Rheumatology
The Starship Paediatric Rheumatology service is primarily an outpatient service that sees patients in outpatient clinics at Starship and some regional centres. Patients may occasionally be seen while admitted to hospital or in the DayStay Unit.
The service is part of the New Zealand Paediatric Rheumatology Service, and provides specialised care for children and young people with rheumatology conditions in the greater Auckland region, the upper North Island and the Far North.
The rheumatology team includes specialist doctors, a clinical nurse specialist, physiotherapist and occupational therapist. They also work closely with other paediatric specialists when required.
What is Rheumatology?
Rheumatology is the specialty of medicine that includes autoimmune and autoinflammatory conditions including arthritis. The term arthritis refers to the inflammation of a joint in the body. An autoimmune or autoinflammatory condition is where an abnormality in the immune system leads to the body’s defence harming its own cells by mistake.
Common Conditions
Paediatric Rheumatology encompasses a wide variety of inflammatory and non-inflammatory conditions of the musculoskeletal system (muscles and joints) as well as conditions of non-infectious multi-system inflammation.
The types of conditions cared for by the Rheumatology team include:
- Juvenile idiopathic arthritis (JIA)
- Systemic lupus erythematosus (SLE)
- Vasculitis (e.g. Kawasaki, Behcet's)
- Connective tissue disease (e.g. juvenile dermatomyositis, scleroderma)
- Autoinflammatory conditions (e.g. chronic recurrent multifocal osteomyelitis, periodic fever syndromes)
Consultants
- Dr Jacqueline Yan Paediatric Rheumatologist
- Dr Anthony Concannon Paediatric Rheumatologist
- Dr Genevieve Ostring Paediatric Rheumatologist
Referral Expectations
Your GP or paediatrician will refer your child to the Starship Paediatric Rheumatology service if they think your child may have an autoimmune or autoinflammatory condition such as arthritis, and they require a specialist opinion regarding the diagnosis or treatment of this condition. Before coming to the clinic your child may need to undergo some tests such as blood tests or x-rays, and it is helpful to bring a list of any medicines they are currently taking.
At the clinic appointment a history of your child's symptoms will be taken as well as a review of any medications they are on. Your child will then be examined, and may be referred for further testing. The specialist will discuss with you the possible diagnosis and what further tests or treatments are recommended. They will also contact your GP and/or paediatrician about the diagnosis, results of tests and a treatment plan.
The rheumatology team includes several different specialties and your child may also be reviewed by other members of the team. Your child may have ongoing follow-up care in our clinic, or be discharged back to the care of your GP. If you are from outside of Auckland, ongoing care may be shared with a local paediatrician.
Common Conditions / Procedures / Treatments
Blood tests
Blood tests can be used to look for how much inflammation there is in the body, monitor certain side effects of the medicines the patient is taking and/or help classify the patient's rheumatological condition.
X-rays
X-rays are used to give a picture of the bones and joints. An x-ray can help to check the position and condition of the bones near a joint.
MRI
MRI (Magnetic Resonance Imaging) gives even more detailed pictures of joints and organs and may be helpful to check if the joint is damaged. Occasionally, if more detailed information about the joints is required, a dye is injected into the vein to show more detail in the picture.
Joint injections
A joint injection is most often done to deliver medicine directly into the joint. This may be done when the other medication the patient is taking is not controlling the arthritis well enough or if the patient has only a few swollen joints. In older children the joint injections are done with the child inhaling Entonox (laughing gas) which helps relieve the discomfort of the procedure. Younger children are given a general anaesthetic.
Drug infusions
Some medications used in rheumatology are given as an intravenous infusion. These are given in hospital as a day admission.
Ultrasound
Ultrasound uses high frequency sound waves/echoes to give images of soft tissues and fluid. These images can be helpful to show areas of inflammation.