Rheumatology

Service category: Medicine and emergency care

Service location(s): East Surrey Hospital

Our Rheumatology professionals provide therapy and support to patients with a range of clinical issues. Typically, these include joints and soft tissues, but also autoimmune diseases, vasculitis, connective tissue disorders and osteoporosis.

Our research continues to confirm the importance of the immune system in treating these conditions. As a result, rheumatology is increasingly the study of immunology.

There are over 200 types of rheumatic diseases. Our rheumatology team offers a service of treatment to include:

• Inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis and reactive arthritis

• Connective tissue disorders 

• Auto-immune conditions such as Lupus (SLE), Scleroderma, Sjogren's Syndrome and Polymyositis

• Vasculitis such as Giant Cell Arteritis (GCA)

• Behçet’s syndrome

• Polymyalgia rheumatica

• Ankylosing spondylitis

• Gout

• Osteoporosis and Metabolic Bone

We sometimes refer patients to orthopaedic surgeons if treatment is needed, such as joint replacement. However, in recent years, better management of rheumatic disease has meant a reduction in the number of patients needing surgery. We also have close links with the extended scope physiotherapy services

Rheumatology: connecting the dots

Rheumatic disease doesn’t just affect the joints. Our consultants work closely with their colleagues in orthopaedics, ophthalmology, neurology, ENT, thoracic, gastro and renal medicine to ensure your treatment plan is as joined up and comprehensive as possible.

Rheumatology outpatient clinics

Our Rheumatology outpatient clinics are held at East Surrey Hospital, Crawley Hospital and Horsham Hospital. 

Osteoporosis specialist clinics are held on Thursdays at the Earlswood Centre, 1 Anderson Court, Royal Earlswood, Redhill, Surrey, RH1 6TP. 

Fracture Liaison Service

We accept referrals in to our Fracture Liaison Service for patients over 50 who may have suffered a fragility fracture. The team will assess in their one stop FLS Clinic and start treatment where appropriate and offer advice and information to help you keep your bones healthy. 


The rheumatology team and their patients are actively involved in clinical trials and research, both nationally and multi-nationally. Clinical trials ensure not only best quality clinical care, but also patient access to the most up to date treatments.

Our clinical trials include:

• How best to manage the early stages of arthritis

• Regular and ongoing contributions to the British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA) which is the largest prospective register in the world of rheumatology patients receiving biologic therapy.

• British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA)

• How to monitor the long-term safety profile of the biologic agents used

• ACTION Clinical Trial: a global study comparing anti-TNFα inhibitors with Tocilizumab as the first biologic treatment for rheumatoid arthritis.

• IMID (Immune-mediated inflammatory Disease)

• SpaExtend study biologic treatment

For more information, please look at the following external resources:

Arthritis UK 

Website: ​www.arthritis-uk.org​​

Helpline: ​0800 5200 520 – Mon to Fri 09:00-18:00

Email: ​​helpline@arthritis-uk.org

The Royal Osteoporosis Society

Website: ​www.theros.org.uk

Helpline: ​0808 800 0035 

Email: ​​nurses@theros.org.uk

The British Society for Rheumatology

Website: ​https://www.rheumatology.org.uk

Website: ​www.rheumatology.org.uk

Email: ​​bsr@rheumatology.org.uk

The Chartered Society of Physiotherapy

Website: ​https://www.csp.org.uk/

If you need advice relating to your rheumatology treatment, you can record a message on the Rheumatology Specialist Nurses helpline at any time, and we will aim to contact you within 48-72 hours. Alternatively, you can email your enquiry to us.

Please note that the helpline is not an emergency line. If you need urgent advice, or advice not related to your rheumatology condition, you should contact your GP, call 111 or attend your nearest Emergency Department or walk-in centre.

You should only call the Helpline if:

• You have a ‘flare-up’ of your condition that has not improved using self-help measures for at least a week.

• You are experiencing side-effects which you feel may be caused by the medication prescribed for your condition.

• You have concerns relating to your condition or treatment which cannot wait until your next rheumatology appointment.

• Your doctor or nurse specifically asked you to report progress.

 

Nurse Specialists and Fracture Liaison Practitioner: 

Divya Thomas

Maria Hewer

Chibuzor Ndukuba

Rashmi Baby

Contact details:

Telephone: ​01737 926346

Email: ​​sash.rheumatologynurses@nhs.net

 

Fracture Liaison Practitioner:

Alain Carmen 

01737 768511 ext. 2118

Rheumatology Medical Secretaries

For administration or appointment queries the rheumatology medical secretaries can be contacted Monday – Friday between 08:00 – 17:00. 

