Rheumatology in Enfield

Welcome to The King’s Oak rheumatology information page. Whether you are experiencing a new onset of symptoms that you are concerned about or you have an existing diagnosis and wish to transfer your care to our specialists we can help. We offer rapid access to our specialists and timely diagnostics including blood tests as well as imaging to accurately diagnose causes for pain and enable treatment to commence without delay.

Our teamwork across our rheumatology specialists, radiologists, orthopaedic surgeons and physiotherapy department enables a comprehensive range of diagnostic and treatment pathways and our personalised approach to care a The Kings Oak follows patient choice at all aspects of the journey.

As part of our comprehensive package of care for patients our rheumatology department accepts referrals and communicates with general practitioners, NHS departments and other private units as patient’s situation dictates to provide optimum continuity of care. 

The medical specialty of rheumatology classically covers problems with joints, but has really expanded to include other problems over the last two decades. The expanded problems that rheumatologists cover include bone problems such as osteoporosis and often includes problems with persistent pain, which other specialties may have struggled to deal with for patients.

Broadly speaking, joints problems fall into two categories. Inflammatory types of joint pain and mechanical type of joint pain. We all, to a greater or lesser extent, suffer with mechanical joint pain as because our joints deteriorate with age. However, some individuals and populations may suffer with mechanical joint pain in differing extents and in different distributions throughout the body.

However, the primary condition that rheumatology expertise is required for is inflammatory joint disease. These group of conditions are really a disease rather than a process. The classical example is rheumatoid arthritis (RA) but there are many other forms of inflammatory diseases which affect joints, skin, muscles and other vital organs. Examples of diseases that tend to come the way of rheumatologists include psoriatic arthritis, inflammatory muscle disease, scleroderma and lupus.

The treatment of rheumatoid arthritis and other inflammatory joint disease was really revolutionized in the last twenty to thirty years. Members of the public may have a notion that people who suffer with these inflammatory joint processes develop very disabling symptoms due to swelling, pain and deformity as the disease progresses. Fortunately, this is a very rare occurrence these days due to new types of medication and modern treatments.

Disease modifying anti rheumatic medications (DMARDS) and biological therapies are groups of medications that are able to suppress parts of an individual’s immune system and suppress the body’s inflammatory response. More recently medications known as janus kinase inhibitors (JAK inhibitors) have also been developed for patients who do not respond to, or get side effects from DMARDs and biological therapies. Long term courses of these medications are often able to significantly reduce symptoms and, therefore, limit deterioration of joints over time. Due to their broad effect, these medications are also used to control other systemic rheumatologic symptoms.

Treatment for mechanical, local problems, such as carpal tunnel syndrome, tennis elbow, golfer's elbow, neck pain and back pain may involve a combination of lifestyle changes and rehabilitation exercises, splints or local injections where symptoms dictate. When it comes on to bone disease such as osteoporosis, under a rheumatologists expertise and monitoring, treatment may include exercise and specialist medication to maintain healthy bone density.

An initial consultation with a consultant rheumatologist will involve establishing where the problems are for the patient. Often a discussion may be quite wide ranging due to the systemic nature of rheumatological problems that a patient may not previously have appreciated. This requires patient focused but guided questions from our experts. Thus, an initial consultation may include questions regarding previous medical problems on, apparently unrelated conditions and symptoms. Examples may include:

• Daily pattern of any symptoms (inflammatory conditions may be worse overnight and early morning)
• Any systemic symptoms; Lethargy, weight loss, sweats
• Associated symptoms such as swelling, redness to the joints
• Breathing problems including any shortness of breath
• Skin conditions which may be related to inflammatory arthritis
• Eye conditions indicating inflammation such as iritis
• Gastrointestinal symptoms and conditions including ulcerative colitis and Crohne’s Disease
• Family history of rheumatologic or immune system diseases 
• Medications as many groups may cause joint problems
• Alcohol consumption, smoking and diet

Typically, following this wide ranging discussion there will be a physical examination. This will be localised to the particular area/s that are causing trouble but, depending on the prior discussion may involve a wider systemic examination of the cardiovascular, respiratory, abdominal and neurological examination because all of these things can be involved and relevant to a systemic immune system problem.

A rheumatologist will, for the most part have a fairly good idea of the diagnosis and any subsequent investigations required following the discussion and will use the physical examination to confirm the diagnostic tests required.

Typically, investigations might include blood tests to look at the levels of inflammatory mediators in the body as well as the relative components of an individuals blood (full blood count), , abnormal biochemistry causes for having thin bones and osteoporosis as well as the function of the liver and kidneys. Certain antigens may also be screened by rheumatologists which give an indication as to the probability to individuals developing different forms of inflammatory/ immune system conditions.

For many presentations, a rheumatologist will also request imaging in the form of x-rays which give a reliable indication of the degree of age related changes to joints but may also demonstrate signs associated with inflammatory joint pains. In certain cases an ultrasound or MRI scan may also be requested. 

Our rheumatology department offers patients the ability to access consultations with experts without typical delay whether an individuals has a known rheumatological condition or requires an assessment for an initial diagnosis. Rapid access to expertise in the field of rheumatology is particularly important as delay to care may result in damage to joins and complications long term.

Our consultant rheumatologists work as a team with our specialist consultants in other diagnostic fields including our radiology consultants (experts in imaging) as well as our pathology teams (experts in analysing blood results). Our teamwork and close communication channels between departments allow diagnostics to be conducted at short notice and our radiology colleagues are key to diagnosing some cases of rheumatology conditions which may require specialists to conduct ultrasound evaluations of joints to determine any underlying inflammation. Furthermore, our close working with consultant radiologists allow referral for interventional procedures such as ultrasound guided injections for certain join and tendon problems.

Furthermore, our rheumatologists have forged strong links with our orthopaedic surgeons and physiotherapy department. For our patients who require any surgical opinion or intervention on a musculoskeletal or orthopaedic problem or guidance and monitoring through an appropriate rehabilitation program for a joint, tendon or muscle problem we liaise with our colleagues accordingly to arrange further care.