Rheumatology is helping people with problems with their Bones and Joints.
This page gives information about our Rheumatology department at Broadgreen Hospital.
Disorders of the musculoskeletal system (joints, bones, muscles and soft tissues) are very common. Many such problems can be managed in other settings for instance by physiotherapy, osteopaths, chiropractors or your GP.
Rheumatology services cover the diagnosis and treatment of those musculoskeletal disorders involving multiple joint areas and requiring complex medical assessment and drug treatment. Operations or any type of surgery is not offered, this is covered by orthopaedics. The rheumatology service also has expertise in managing certain other systemic inflammatory diseases which don’t always cause joint problems or arthritis.
The rheumatology department at the Royal Liverpool and Broadgreen University Hopitals NHS Trust provides comprehensive diagnosis and ongoing care for individuals with a wide range of arthritis and other inflammatory diseases including rheumatoid arthritis, adults with juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, vasculitis, SLE, Sjogrens syndrome, and Behcets disease among others.
Individuals with such disorders have a number of different needs, including medical treatment with medication, joint injections, infusion or drip treatments, physical therapy, monitoring and support. For this reason the rheumatology service has a number of different health professionals who address different aspects of your care, for instance specialist nurses, physiotherapists, occupational therapists, podiatrists and others. We call this the ‘multidisciplinary team’ (MDT). Such a team approach is essential for managing many of the conditions we see.
The following conditions can usually be managed by your GP and/or other health professionals such as physiotherapists, but may be referred to the rheumatology service for clarification of the diagnosis or advice on management:
Most patients will be referred via the national appointments system (‘Choose and Book’). Direct referrals via letter or fax from GPs or other hospital departments are also accepted.
For a first appointment, 30 minutes is allocated. Before you are seen, you will be weighed, and your blood pressure will be checked. You will have been asked to bring a urine specimen – this will be tested. You may be seen by any member of the team including Registrars, Junior doctors, Specialist Nurses or Physiotherapists.
Subsequently your problems may be discussed with a Consultant who may see you as well, if necessary. The initial part of the consultation will cover the history of your complaints/problems. Please consider what you want to tell us about before your appointment as we know many people forget to tell us all of their concerns during the appointment. Consider writing things down as a reminder or making a list.
For almost everyone some sort of a physical examination is necessary. Often a more comprehensive examination of all your joints including feet is needed, and we will sometimes need to do a general examination such as of heart, chest and abdomen. Please dress appropriately for instance loose fitting clothing that can be pulled up above knees or elbows, or that can be removed easily. After you have been seen you may be sent for tests, you should allow at least 2 hours in total for your visit.
After your initial consultation a clear diagnosis and plan may be established based on your history and findings from a physical examination. However in many cases more information from tests may be needed. Such tests could be blood tests, xrays, more detailed scans such as ultrasound or MRI scans, or neurophysiology tests. Very few of these tests give a clear cut diagnosis by themselves and their interpretation in the overall context of your problems is important. Blood tests and xrays can be done on the same day as your initial appointment. Most other tests will need a separate visit. When your tests are completed, we may arrange to see you again if it’s necessary, or inform you of the results by other means such as a letter, and share your results with your GP.
Following your assessments a number of treatments may be offered. Medication may be prescribed, or your GP advised to alter your current prescription. Some conditions respond to a steroid injection. This can often be done during your clinic appointment without an additional referral or visit being necessary, for instance knee or shoulder injections. If more detailed information about the particular joint area is required, or the injection is technically difficult to do, you may be referred for an injection under ultrasound or xray guidance. A separate visit will then be required.
You may be referred to a range of other health professionals in the extended MDT. Physiotherapy can be offered to help with a number of problems. Physiotherapists can help you to improve joint mobility and function, muscle strength and soft tissue tightness. This is achieved using manual techniques and exercise. Physiotherapists can provide specific advice and support regarding many other aspects of your condition, and can employ some specific pain- relief measures such as TENS (‘transcutaneous electrical nerve stimulation’) or acupuncture in the appropriate circumstances.
Occupational therapists provide advice and interventions such as specific aids and adaptations to assist with specific functional difficulties or activities caused by arthritis or other musculoskeletal disorders. They have a special role in the assessment and management of many hand problems including making splints. Occupational therapists can advise you regarding modification of your home or work environments, and can liaise with a number of other services such as social services or local councils for instance regarding home modifications.
Podiatrists have a lot of expertise in assessment and management of foot problems. Podiatrists can advise about appropriate footwear, can assess for and provide appropriate orthotics (insoles) and custom-made footwear for foot and ankle disease, and arrange referrals for scans or foot surgery if appropriate.
Liverpool L14 3LB
Fax number 0151 282 6172
Specialist nurse advice line 0151 282 6060
Consultant secretaries - contact numbers as above
The outpatient department is located on the ground floor (Level 1) of the Alexandra Wing at Broadgreen Hospital. On entering the Alexandra Wing continue all the way along the corridor to the outpatient department which is the last door on the left. Pass the lung function/ECG window and book in at the Reception desk. Take a seat initially in the main waiting area. Once you have had blood pressure, weight and height recorded you will be shown in to the rheumatology waiting area.
For infusions and injections you may be asked to come to our day unit on Ward 4. Take the stairs or lift up one floor to Level 2, then the last corridor on the right. Ward 4 is clearly signed to the left at the end of the corridor.