Email: sash.rheumatologysecretary@nhs.net

East Surrey Hospital Switchboard: 01737 768511

Dr Shianne Varrier​ext. 6765

Prof Ursula Davies ​ext. 1798

Dr Raad Makadsi ​ext. 1798

Dr Helen Linklater​ext. 6853

Dr Jennifer Hannah ​ext. 6853

Dr Sian Griffith ​          ​ext. 6765

Dr Bethan Forgie ​ext. 6765 

Please note that medical secretaries are not permissible to provide patients with results of blood tests or radiology investigations. These will be discussed at your next follow up appointment or, if your consultant feels it necessary, they will write/contact you. Patients with clinical queries, or those encountering problems with their medication, can email sash.rheumatologynurses@nhs.net

Rheumatology Medical Secretaries

For administration or appointment queries the rheumatology medical secretaries can be contacted Monday – Friday between 08:00 – 17:00. 

Email: sash.rheumatologysecretary@nhs.net

East Surrey Hospital Switchboard: 01737 768511

Dr Shianne Varrier​ext. 6765

Prof Ursula Davies ​ext. 1798

Dr Raad Makadsi ​ext. 1798

Dr Helen Linklater​ext. 6853

Dr Jennifer Hannah ​ext. 6853

Dr Sian Griffith ​          ​ext. 6765

Dr Bethan Forgie ​ext. 6765 

Please note that medical secretaries are not permissible to provide patients with results of blood tests or radiology investigations. These will be discussed at your next follow up appointment or, if your consultant feels it necessary, they will write/contact you. Patients with clinical queries, or those encountering problems with their medication, can email sash.rheumatologynurses@nhs.net

Blood tests

Blood test booking service (East Surrey Hospital, Crawley Hospital, Horsham Hospital)

Online: ​swiftqueue.co.uk/surreyandsussex.php

Telephone: ​0300 613 4117

Blood test booking service (East Surrey Hospital, Crawley Hospital, Horsham Hospital)

Online: ​swiftqueue.co.uk/surreyandsussex.php

Telephone: ​0300 613 4117

Referrals

All GP referral letters, except those referred through the Choose & Book System or Two-Week Rule method, should be sent directly to the Outpatient Booking Office at East Surrey Hospital. Please do not send referrals directly to a consultant, medical secretary or any other department. 

The Outpatient Booking Office is responsible for processing ALL referrals for outpatient appointments which then initiates the patient’s 18-week RTT status.

Outpatient referrals made under the Two-Week Rule method should be emailed to sash.cwtreferrals@nhs.net

Download the early inflammatory arthritis referral form

Suspected Giant Cell Arteritis

GPs should refer these patients urgently (same-day) by bleeping the Rheumatology Registrar at East Surrey Hospital, on Bleep 636. Outside of normal working hours (17:00-09:00) patients should be referred to the medical registrar on-call via hospital switchboard 01737 768511. 

Giant Cell Arteritis (GCA) Management Pathway​(create as link within this page)

Vaccination

Patients on DMARDS (Methotrexate. Leflunomide, Biologics) are eligible for Flu /Covid and one-off pneumococcal vaccine. You are also eligible for Covid Booster Vaccines and non-live shingles vaccination.

If you are on Rituximab infusions, we prefer you to have your vaccination 4 weeks before the infusion or 6 months after the infusion.

You are not allowed to have live vaccinations while on immunosuppression.

For travel vaccinations please contact your vaccination team with a copy of your Rheumatology clinic letter 

For more info - https://www.versusarthritis.org/about-arthritis/living-with-arthritis/vaccinations

For medication pathways and shared care guidelines please see Surrey Prescribing Advisory Database.

 

During an infection

Your Rheumatology medications including tablets (Methotrexate, leflunomide, Mycophenolate mofetil, Azathioprine) and biologics injections must be stopped during an infection. You could restart once you have completely recovered, off antibiotics.

 

If you have scheduled surgery including dental procedures

Biologic medications need to be stopped before surgery (Please see the table below). Biologics could be restarted once you have completely recovered (no infection, good wound healing).

 

 

 

 

 

Medication

When to stop prior to surgery

 

 

Etanercept

2 weeks before

 

 

Adalimumab

3 weeks before

 

 

Infliximab

2 weeks before

 

 

Certolizumab

2 weeks before

 

 

Rituximab

4 months before

 

 

Subcutaneous Tocilizumab

3 weeks before

 

 

IV Tocilizumab

5 weeks before

 

 

Secukinumab

12 weeks before

 

 

Abatacept

2 weeks before

 

 

Baricitinib Tofacitinib

Filgotinib Upadacitinib

2 days before

 

 

Apremilast

2 days before

 

 

 

 

 

Biologic prescriptions are renewed every 6 months and are linked to your clinic appointment. Please remember to do your monitoring blood tests regularly to avoid a delay with your prescription.

Young patients with suspected rheumatoid disease should be referred by their GP to the paediatricians, who may then refer onwards to paediatric rheumatologists at Great Ormond Street Hospital.

In emergency cases GPs can contact a Rheumatology consultant via the acute Rheumatology bleep during the day, Monday to Friday.

Out of hours, emergency Rheumatology patients are seen by the Emergency Department or Orthopaedics.

Giant Cell Arteritis (GCA) Management Pathway