Conditions treated by the Rheumatology department

The Rheumatology department at Great Ormond Street Hospital treats a range of conditions.

These include:

  • juvenile idiopathic arthritis (JIA) are a group of different types of arthritis including:

    • systemic JIA

    • polyarticular JIA

    • polyarticular onset: rheumatoid factor positive JIA 

    • oligoarticular arthritis

    • enthesitis-related arthritis

    • psoriatic arthritis

  • arthritis associated with other chronic diseases
  • scleroderma including systemic sclerosis and localised scleroderma 

  • juvenile dermatomyositis

  • 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
  • Complex regional pain syndrome (usually seen by our 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.

Referral Criteria

  • 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 Patient Referral Form) and a physiotherapy assessment form here: Physiotherapy Proforma NIMPS
  • Physiotherapy Proforma NIMPSwill 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.

OR

  • 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.