Rheumatology

Rheumatology is the study of rheumatic disease, arthritis and disorders of the joints, muscles and ligaments. Many types of rheumatic disease affect the organs of the body as well as the joints, including the skin, mucous membranes, internal organs, circulation and nervous system.
The term ‘arthritis’ means ‘joint inflammation’ and refers to a disease of a joint, or often multiple joints. There are many forms of arthritis, and specific treatment and medication for those individual types. A Rheumatologist is a doctor with specific skills that allow him or her to differentiate between the different kinds of arthritis and prescribe the relevant course of treatment, with the aim of maximizing joint function and health.
Rheumatologists at UPMC Sports Surgery Clinic will determine if a patient’s arthritis is one of many different types, such as osteoarthritis, inflammatory arthritis (e.g. rheumatoid arthritis), crystalline arthritis (e.g. gout), connective tissue disease (e.g. lupus or SLE) or fibromyalgia. Differentiating between the different arthritides is important because each type carries its own specific prognosis and will require different therapeutic approaches.

Osteoarthritis

Osteoarthritis (OA) is also referred to as ‘degenerative’ arthritis, ‘wear-and-tear’ arthritis, or arthritis ‘of advancing age’. The lay term ‘rheumatism’ refers to OA. It is the most prevalent arthritis worldwide, with 10 to 20% of the adult population suffering from symptoms of OA.
This condition can affect a single large joint such as a hip or a knee, but commonly affects multiple joints, including those of the spine, the thumb base and wrist, the joints in the fingers closest to the nails (manifesting as bony lumps) and that of the ‘big toe’.
A joint with osteoarthritis is typically more painful during or immediately after activity; it may be stiff for a short time after sitting or resting it, and may intermittently swell or even develop permanent deformity.

Inflammatory arthritis

Inflammatory arthritis (IA) is that which is caused by, or involves, aberrancy in the immune system such that a system that ordinarily is used by the body to fight infections, turns on specific components of the body, in this case the joints, and attacks them. This results in joint inflammation, which manifests as pain, swelling and morning stiffness. Characteristically, these symptoms of inflammatory arthritis improve with movement or exercising the joint.
There are a variety of specific types of inflammatory arthritis, including Rheumatoid Arthritis (RA), Psoriatic Arthritis and Ankylosing Spondylitis.
Rheumatoid arthritis is the most prevalent IA in the community and, left undiagnosed and untreated, results in joint deformity and disability, particularly in the hands and feet.
Psoriatic arthritis and ankylosing spondylitis belong to a group of IA conditions called ‘Spondyloarthritis’. The spondyloarthropathies (‘spondylo’ refers to the spine) have common features, which can include psoriasis, bowel and/or eye inflammation (e.g. Crohn’s disease, ulcerative colitis and uveitis). Both diseases can affect the joints of the limbs and of the spine. As with rheumatoid arthritis, left untreated, joint deformity and disability is a significant risk for sufferers.
Psoriatic arthritis more commonly affects the peripheral joints, while ankylosing spondylitis primarily affects the joints of the spine, from the neck down, including the joints of the rib-cage. ‘Ankylosis’ means ‘fusion’ and ‘spondylitis’ refers to inflammation of the spine. Through this process of inflammation, the many articulations of the spine fuse, which can cause severe restrictions in movement for a patient.

Treatment Advances in Inflammatory Arthritis

Enormous strides in understanding the genetics and immunology of IA have been made in the last three decades, culminating in an expanding repertoire of highly effective medications and treatment strategies that target and block specific problematic components of the immune system. This modern approach has helped to restore many patients’ independence and quality of life.
For further information or to make an appointment with a Consultant Rheumatologist, please contact +353 1 526 2371 or email: rheumatologyssc@upmc.ie

OSTEOARTHRITIS

Knee Osteoarthritis Knee Surgery

Osteoarthritis (OA) is a process of gradual degeneration of the joint. The knee and hip are among the joints most commonly affected. However, any joint in the body can be affected and for many people with OA, only a single joint may become problematic.
The first symptoms of OA include short-lived pain and stiffness during or shortly after a particular activity, and over time, patients may notice a gradual deterioration in the function of the affected joint with difficulty performing everyday activities.
There are certain risk factors associated with the development of OA. These include: prior injury to a joint (e.g. tearing a cruciate ligament in a knee, joint dislocation), overweight/obesity, increasing age, female gender and the type of genes one is born with.

KNEE OSTEOARTHRITIS

Knee OA is one of the most common types of arthritis. One of the strongest risk factors for development and progression of knee OA is being overweight.
Other factors that can contribute to the development of knee OA and the joint’s deterioration include weakness in the muscles surrounding the knee and poor alignment of the structures in the knee joint which can be influenced by abnormalities above and/ or below the knee, such as ‘flat feet’ or ‘fallen arches’.

KNEE REPLACEMENT

Many patients have benefitted greatly from knee replacement, including many thousands of patients at SSC.

During a knee replacement, the orthopaedic surgeon removes severely degenerated cartilage and bone from the joint and substitutes it with artificial structures made from metal and plastic.

While knee replacement surgery results in positive outcomes for the majority of patients, it is still considered major surgery and carries with it a number of risks, including infection.
As a result, knee replacement is considered a treatment of last resort and other less risky and less invasive interventions are pursued in the first instance.

