Rheumatology Services | Waitematā

Your GP will refer you to our department if they think you may have arthritis or an autoimmune disease and they require a specialist opinion regarding the diagnosis or treatment of the condition.
Waiting times for clinics range from 1-6 months depending on urgency, which is assessed from the referral letter we receive from your GP. Prior to coming to our clinic you may be asked to undergo tests such as blood tests or x-rays.
Clinic appointments last 30-40 minutes. You will be seen by a rheumatologist or registrar (a doctor training to become a specialist who is under supervision). A history of your symptoms will be taken, as well as a review of any medications you are on (so please bring these with you). You will then be examined which may include a general examination or only examination of your joints, depending on what condition your specialist is looking for. You may have further testing to establish the diagnosis.

The specialist or registrar will discuss with you the possible diagnosis and what further tests or treatments are recommended. They will contact your GP about your diagnosis, results of tests and a treatment plan. You may have ongoing follow-up in our clinic or be discharged back to the care of your GP.

You may see one of our rheumatology nurse specialists, who can provide further education and information on rheumatological diseases and the medications you are prescribed. The nurse may also provide you with support.

You may also be referred to a physiotherapist, orthotist, or occupational therapist.
A physiotherapist provides physical therapy to assist with any disability you have.
An orthotist provides practical aids/footwear to help in overcoming any disability.
An occupational therapist reviews what equipment/advice will assist in activities of daily living if you have a disability.

We also have beds available in the hospital under the care of a rheumatologist if you require admission to hospital for any treatment or testing.

• Inflammatory Arthritis
• Connective Tissue Disease
• Difficult to manage Gout
• Spinal Disorders (subacute back pain where spondylitis is a possibility)
• Regional Musculoskeletal Syndromes (soft tissue rheumatism), e.g. Carpal tunnel syndrome, rotator cuff degeneration.

• Outpatient diagnosis and formulation of management plan for patients with disorders of the musculoskeletal system (11 clinics per week)
• Shared care with GPs for people with complex problems
• Referral to, consultation with, and co-ordination of allied health professionals, in particular physiotherapists, occupational therapists, social workers, orthotists and podiatrists
• Inpatient management of acute illness associated with rheumatic disorders and their treatment
• Intensive interdisciplinary inpatient rehabilitation in those instances where outpatient programmes are sub-optimal.

• Chronic Fatigue without muscular pain
• Chronic pain syndrome (refer to Pain Clinic).

Tests that may be required during or after your visit to the clinic include the following:

Local anaesthetic is injected into the skin to numb the area and then a needle similar in size to that used to take a blood test is inserted into the space of your joint to take a sample of fluid. This is then sent to the laboratory for testing to aid in the diagnosis of your arthritis.

Some conditions involve a rash and to make the diagnosis a biopsy needs to be taken. Local anaesthetic is injected into the skin to numb the area then a small cutting of skin is removed to be sent to the laboratory and examined under the microscope. The area is treated with a gauze dressing afterwards and usually doesn’t involve having any stitches.

X-rays are useful to examine joints and these may be requested of joints that give you pain and sometimes joints that have no symptoms to help with the diagnosis.
An X-ray is a high frequency, high energy wave form. It cannot be seen with the naked eye, but can be picked up on photographic film.

MRI (Magnetic Resonance Imaging) gives even more detailed pictures of joints and organs so may be requested.
An MRI machine does not work like an X-ray or CT; it is used for exact images of internal organs and body structures. This method delivers clear images without the exposure of radiation.
The procedure uses a combination of magnetic fields and radio waves which results in an image being made using the MRI’s computer.

The New Zealand Rheumatology Association website, www.rheumatology.org.nz/ contains useful information on rheumatic diseases and treatments, a directory of New Zealand Rheumatologists as well as links to other rheumatology sites.

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