The Rheumatology department at Great Ormond Street Hospital treats a range of conditions.
juvenile idiopathic arthritis (JIA) are a group of different types of arthritis including:
polyarticular onset: rheumatoid factor positive JIA
- arthritis associated with other chronic diseases
scleroderma including systemic sclerosis and localised scleroderma
vasculitides including Kawasaki disease, polyarteritis nodosa and other vasculitides
- systemic lupus erythematosus
overlap connective tissue disease
chronic infantile neurological cutaneous and articular syndrome
chronic recurrent multifocal osteomyelitis
periodic fever syndromes including familial mediterranean fever (FMF), Cryopyrin-Associated Periodic Syndrome (CAPS) and other genetic periodic fevers
Non-inflammatory Assessment Service
The department also offers an assessment service for children referred for non-inflammaotry rheumatological problems such as:
- Musculoskeletal pain
- Chronic pain syndrome
We do not see children with referrals of patients with Complex Regional pain Syndrome – these should be referred to the chronic pain team.
The service offers a full multidisciplinary (MDT) assessment process and provides comprehensive report of the findings and advice for ongoing management at local level.
- As a tertiary care hospital, children must be referred via local hospital consultants. GP referrals are not accepted to this service
- Any child referred to the service will need to be under the continuing care of a local Consultant
- Any child referred to this assessment service should already have had a local physiotherapy assessment and a local physiotherapy service should be available to supervise and undertake any ongoing exercise programme if this is deemed appropriate
- All referrals must be accompanied by a completed pre-referral proforma (which can be found here: Rheumatology pre-referral proforma (39.75 KB) and a physiotherapy assessment form here: Physiotherapy Proforma NIMPS
- Physiotherapy Proforma NIMPS will not be accepted until a completed proforma has been received.
The Assessment Process
The appointment at GOSH is a joint MDT assessment by the Rheumatology team, which includes a medical review, physiotherapy assessment and may also include a psychology assessment and occupational therapy assessment. Following the joint review a verbal report will be given to the parents before they leave clinic. A formal report will be sent to the referral source within 2 weeks of the appointment, providing findings and advice regarding ongoing care that may be needed to be provided locally.
In some cases it may be felt that a more detailed assessment is required due to the nature and extent of the psychological and/or physical symptoms. In this situation the family will be either:
- Given an appointment to attend a multidisciplinary pain education session usually within 1-4 weeks of the initial MDT assessment.
- Based on a screening process (including questionnaires completed by families, information received from the referrer and initial MDT assessment) some children with more complex issues will undergo an extended psychology assessment. This will take place at GOSH within 3 weeks of the initial appointment.
If a child undergoes either part of the extended assessment process as explained above, they will be seen for a final appointment at GOSH no more than eight weeks following the initial MDT assessment, when they will receive verbal feedback of the full assessment from appropriate members of the MDT. The patient will be discharged and a final report sent to the referring team with advice regarding future management within 2 weeks of this appointment. The service does not provide any ongoing treatment or follow up at GOSH and the child will remain under the continuing care of the referring consultant.
If an inflammatory rheumatological condition or a genetic condition is identified, the family will be referred to the appropriate clinic at GOSH for ongoing management in conjunction with the local consultant. Re-referrals to the non-inflammatory assessment service will only be accepted if there has been a significant change in rheumatological symptoms and following consultant to consultant discussion.