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Arthritis Clinic
Consultant Rheumatologist
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The office is open 9 am -5 pm, Monday to Friday

The Clinics times are Flexible to accommodate the needs of our patients: mornings and evenings, Monday to Friday.

Regular Clinics are also held on Tuesday afternoons and Thursday Mornings.

Phone: 01 200 0520

Fax: 01 200 0521

There are many Rheumatic Conditions associated with Arthritis  

Rheumatoid Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis
Reactive Arthritis
Systemic Lupus Erythematosis
Behcet's disease
Wegeners Granulomatosis
Microscopic angiitis
Takayasau's vasculitis
Churg Straus Syndrome
Temporal arteritis/Giant cell arteritis



Gout is a form of arthritis. It can cause pain and swelling in the joints. At first, it tends to affect only one joint — most frequently in the big toe. It happens in people who have too much uric acid in the blood. Uric acid is a chemical that is produced when the body breaks down certain foods. Uric acid can form sharp needle-like crystals that build up in the joints and cause pain. Uric acid crystals can also form inside the tubes that carry urine from the kidneys to the bladder. These crystals can turn into “kidney stones” that can cause pain and problems with the flow of urine.

People with gout get sudden attacks of severe pain, most often the big toe, ankle, or knee. Often the joint also turns red and swells. Usually, only one joint is affected, but some people have pain in more than one joint.  The pain from gout can be extreme. The pain and swelling are worst at the beginning of a gout attack. The symptoms then get better within a few days to weeks. It is not clear how the body “turns off” a gout attack.

To test you for gout, your doctor can take a sample of fluid from the joint that is in pain. If he or she finds typical gout crystals in the fluid, then you have gout. Even without checking fluid from a joint, the doctor might still strongly suspect gout if: You have had pain and swelling in one joint, especially the joint at the base of the big toe, Your symptoms completely go away between attacks, at least when you first start having them or Your blood tests show high levels of uric acid.

There are a few medicines that can reduce the pain and swelling caused by gout. When you find one that works for you, make sure to keep it on hand all the time. That way you can take it as soon you feel an attack starting. Gout medicines work best if you take them as soon as symptoms start.

The medicines used to treat attacks of gout and prevent future attacks include: NSAIDs,Colchicine, Steroids: Steroids come in shots or as pills,Allopurinoll, Febuxistat and  Probenecid. People with severe gout can also get a medicine called Pegloticase, which is given through a vein. This medicine can cause an allergic reaction in some people.

If you take one of the medicines to prevent gout, your doctor will want to make sure that you use it safely. He or she might also want to check that your uric acid level gets low enough to dissolve the gout crystals. Allopurinol, febuoxistat and Probenecid can actually increase gout attacks when you first start taking them. To prevent these attacks, your doctor might suggest that you take low doses of Colchicine when you start the medicines. This will give the gout crystals time to dissolve, and that will put a stop to the attacks.

There are a number of things you can do to prevent Gout attacks. If you are overweight, losing weight can help relieve gout. Plus, you can make changes to your diet that may help prevent future attacks.

You should cut down on Red meat and seafood, Beer and hard alcohol, such as gin or vodka, Foods and drinks that have high-fructose corn syrup (that includes most sodas, and store-bought cakes and cookies). Instead, you should eat lots of Low-fat dairy products, such as low-fat milk, cheese, and yogurt, Whole grains and vegetables


Arthritis is a general term that means inflammation of the joints. There are dozens of types of arthritis. Osteoarthritis is the most common type. It often comes with age, and it often affects the hands, knees and hips.

The place where two bones meet is normally covered with a rubbery material called cartilage. This material allows the bones to slide over each without causing pain. When osteoarthritis sets in, the cartilage begins to break down. As it wears away, the bones in the joint start to rub against each other causing pain, stiffness, and swelling.

To ease your symptoms: Rest for several minutes when your pain is at its worst – But don’t rest too long. That can make your muscles weak and your pain worse. Lose weight (if you are overweight) – Being heavy puts extra strain on your joints. Get some physical therapy and exercise – Having strong muscles takes some of the strain off of your joints. It can reduce your pain in the long run, even though it hurts to do at first. Use shoe inserts, splints, canes, walkers, or any other devices that help you – These devices can help keep your joints stable or take weight off them. Use hot or cold packs Learn about arthritis – That way you can work with your doctor to find the things that will help you.

There is no strong evidence that supplements of any sort work on arthritis symptoms. That’s true even for glucosamine and chondroitin. Those are two supplements people seem to think help with arthritis. If you decide to try any supplements or herbs, check with your doctor before taking them.

There are lots of medicines that can help you manage your osteoarthritis symptoms. Some simply reduce pain; others reduce swelling and pain. There are also creams and gels you can put on your skin to reduce pain. Plus, there are shots that go into the joint that can help with pain.

