroxychloroquine are relatively safe). Please let us know urgently should this occur so that we can liaise with the patient and obstetrician.