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Rheumatology

 

 

 

Welcome to Rheumatology

Rheumatology Department, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW

The Department of Rheumatology is based in the University Hospital of Wales and Llandough Hospital offering both outpatient and day case services.

Our rheumatologists run specialist clinics for conditions affecting the joints and surrounding tissues such as arthritis, connective tissue and autoimmune disease. 

Conditions treated include arthritis, osteoporosis, connective tissues and other systemic autoimmune diseases.

Our department specialises in the diagnosis, treatment and ongoing management of a wide range of conditions which affect the joints and surrounding tissues. Joint and soft tissue injections are provided within general clinics, joint injection clinics under radiographic guidance are arranged with the radiology department.

With over 200 types of arthritis and rheumatic diseases, the department offers a comprehensive diagnostic and treatment service, via face to face and telephone appointments. Specialist clinics are run for the monitoring of medication, including disease modifying and biologics therapies. Patients with inflammatory conditions, such as rheumatoid arthritis, connective tissue diseases and spondyloarthropathies, are followed up in the service. 

Treatment with biologic drugs ( anti TNF) are carried out in the day unit.

 

Location

The Rheumatology department run appointments from the Rheumatology Day Unit and from Outpatients in the University Hospital of Wales and University Hospital Llandough.


Outpatient Corridor
University Hospital of Wales
Heath Park
Cardiff
CF14 4XW

 


Main Outpatients
University Hospital Llandough
Penlan Road
Llandough
CF64 2XX

 

 

Cardiff & Vale Parking

For more details on parking, you can visit the Cardiff & Vale UHB Parking Page.

Advice about appointments

If you would like to know when your next appointment is or rearrange this please call Appointment booking telephone number : 02920 748181

PIFU (Patient initiated follow up) or SOS (See on symptom) 

Contact: 029 21848181 or email: Cav.appointments@wales.nhs.uk

 

Useful contact numbers

Appointment booking telephone number: 02920 748181

Christian Byard: Secretary to Dr Jones, Dr Al-Mudhaffer 02921 842627

Helen Jones : Secretary Dr Beynon, Dr Lawson and Dr Prasad. 02921 842346

Cathryn Donald : Secretary to Dr Negi, Dr Davies 02921 842626

 

Rheumatology Software

http://10.59.11.51:8080/cellmaWEB/index.do

Meet the Team

 

Dr Sharon Jones BM, MD, FRCP

Clinical Director

Consultant Rheumatologist

Secretary: Christian Byard 02921 842627

 

Dr Al-Mudhaffer

Consultant Rheumatologist

Secretary: Christian Byard 02921 842627

 

Dr Tom Lawson

Consultant Rheumatologist

Secretary: Helen Jones 02921 842346

 

Dr Celia Beynon

Consultant Rheumatologist

Secretary: Secretary: Helen Jones 02921 842346

 

Dr Roopa Prasad

Consultant Rheumatologist

Secretary: Secretary: Helen Jones 02921 842346

 

Dr Anurag Negi MBBS, FRCP

Consultant Rheumatologist

Secretary: Cathryn Donald 02921 842626

 

Dr Ruth Davies

Consultant Rheumatologist

Secretary: Cathryn Donald 02921 842626

 

Frequently asked questions:

Link to Versus arthritis website for lots of useful information about medications and rheumatological conditions: https://versusarthritis.org

Vaccination Information

  1. Which vaccinations are safe for me to have with my medications? 

If your immune system is suppressed due to medication, it is important that you are adequately protected. It is usually recommended to have flu, Covid and pneumovax vaccinations.

If you are receiving treatment with immunosuppressive drugs such as methotrexate, leflunomide, azathioprine, biologic medications and high dose steroids (oral prednisolone 20mg daily or more for more than 14 days) you should avoid 'live' vaccinations: these include oral polio vaccine, BCG, MMR, yellow fever vaccine and German measles (Rubella). An alternative inactivated polio vaccine is available, if required.

You should also avoid contact, where possible, with adults or children who have received the 'live' oral polio vaccine for 6 weeks after vaccination: in particular you should not change babies' nappies, since they will excrete the live polio virus in their faeces for this time.

Vaccination against yellow fever may be an entry requirement for some countries, so discuss this with your GP before making travel arrangements. If you are planning to travel abroad, you should seek advice from your GP at least six weeks before your departure since some vaccinations may need ordering.

Please see Vaccinations | Side-effects, protection and infection (versusarthritis.org) for more information

  1. Should I withhold medication if I am having a Covid or flu vaccination?

Covid: There is some evidence that for people taking methotrexate, abatacept and Rituximab withholding these medication after vaccination can improve your body’s response to the Covid vaccination.

Methotrexate can be withheld for 2 weeks after the covid vaccination/booster.

Abatacept can be withheld for 1 week after covid vaccination.

Covid vaccination should be given at least 4 weeks before Rituximab and if you have already had Rituximab it is best to wait 4 months after the infusion to have the covid vaccination.