What about surgery? — When other treatments do not help enough, some people with osteoarthritis get surgery. For instance, some people have surgery to replace a knee or a hip. Surgeons are working on other types of surgery for arthritis, too.

Try different things until you find what works — The symptoms of osteoarthritis can be hard to handle. But don’t lose hope. You may need to try different combinations of medicines, exercises, and devices to find the approach that works for you. But most people do find ways to go back to doing many of things they like to do.

Rheumatoid arthritis


Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in the joints. It is one of many different types of arthritis. Doctors do not know what causes it. But they do know that it happens when the immune system, “attacks” the joints.

Rheumatoid arthritis usually starts by affecting the small joints in the fingers, the balls of the feet, and the wrists. It usually affects both the left and the right side at the same time. (Other types of arthritis tend to first affect larger joints, like the knees or hips. And they may affect one side much more than the other.)

Sometimes it damages the joints forever. Plus, rheumatoid arthritis can cause problems in other parts of the body, such as the heart, lungs, or eyes. Doctors have no way of knowing which people will get which symptoms or how bad the symptoms will get.

Start treatment right away. Do not wait until your symptoms get worse. Getting treated early can help prevent a lot of the damage the disease can do to your body.

There are dozens of medicines for rheumatoid arthritis. The right one for you will depend on: How bad your symptoms are, How many of your joints are affected, How your disease has changed over time, What side effects you feel with the medicines you try, What your X-rays look like and The results of certain blood tests

It is very important that you stay active. You may want to avoid being active because you are in pain. But that can make things worse. It will make your muscles weak and your joints stiffer than they already are. A physical therapist can help you figure out which exercises will do the most good. An occupational therapist can help you figure out how to keep doing the everyday tasks you need to do—even with arthritis.

Another thing you can do to on your own is to eat a healthy diet. People with rheumatoid arthritis are at risk for heart disease, so avoid fatty foods. Instead, eats lots of fruits and vegetables.

If you want to get pregnant, talk to your doctor or nurse about it before you start trying. Some of the medicines used to treat rheumatoid arthritis are not safe for a baby, so you may need to switch medicines before you get pregnant. Plus, there are things you should do to help prevent problems during the pregnancy. The symptoms of rheumatoid arthritis often get a lot better during pregnancy. But they can get worse again after the baby is born.

Psoriatic arthritis.


Psoriatic arthritis is a type of arthritis that causes joint pain, swelling, and stiffness in people with psoriasis. Psoriasis is a chronic skin condition that causes patches of thick, inflamed red skin that are often covered with silvery scales.

Psoriatic arthritis affects men and women equally. Most people who develop psoriatic arthritis have skin symptoms of psoriasis first, followed by arthritis symptoms. However, in about 15 percent of cases, symptoms of arthritis are noticed before psoriasis appears.

Researchers have not identified the exact cause of psoriatic arthritis. However, they believe that the disease develops due to a combination of genetic, immunologic, and environmental factors.

Psoriasis frequently appears at sites where there is skin trauma. This is called the Koebner phenomenon. Some patients develop arthritis in an injured joints. 

Symptoms of psoriatic arthritis include: Pain and tenderness in the joints,  Difficulty moving or stiffness in the joints and/or in the back. About half of all patients have morning stiffness lasting more than 30 minutes.  Skin patches (also called plaques) that are dry or red, usually covered with silvery-white scales, which may have raised edges, Nail abnormalities, such as pitted, discolored, or crumbly nails, Some people with psoriatic arthritis have more difficulty with stiffness and immobility than with joint pain.

Psoriatic arthritis tends to affect certain groups of joints. The following terms are used to describe patterns of psoriatic arthritis: Distal arthritis, Asymmetric oligoarthritis, Symmetric polyarthritis, Arthritis mutilans and Spondyloarthropathy — This arthritis affects the joints of the spine.  Polyarthritis is the most common type of psoriatic arthritis, followed by oligoarthritis.

In addition to the joint pain and stiffness that psoriatic arthritis causes, there may also be swelling in the areas where tendons attach to bones, a condition called enthesitis. Another condition, tenosynovitis, can occur when the sheaths surrounding certain tendons, especially those in the hands and arms, become swollen and inflamed.

Almost half of people with psoriatic arthritis also experience dactylitis, which causes an entire finger or toe to swell (sometimes called sausage finger or toe). Eighty to 90 percent of people with psoriatic arthritis have nail problems. They may develop pitted nails, Or, there may be early separation of the nail from the nail bed. In some cases, people with psoriatic arthritis also experience eye problems. Inflammation of the structures of the eye can cause eye pain and redness and is referred to as uveitis or iritis.

