Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
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2 Specialties RheumatologyRheumatology ∗Dr Ian Rowe FRCP MA MD <strong>Consultant</strong> rheumatologistDr Neil Snowden FRCP <strong>Consultant</strong> rheumatologistDr Ruth Richmond FRCP <strong>Consultant</strong> rheumatologistDr Marwan Bukhari FRCP PhD <strong>Consultant</strong> rheumatologist1 Description <strong>of</strong> the specialtyRheumatology deals <strong>with</strong> the investigation, diagnosisand management <strong>of</strong> <strong>patients</strong> <strong>with</strong> arthritis and othermusculoskeletal conditions. This incorporates morethan 200 disorders affecting joints, bones, muscles ands<strong>of</strong>t tissues, including inflammatory arthritis and othersystemic autoimmune disorders, vasculitis, s<strong>of</strong>t-tissueconditions, spinal pain and metabolic bone disease. Asignificant number <strong>of</strong> musculoskeletal conditions alsoaffect other organ systems.Rheumatology is a multidisciplinary specialty and therheumatologist works in close liaison <strong>with</strong> othermedical specialists and healthcare pr<strong>of</strong>essionals.Accredited training for paediatric and adolescentrheumatology is based <strong>with</strong>in paediatrics, althoughadult rheumatologists should be aware <strong>of</strong> the spectrum<strong>of</strong> conditions that affect children in order to take part inthe transitional care <strong>of</strong> older adolescents and youngadults. Specific training is available in sports andrehabilitation medicine.Who are the <strong>patients</strong>?The burden <strong>of</strong> musculoskeletal disease in the UK issignificant (Table 1), <strong>with</strong> 10 million <strong>working</strong> days lostin 2006–7 due to musculoskeletal conditions, which issecond only to stress, depression and anxiety. 1 Theestimated cost to society is £5.7 billion per year.2 Organisation <strong>of</strong> the service and patterns<strong>of</strong> referralUp to 30% <strong>of</strong> people who consult their GPs and 40% <strong>of</strong>those who attend NHS walk-in centres do so <strong>with</strong> amusculoskeletal complaint. 10 Those <strong>with</strong> inflammatoryarthritis or autoimmune connective tissue diseaserequire input from a rheumatologist. Early referral for<strong>patients</strong> <strong>with</strong> inflammatory disease is vital to minimisejoint damage and is cost-effective. Treatment is mosteffective if started <strong>with</strong>in 3 months <strong>of</strong> symptom onset. 5Referral to secondary care via a rapid-access system isappropriate for <strong>patients</strong> <strong>with</strong> ‘red flags’, includingsystemic disorders such as malignancy or complexmultisystem disease. Most self-limitingnon-inflammatory disorders and exacerbations <strong>of</strong>chronic degenerative disease such as osteoarthritis andback pain are managed in primary care.The NHS white paper 11 for England will giverheumatologists more opportunities to work directly<strong>with</strong> frontline colleagues in primary care. Thecommissioning proposals should lead to improvedintegration <strong>with</strong> primary care and increased access tosupport and advice for GPs to manage musculoskeletaldisease in the community. Integral involvement <strong>of</strong>rheumatologists will ensure the appropriateformulation <strong>of</strong> quality and outcome measures in line<strong>with</strong> national standards and guidance.The Department <strong>of</strong> Health (DH) in England’s bestpractice guidance document The musculoskeletal servicesframework (MSF) 10 has emphasised the role <strong>of</strong> triage,assessment, diagnosis and treatment by practitioners<strong>with</strong> special interests (GPs, therapists and specialists)and the establishment <strong>of</strong> intermediate services betweenprimary and secondary care known as clinicalassessment and treatment services (CATS). The CATShave been proposed in order to improve the efficiencyand appropriateness <strong>of</strong> referrals. In order to besuccessful, the CATS must work in close liaison <strong>with</strong>rheumatologists and primary care specialists and shouldbe integrated <strong>with</strong> regard to continuing pr<strong>of</strong>essionaldevelopment (CPD) programmes, audit and teaching <strong>of</strong>specialist staff and students, rather than beingstand-alone entities.∗ Please see an appendix to this chapter, which has been written for the revised 5th edition 2013 (p. 249). The rest <strong>of</strong> the text has been reproduced fromthe 2011 edition.C○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013 235