We recommend continuing other conventional DMARDs and biologics.

Flu: If you're being treated with rituximab, you should try to have the flu vaccine either 4 weeks before an infusion or 6 months after an infusion. If the flu vaccine is given within 6 months of a rituximab infusion you may not be fully protected against flu. Other biologics and DMARDs don’t need to be stopped before/after flu vaccination. 

 

Advice about RA flares

  1. What is a flare?

The activity of inflammatory arthritis varies and there will be times when your arthritis will be quiet and manageable.

  • A ‘flare' of arthritis may result in some of the following symptoms:
  • Worsening pain in the joints
  • Increase in swelling and / or stiffness in the joints
  • Increased tiredness
  • General 'unwell' feeling

A flare can last for hours, days or weeks. Some flare triggers include infection, such as a chest or urinary infection, or physical or mental stress. Sometimes there is no obvious trigger. If you have an infection, it is best to consult your GP, as you may require treatment.

 

  1. Medication for flares

Taking your painkillers and/or anti-inflammatory tablets regularly should help to control the pain.  Don’t exceed the maximum recommended dose.

You should continue to take your other usual medications. If you are taking steroid tablets, it is important that you do not alter the dose without consulting your GP or a member of the Rheumatology team, unless this has been pre-agreed. 

Anti-inflammatory gels may be applied locally to swollen and inflamed joints following the manufacturer's instructions.

  1. Heat or cold for flares

Heat or cold applied to joints may reduce pain and inflammation.

  • Heat: wheat bag, hot water bottle, heat pad.
  • Cold: bag of ice cubes or frozen peas, wheat bag or gel pack.

These treatments may be applied for up to 15 minutes. Always place a towel between the skin and heat/cold source to prevent burning or skin damage.

  1. Rest and exercise for flares

During a flare it is important to pace your activities. It is best to plan your day taking into consideration your increased tiredness.

Short rests in between activities may be needed but it is best to keep your joints moving. This will help prevent stiffness and maintain muscle tone.

  1. What should I do if my flare does not settle?

If your flare has not responded to these treatments after seven days and you need further help, you should contact your GP or the rheumatology helpline for advice and/or treatment.

Stopping DMARD/biologic if unwell

  1. Should I stop my DMARD/biologic if I am unwell?

DMARD: If you are taking Methotrexate or leflunomide we advise you to withhold these if you develop an infection. You usually do not need to stop other disease-modifying treatment (such as hydroxychloroquine and sulfasalazine) whilst taking antibiotics. If you are on long term antibiotics for another condition please discuss with your rheumatologist.

Biologic: You should not take biologic medication if you are unwell due to an infection or on antibiotics. They can be restarted once you are feeling well and off antibiotics.

If you have symptoms of an infection you may need to see your GP. I you have symptoms of an infection and are attending for biologic infusion on the day unit this will likely need to be postponed until the infection is cleared/you are off antibiotics.

 

Stopping medication before surgery

  1. Should I stop my DMARD if I am having surgery?

There is no convincing evidence that continuing these medications (methotrexate, leflunomide, sulphasalazine, hydroxychloroquine, ciclosporin, mycophenolate mofetil) affect surgery. Stopping them could cause a flare in your condition which can be more problematic.  Therefore, we recommending continuing them. However, if the surgical team has specific concerns about individual cases, they can contact us.

  1. Should I stop my biologic if I am having surgery or dental extractions?

Biologics should be stopped before surgery and dental extractions, please see the table below for guidance on individual biologics.

Biologics can be restarted around 14 days post operatively once the surgical team is happy with the wound, the surgical site is healing well and there are no signs of local or systemic infection

 

Drug Usual Dosing Frequency How many weeks after last dose should surgery be scheduled?

Etanercept (Benepali, Enbrel)

 

 Weekly Week 2
Adalimumab (Yuflyma, Amgevita, Humira) Every 2 weeks Week 3
Certolizumab (Cimzia) Every 3 weeks Week 3
Golimumab (Simponi) Every 4 weeks Week 5
Infliximab Every 4,6 or 8 weeks Week 5, 7 or 9
Sarilumab (Kevzara) Every 2 weeks Week 4

Tocilizumab IV

Tocilizumab subcutaneous (Actemra)

Every 4 weeks

Every week

Week 5

Week 3
Secukinumab (Coseyntx) Monthly Week 12 
Ixekizumab (Taltz) Monthly Week 10
Ustekinumab (Stelera) Every 12 weeks Week 13

Abatacept IV

Abatacept subcutaneous (Orencia)

Monthly

Weekly

Week 5

Week 2

Guselkumab (Tremfya)

 

 4-8 weekly Week 5-9
Risankizumab (Skyrizi) Monthly Week 5
Baracitinib (Oliuminat) Daily Stop dosing 2 days before surgery
Tofacitinib  (Xeljanz) Twice per day Stop dosing 2 days before surgery
Filgotinib (Jyseleca) Daily Stop dosing 2 days before surgery
Upadacitinib (Rinvoq) Daily Stop dosing 2 days before surgery
Apremilast Daily Stop dosing 2 days before surgery
Rituximab    

 

Biologics do not need to be stopped before endoscopy, cystoscopy, liver/kidney biopsy, lymph node biopsy or punch biopsy. Biologics should also be stopped prior to biopsies resulting in open granulation tissue.