Healthcare providers diagnose psoriatic arthritis by obtaining the medical history, performing a physical examination, and taking x-rays of the joints to check for inflammation. Blood tests or joint fluid tests may be done to rule out other diseases, such as rheumatoid arthritis and gout.

Psoriatic arthritis treatment can help to relieve joint pain and stiffness as well as the other symptoms of psoriasis these include; Exercise and physical therapy, Nonsteroidal anti-inflammatory drugs (NSAIDs), Glucocorticoid injections, Methotrexate, Sulfasalazine, Leflunomide, TNF inhibitors, Cyclosporine and others.

Ankylosing Spondylitis 

Ankylosing spondylitis is a disease that causes pain and stiffness in the back, neck, and hips. It begins with inflammation around the bones in the spine or in some joints. Later, it causes the bones in the spine to fuse together.

The most common symptom is pain in the low back. This pain usually starts between the ages of 20 and 30, comes on slowly, lasts for more than 3 months, is worse after resting, such as first thing in the morning and feels better with movement.

The back might also become less flexible. This can make it harder to do things like bend forward to put on socks or shoes. Other symptoms might include:pain, swelling or arthritis in other joints, such as the hips or shoulders, the elbows, heels, or ribs, feeling tired and not well.

In rare cases, ankylosing spondylitis can lead to other problems, such as:Inflammation of part of the eye – This is called “iritis” or “uveitis,” and causes eye pain and blurry vision, problems with the spinal cord – Ankylosing spondylitis makes it more likely that the spine will break in an accident. This can hurt the spinal cord, problems with the way the heart valves work, breathing problems – Some people have stiffness between the ribs and spine. This can make it harder to breathe deeply and to exercise. Inflammation of the inside of the intestines, which usually does not cause any obvious symptoms

There is no one test that can tell if you have ankylosing spondylitis. Your Rheumatologist should be able to tell if you have it by learning about your symptoms, doing an exam, and using imaging tests to look at your bones and joints.

Treatment depends on your symptoms and how severe your condition is. The goal of treatment is to relieve your symptoms, help you do your normal activities, and keep your condition from causing other problems.

Exercise is an important part of treating ankylosing spondylitis. Some people work with a physical therapist (an exercise expert) to learn the best way to exercise. As part of their exercise routine, most people work on posture, do deep breathing, and stretch their back.

Many people with ankylosing spondylitis also take one or more medicines. These might include:NSAIDs, These medicines can help relieve pain and stiffness. Other medicines – There are other medicines that can help treat symptoms and keep ankylosing spondylitis from getting worse. Your doctor will decide which medicines are best for you. Surgery can help some people with severe ankylosing spondylitis. For instance, some people have hip replacement surgery to replace a bad hip joint.

You can reduce the chance that your condition will cause problems if you:Stop smoking Exercise, Get plenty of calcium and vitamin D – This can help to keep your bones from getting weak and Use a thin pillow – Sleeping on a thick pillow can cause neck problems in people with ankylosing spondylitis

Reactive arthritis (Reiter syndrome) 

Reactive arthritis is a kind of arthritis that happens after an infection. It causes pain and swelling in joints. It usually affects people who have or just had:

· Food poisoning or another kind of infection of the intestines

· An infection that you catch through sex

The main symptoms of reactive arthritis are pain and swelling in the joints. These usually happen 1 to 4 weeks after an infection. In most cases, the symptoms affect only a few joints, usually in the knees, ankles, or feet.

Other symptoms might include: Pain in the tendons in the feet and ankles (tendons are tough bands of tissue that connect muscles to bones), Irritation of the eye called “conjunctivitis” (also known as pinkeye), Pain when urinating.

If your doctor can figure out what type of germ caused your infection, he or she should be able to tell if you have reactive arthritis. Your doctor can test your stool (bowel movements) or urine to look for certain kinds of germs. If your doctor can’t tell what germs caused your infection, he or she will study your symptoms to decide how likely it is that you have reactive arthritis.

The symptoms of reactive arthritis are treated with medicines, including: NSAIDs, Steroids, and other medicines that might help if your symptoms do not get better with NSAIDs or steroids. Eye drops – Special drops can help relieve redness and irritation in your eyes. But if you have eye pain or trouble seeing, visit an eye doctor to make sure you don’t have a more serious problem.

Antibiotics do not usually help with the joint symptoms of reactive arthritis. Even so, your doctor might prescribe them if you still have an infection.

Most people with reactive arthritis get better quickly. Some people continue to notice symptoms, either constantly or just once in a while. If your back gets very stiff and sore, see your doctor. This might mean that your reactive arthritis has turned into a more serious problem.

Systemic Lupus


When it is working normally, the body’s immune system kills germs and “bad” cells that could turn into cancer. Sometimes, instead of killing only bad cells, something goes wrong and the immune system starts to attack healthy cells. That is called an autoimmune response. It is what happens in lupus. In other words, if you have lupus, your body is attacking itself.

People with lupus may: Feel tired or weak, Lose or gain weight, Get fevers, Get headaches, Get a rash on their nose and cheeks shaped like a butterfly, especially if they spend time in the sun), Lose some hair, Get chest pain, Have trouble breathing, Bruise easily, Have joint pain and stiffness, Get sores in the mouth, Get cold fingers or toes that turn pale or blue, Lupus can also make it hard to think clearly, and it can make people feel anxious and sad. That is partly because the disease attacks the brain, and partly because the disease is hard to deal with.

It can help to eat a healthy diet, full of fruits and vegetables. It’s also important to stay active, even if you do not feel well. If you rest too much, your muscles will get weak and you may feel even worse later. Also, any time a doctor or nurse gives you medicine, make sure he or she knows you have lupus. Some medicines make lupus worse. It is important that you not take them.

There are medicines that can ease lupus symptoms, decrease the autoimmune response, or both. These medicines include: NSAIDs, which can ease joint pain, Malaria-fighting medicines, which help with lupus even though they were originally made to treat malaria, Steroids and related medicines, which partly “turn off” the immune system, and can help with many of the problems caused by lupus (these are not the same steroids that athletes take to build up muscle)

Steroids can do a lot of good, because they control the disease. But they can also cause problems of their own. For instance, steroids can cause weight gain, make bones weak, or make diabetes worse (or even cause diabetes).

Women with lupus are more likely than other women to have problems with pregnancy. But they can have healthy babies.

If you would like to get pregnant, speak with your doctor or nurse before you start trying to get pregnant. There are ways for you to reduce the chances of having problems. For instance, it is important that you wait until you have not had lupus symptoms for at least 6 months.

You will have lupus for the rest of your life. It may be severe, or it may be mild. Either way, doctors today know a lot about how to handle the disease. You are likely to live a long time. And you may even find that your symptoms go away for long periods.

Polymyalgia rheumatica and giant cell arteritis


Polymyalgia rheumatica is a condition that can cause stiffness and aching in the shoulders, neck, and hips. Sometimes it also causes swelling in joints such as the knees, hands, and feet. It usually occurs in people age 50 and older.

Giant cell arteritis is a condition that can cause headaches, trouble seeing, and jaw or arm pain. This condition affects blood vessels, usually in the head and sometimes in the neck. Blood vessels in the brain are not affected. Giant cell arteritis is sometimes called “temporal arteritis” because it often affects a blood vessel in the temple on the side of the head.

Polymyalgia rheumatica and giant cell arteritis are two different conditions. But they often occur together. Usually, these conditions last between one and three years.

The most common symptoms of polymyalgia rheumatica are: Pain and stiffness in the shoulders, hips, neck, or upper part of the body that is usually worse in the morning – These symptoms occur on both sides of the body and last 30 minutes or longer after getting up.  Swelling and stiffness in the knees, hands, wrists, ankles, or feet.  Feeling tired, Weight loss and Fever

The most common symptoms of giant cell arteritis are: Headaches – The pain is often over the temples (sides of the forehead) but can also be in the front or back of the head. Some people also have pain in the scalp when it is touched, Pain in the jaw, especially after chewing or talking, Pain or weakness in the arm, especially when you move your arm, Trouble seeing clearly, or trouble seeing out of one eye, Cough (that is new) or sore throat.

Other symptoms of giant cell arteritis can include: Fever, Feeling tired and weight loss.


If your doctor or nurse suspects that you have polymyalgia rheumatica or giant cell arteritis, he or she will do an exam and order blood tests. He or she might also order an X-ray, MRI, or other imaging test. Imaging tests create pictures of the inside of your body.

To check for giant cell arteritis, your doctor might order a test called a biopsy. During a biopsy, a doctor takes a small piece of a blood vessel from under your skin on the side of the head. He or she then looks at the tissue under a microscope.

Both polymyalgia rheumatica and giant cell arteritis are treated with medicines called steroids. (These are not the same steroids that athletes take to build muscle. These steroids reduce swelling and ease pain.) Many people feel better after taking their first dose. But most people need to take steroids for one to two years.

Steroids can have side effects, so your doctor will want to make sure you are on the lowest dose possible for the shortest amount of time possible.

Doctors might also prescribe other types of medicines for people with giant cell arteritis. For example, most people with giant cell arteritis also take a low dose of aspirin every day to prevent vision loss or a stroke.

It is important to follow all of your doctor’s instructions about treatment and follow-up. For example, if you have giant cell arteritis, your doctor might order a test called a chest X-ray every year to check the blood vessels in your chest.

It’s also important to let your doctor know if you have side effects from the treatment or if you develop new symptoms.


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