TREATING KNEE OSTEOARTHRITIS

The aim of treating OA is to restore normal function to the joint, alleviate pain, preserve the integrity of the joint structures and prevent further joint deterioration.
Exercise and weight control through diet are the two most effective treatments currently available to treat knee OA.
However, neither represent the ‘quick fix’ we would all prefer when it comes to dealing with arthritis.
Uptake of an exercise or a weight loss programme poses multiple challenges for patients, including time constraints, motivational difficulties and psychological barriers.
As a result, many OA sufferers prescribed these two treatments struggle or fail to achieve the intended goal, resulting in further progression of OA in the knee and ultimately requiring major surgical intervention in the form of knee replacement.
For this reason, UPMC Sports Surgery Clinic has established OPAS.
For further information on OPAS or to make an appointment please call 015262300 or email opas@sportssurgeryclinic.com

ASSESSMENT

WHAT CAN I EXPECT WHEN I ATTEND OPAS?

There are two main components to OPAS: an educational module and an individualized assessment
component.

Education Module (approximate duration 1.5 hours)

Each OPAS session commences with the Education component, where a small group of patients with OA will sit together and learn about OA. Our OPAS team have created a friendly and open environment that facilitates interaction and encourages discussion to enable you to learn as much as possible about your arthritis.

You will hear short talks from:

  • The OPAS Rheumatologist (Dr Barry Sheane) explaining how OA develops, how it can be treated and how we can try and delay or even prevent joint replacement.
  • The OPAS Physiotherapist advising about the importance of exercise in treating OA and how we can help you begin an exercise regimen designed with your specific needs in mind.
  • The OPAS Dietician on how your diet can be used as a way to reduce pain/manage OA through healthy eating and/or losing weight.

These talks will be informal and we strongly encourage patient-speaker interaction during the Education module!

Understanding OA is a key component in any treatment strategy and the OPAS team welcome any and all questions.

Assessment Module (approximate duration: 1.5 hours)

The Assessment Module is the second part of OPAS. You will be individually assessed by the Physiotherapist
and Dietician.

  • The Physiotherapist will assess the range of motion in your affected joint(s), identify any muscle weakness that might be contributing to your OA, and check the alignment of the joints in your legs. Based on this information, you will receive an individualized treatment and exercise plan to help maximize your mobility and enhance your participation in the daily activities that you enjoy most.
  • The Dietician will assess your weight, body mass index (BMI) and daily diet. Based on this information, you will receive advice on how to eat healthily in OA, and how you can change your daily diet to help lose weight, thus unloading excess pressure from the joints in your legs and reducing pain.
For further information on OPAS or to make an appointment please call  015262300 or email opas@sportssurgeryclinic.com

FAQ

HOW LONG IN TOTAL WILL I BE AT THE HOSPITAL FOR OPAS?

You will be at the Hospital for approximately 3 hours on the day of your attendance at OPAS. However, as OPAS is delivering individualised treatment for each patient, these times may be longer (or shorter).

IS THERE ANYTHING I NEED TO DO BEFORE I ATTEND OPAS?

Before attending OPAS, you will receive a number of questionnaires relating to your OA. Kindly complete these questionnaires and bring them with you on the first day of OPAS.

These completed questionnaires will help the OPAS team understand your pain level, how OA is affecting your day-to-day activities and your mood, and will assist us in devising a treatment programme that works best for you.

You will also be asked to complete a ‘food diary’ for 5 days prior to attending to help us advise on your diet.

WHAT HAPPENS IMMEDIATELY AFTER MY OPAS ASSESSMENTS?

Following these two assessments, you will conclude your visit with the OPAS Nurse.

The Nurse will review with you the advice and instructions you will have received from the Physiotherapist and Dietician and answer any questions you might have about your treatment plan.

WHAT HAPPENS IN THE WEEKS AFTER ATTENDING OPAS?

You will have access to two additional interactive group sessions taken by the OPAS Dietician.

Each of these sessions will cover a different topic relating to diet/ weight loss and arthritis, including Eating Habits and Barriers to Weight Loss.

There will be time at the end of each of these sessions to discuss your individual progress with the Dietician.
Two additional sessions with the OPAS Physiotherapist will also be available if you so require as part of the comprehensive package from OPAS.

As additional support, after the Dietician’s talks, the OPAS Nurse will also be available to discuss your progress and address any ongoing difficulties you may be experiencing with your individualized OPAS exercise and dietary plan.

The Nurse will assist you as necessary in helping you progress with your treatment.

DO I NEED TO BE REFERRED BY A DOCTOR TO OPAS?

In order for the OPAS team to deliver individualized treatment specifically for Osteoarthritis, patients require a formal consultation from an Orthopaedic Surgeon, Sports Physician or Rheumatologist prior to attending OPAS, in order to confirm patient suitability.

HOW MUCH DOES IT COST TO ATTEND OPAS?

The cost of attending OPAS is €300. This will cover three interactive sessions with the OPAS Dietician, a comprehensive assessment from the OPAS Physiotherapy Team, design and prescription of an individualized physio and exercise programme tailored for your specific needs, two follow-up sessions with the OPAS Physio Team to address any difficulties requiring additional input, and follow-up and support from the OPAS Nurse Co-ordinator.

In addition, this cost will include access to the Educational component of OPAS, including an educational lecture about OA from Dr Barry Sheane (Consultant Rheumatologist) and on ‘Exercise and OA’ from the OPAS Physiotherapy Team.

For further information on OPAS or to make an appointment please call  015262300 or email opas@sportssurgeryclinic.com

SPECIALISTS IN THE FIELD

Barry J Sheane

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Catherine Sullivan

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File downloads

Click here to download OPAS Referral Form

Click here to download OPAS OSTEOARTHRITIS PROGRAMME