Nausea and methotrexate

  1. I feel sick after taking my Methotrexate, what can I do?

Feeling sick (nausea) is a common side-effect of methotrexate, especially when treatment starts. This normally gets better, but for some people it may continue.

This feeling may be helped by:

  • taking the methotrexate with or after food
  • taking the methotrexate just before you go to bed; you may be able to sleep through the feeling of sickness
  • making sure you take your folic acid
  • switching to injectable methotrexate.

Sometimes the number of days that you take folic acid can be increased, but this should only be done after speaking to a doctor. 

Injection site reactions

Injection site reactions include redness, pain, swelling or itching at the injection site. They usually occur 1-2 days after an injection and go away within 3-5 days. They are most common during the first few months of treatment.

Applying a cold compress to the site can help. Anti-histamine tablets or creams available from your chemist can also help.

You can try changing where you give the injection each time: you can inject into the front of the thigh and abdomen. If you have pain, redness, or swelling around the injection site that doesn't go away, or gets worse please contact the rheumatology helpline.

Delivery queries for biologic medication

1.The delivery company says my prescription has run out – what should I do?

Please ring the rheumatology helpline 02920 7481891 so that we can check if your repeat prescription has been done.

2. My drugs have not been delivered – what should I do?

Please ring the homecare company directly 

I am going on holiday- what should I do about my medication?

You need to take your medication with you, including any injections you need, when you go on holiday.

If you get your prescription from your GP, please get in touch with them in good time to request extra medication for when you are on holiday.

If we supply your medication, please contact us for a travel letter if you are taking injections with you on a plane.

Keep your medication in your hand luggage if you are flying.

If you self-inject medication such as biologics please ensure there are refrigeration facilities. Before you go, make sure you have enough supplies of your medication and 'sharps' bins for disposal of used syringes. Request a holiday letter from the delivery company or Rheumatology team to have with you when taking injectable medication through customs.

Conception and Pregnancy

Some of the medication used to treat rheumatological conditions can harm an unborn baby (for example methotrexate and leflunomide). We recommend that you let your rheumatologist know if you are planning to become pregnant or father a child.

Your treatment may need to be changed before you stop using contraception.

If you have an unplanned pregnancy, and are stopping / have recently stopped taking regular medication for your arthritis, please seek advice from your rheumatology team as soon as possible.

Please see Pregnancy, fertility and arthritis | Drugs, breastfeeding and supplements (versusarthritis.org) for further information

Blood monitoring for medication

You will be given advice about how often you need blood monitoring when starting a DMARD (disease modifying drug). The table below summarises the usual regime for different medications. Sometimes the schedule changes depending on individual circumstances.

Drug

Monitoring

After dose increase

Methotrexate

 

FBC, LFTs, U&E every 2 weeks for 4-6 weeks then monthly, then 3 monthly after 1 year.

 

 FBC, LFT 2 weeks after any dose increase

Sulfasalazine

 

FBC, LFT every 2 weeks for 3 months. Thereafter, routine monitoring is not required unless toxicity suspected.

 

 Repeat FBC and LFTs 2 weeks after dose increases

Mycophenolate

 

FBC weekly for 4 weeks then 2 weekly for 8 weeks, then monthly for 1 year then 3 monthly

 

  

Leflunomide

 

Baseline blood pressure, weight.

FBC & LFTs and blood pressure - every 4 weeks for 6 months and then 2 monthly.

 

  

Azathioprine

 

FBC weekly or fortnightly for first 4-8 weeks (or until two weeks after the

final dose increase- whichever is sooner) and then every 3 months.

LFTs at one month, two months, and then every three months.

 

LFT and FBC two weeks after any dose increase.

 

FBC: full blood count, LFT: liver function tests

How do I find out my test results?

We will give you the results of any investigations at your next review, or sooner if appropriate

Location

The Rheumatology department run appointments from the Rheumatology Day Unit and from Outpatients in the University Hospital of Wales and University Hospital Llandough.


Outpatient Corridor
University Hospital of Wales
Heath Park
Cardiff
CF14 4XW


Main Outpatients
University Hospital Llandough
Penlan Road
Llandough
CF64 2XX

 

 

Cardiff & Vale Parking

For more details on parking, you can visit the Cardiff & Vale UHB Parking Page.

 

Useful Links

Here are some useful links and resources for people living with arthritis and rheumatic diseases;

 

Links for Healthcare Professional