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Rheumatology - Royal North Shore Hospital

Ambulatory Care Centre (outpatient clinics)
Level 3 (main entry-level)
Acute Services Building (main building)
Royal North Shore Hospital
Reserve Road

St Leonards

2065

Rheumatology - Royal North Shore Hospital

Contact Us
Phone: 02 9463 1887
Fax: 02 9463 1077
Email: NSLHD-RNS-Rheumatology@health.nsw.gov.au

Monday: 08:00 AM to 4:30 PM
Tuesday: 08:00 AM to 4:30 PM
Wednesday: 08:00 AM to 4:30 PM 
Thursday: 08:00 AM to 4:30 PM
Friday: 08:00 AM to 4:30 PM
 

 What we do

We provide assessment and treatment for all arthritis, musculoskeletal problems and autoimmune disease, including:
•    Rheumatoid arthritis
•    Spondyloarthritis e.g. psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease associated, reactive arthritis 
•    Viral arthritis
•    Polymyalgia rheumatica
•    Systemic lupus erythematosus 
•    Vasculitis e.g. giant cell arteritis, temporal arteritis, Takayasu arteritis, polyarteritis nodosa, ANCA positive vasculitis 
•    Juvenile idiopathic arthritis and other childhood and adolescent chronic MSK conditions. (patients aged > 16 years old)
•    Scleroderma  
•    Sjogren’s syndrome 
•    Inflammatory myopathies e.g. dermatomyositis, polymyositis 
•    Recurrent gout/pseudogout 
•    Back pain – acute without neurological signs, and chronic 
•    Osteoporosis 
•    Osteoarthritis 
•    Undifferentiated musculoskeletal and autoimmune conditions 
•    Fibromyalgia, to confirm diagnosis 

 What to bring

●    Relevant blood tests, imaging results (e.g. X-rays, ultrasounds, MRIs, CT, bone mineral density, bone scans, PETs), 
●    List of current medications and drug allergies 
●    Medicare/DVA card 
●    Referral letter from GP/Specialist

 When to visit us

Your GP or non-GP specialist is always your first step in seeking treatment for any condition. You will be referred to our service if your treating doctor feels that your treatment requires the input of a Rheumatologist. Once we receive the referral it will be reviewed by a doctor and you will be notified of the outcome and next steps. Please allow at least 4 weeks for this process to be undertaken. We see patients either face to face or via telehealth - your specialist will let you know what the best option is for you.   

 

Please note that phone calls from the hospital will appear as a blocked number.   

 

If you have a scheduled appointment you will receive a reminder text message.   

 

Please allow a full morning or afternoon for your appointment. Some patients require a longer review and delays can occur. 

 How to visit us

Exit off Pacific Highway and the M1 will take you to the hospital on Reserve Road in St Leonards

Bus Route 114 stops directly at the hospital

The hospital is close to St Leonards train station

The hospital is a 5 minute walk from St Leonards Station

Street and multi storey car parking are available on the Royal North Shore hospital campus. Fees apply, so please check signage. Concession parking rates are available for patients and carers. Click here for more details.

The Rheumatology Clinic is located at Check in D. 

 

When you enter the hospital walk past the yellow lifts. The Ambulatory Care Centre will be on your right hand side between the orange and green lifts. Check in D can be found by turning left after you pass the enquiries desk. 

 Referral information

The Rheumatology service accepts GP and specialty referral letters by:
•    Fax to (02) 9463 1077, 
•    eReferral system through HealthLink, or 
•    Email to: NSLHD-RNS-Rheumatology@health.nsw.gov.au

Referrals will be triaged based on information contained in the referral letters and will be streamlined into the most appropriate clinic. This may be different to the specialist addressed on the referral letter. Please see “other information” for description of clinics available. 

The triage process may take between 1-4 weeks. The patient will be notified of the outcome as soon as possible. 

For urgent referrals, referring doctors to please contact RNSH on (02) 9926 7111, and request Rheumatology Advanced Trainee
 or Rheumatologist on Call.   
Indications for urgent Rheumatology referral to RNSH Emergency Department  
•    Suspected GCA, especially if any concerns regarding ocular involvement  
•    Suspected Vasculitis e.g. rash, arthritis, nephritis, ANCA positive
•    Rapidly progressive or acute severe, organ threatening, autoimmune disease
•    Acute severe back pain with new neurological features, or concerns for spinal sepsis 
•    Possible septic arthritis 

Exclusion criteria
•    Patients aged < 16 years old 
•    Poor quality referral without appropriate information e.g. duration and adequate description of symptoms not provided not specified. The referring doctor will be contacted if more information is needed.
•    2nd opinions will be accommodated where possible, however ongoing review at RNSH may not always be available.

 For patients living outside of NSLHD, the reason must be stated explicitly and can include:
•    Resident of other LHD that does not provide the clinical service
•    Continuing care of existing complex multisystem condition already managed by NSLHD
•    Compassionate circumstances 

Please include patient details (name, date of birth, address, telephone number), and the following information for these 
common conditions:

Condition

Clinical information to include in referral

Investigations to attach to referral

Inflammatory arthritis

  • Pattern of pain and/or stiffness
  • Examination findings e.g. joints affected with redness, swelling, and/or warmth
  • Therapies trialled and effectiveness
  • FBC, EUC, LFT, ESR, CRP, RF, anti-CCP, ANA
  • X-rays/imaging of affected joints

Spondyloarthropathy

  • Onset, duration and severity of back or joint pain
  • Response to NSAIDs
  • Presence of psoriasis, inflammatory bowel disease, uveitis
  • FBC, EUC, LFT, CMP, ESR, CRP, RF, anti-CCP, CK, TSH, HLA-B27 genetic testing
  • X-Ray AP pelvis/sacroiliac joint

Polymyalgia rheumatica

  • Duration and pattern of pain and stiffness
  • Glucocorticoid use including initial dose, tapering regimen, and current dose

 

Note: If features of giant cell arteritis present (headaches, jaw claudication, and/or episodic visual loss), please discuss with on-call rheumatologist as an emergency

  • FBC, EUC, LFT, CMP, ESR, CRP, RF, anti-CCP, CK, TSH, BSL, Vit D
  • X-rays/imaging of affected joints
  • Bone mineral density results if performed

Crystal arthritis

  • Age of onset
  • Frequency of attacks
  • Presence or absence of tophi
  • FBC, EUC, LFT, CMP, Uric acid, ESR, CRP,  
  • X-rays/imaging of affected joints
  • Joint aspirate results if performed

Connective tissue disorders

 

(e.g. SLE

 

Systemic sclerosis

 

Vasculitis

 

Myositis

  • If present, please include:
  • Mucocutaneous symptoms e.g. sicca symptoms, mouth ulcers, rash, skin tightening, telangiectasia,
  • Raynaud’s phenomena
  • Joint pain, stiffness and/or swelling
  • Respiratory symptoms e.g. dyspnoea, ILD, dysphagia, haemoptysis
  • Neuropathies e.g. drop wrist, drop foot
  • Constitutional symptoms e.g. fevers, weight loss
  • Therapies trialled and their effectiveness
  • FBC, EUC, LFT, CMP, ESR, CRP, RF, anti-CCP, CK, TSH, ANA (and if positive, then request ENA, dsDNA, C3, C4), ANCA
  • Urine analysis including protein/creatinine ratio, MCS (and red cell morphology if haematuria present), and casts
  • Skin biopsy if performed
  • TTE if performed
  • Respiratory function tests and/or CT chest if performed

Complex osteoporosis

  • Minimal trauma fracture history
  • Loss of height
  • Use of corticosteroids, aromatase inhibitors, androgen deprivation therapy
  • Early menopause
  • Relevant co-morbidities e.g. rheumatoid arthritis, smoking, renal failure, gastrointestinal disease, HIV etc. 
  • Family history of hip fracture
  • Previous osteoporosis treatment

 

Note: post-menopausal, osteoporosis without fracture not considered as complex 

  • FBC, EUC, LFT, CMP, ESR, CRP, TSH, Vit D
  • Bone mineral density scan results
  • X-ray lateral thoracolumbar spine if back pain or loss of height reported

Osteoarthritis

  • Duration of symptoms and functional impact
  • History of joint surgery
  • Therapies trialled and their effectiveness e.g. weight loss, exercise/physiotherapy for muscle strengthening, pain management

 

Note: a management plan and review will be provided, however ongoing care for mild/mod OA will not always be possible.

  • FBC, EUC, LFT, CMP, ESR, CRP, RF, Anti-CCP, TSH, CK, ANA (if available)
  • X-Ray of affected joints

Non-inflammatory musculoskeletal condition (e.g. back pain, soft tissue rheumatism, fibromyalgia)

  • Duration of symptoms
  • Mood, and sleep quality
  • Examination findings

Note: a management plan and review will be provided, however ongoing care for mild/mod MSK conditions will not always be possible.

  • FBC, EUC, LFT, CMP, ESR, CRP, TSH, Vit D

 

 

 Other information

Our team provide a range of Rheumatology clinics including:

 

Prof Lyn March AM  - General Rheumatology Clinic, Osteoporosis Re-fracture Prevention Clinic,

Inflammatory Arthritis Research Clinic

Staff Specialist Rheumatologist & Head of Department, University of Sydney Liggins Professor of Rheumatology & MSK Epidemiology                      

Dr Rodger Laurent - General Rheumatology Clinic, Back Pain/Ankylosing Spondylitis Clinic

Staff Specialist Rheumatologist                

Emeritus Prof Les Schrieber - Autoimmune/Connective Tissue Disease Clinic

Honorary Medical Officer, Rheumatologist                            

A/Prof Sean O’Neill - General Rheumatology Clinic, Lupus/Vasculitis Clinic

Clinical Academic Rheumatologist                            

Prof David Hunter - Osteoarthritis Chronic Care Program

Clinical Academic Rheumatologist, University of Sydney Florance & Cope Professor of Rheumatology

               

Dr Shirley Yu - General Rheumatology Clinic, Osteoarthritis Chronic Care Program

Staff Specialist Rheumatologist 

               

Dr Premarani Sinnathurai - General Rheumatology Clinic, Rapid Access/Early Arthritis Clinic, Psoriatic Arthritis Clinic

Staff Specialist, Rheumatologist               

Dr Leticia Deveza - General Rheumatology Clinic, Osteoarthritis Clinic , Osteoporosis Clinic

Locum Staff Specialist. Rheumatologist

Dr Beatrice Janssen - General Rheumatology Clinic

Visiting Medical Officer Rheumatologist               

Ms Helen Martin - Rheumatology & Clinical Research Clinics

Rheumatology Clinical Nurse                    

Ms Melanie Ross - Rheumatology & Clinical Research Clinics

Rheumatology Clinical Nurse                    

Daniela Da Costa - Department Secretary              Mon to Fri

Melanie White - Department Secretary                  Mon, Tue, Thu, Fri

Ruth Fentie - Department Secretary                         Mon, Tue, Thu

 Related links

Further information regarding rheumatology conditions and treatment options, can be found at: