West Midlands

Physician Associates Conference

Friday 16 February 2018

Developing a role for the Physician Associate in

Rheumatology Dr Andrew Whallett

Consultant Rheumatologist

Dudley Group NHS Foundation Trust

Deputy Postgraduate Dean, HEE West Midlands

An approach to Musculoskeletal Medicine

Musculoskeletal pain

Common

20 – 25% GP consultations

30% of all disability due to musculoskeletal disorders

Who’s who?

ORTHOPAEDICS Trauma

Mechanical

Developmental

RHEUMATOLOGY

Severe

(often systemic)

joint disorders

GENERAL PRACTICE

Minor traumatic and ‘arthritic’

conditions

Overall frequency of Musculoskeletal disorders

Back pain

Osteoarthritis

Soft tissue disorders

Inflammatory arthritis

Presentation of musculoskeletal disorders in New Patient Clinics

PATTERNS OF MUSCULOSKELETAL DISEASE

• Monoarthritis vs. polyarthritis

• Inflammatory vs. non-inflammatory (i.e. mechanical/structural) arthritis

Inflammatory/Mechanical

• Inflammatory – pressure and stretching of synovium and peri-articular structures

• Inflammation(red, warm, swollen)

• Systemic upset.

• Mechanical – prevents normal smooth movement

• Pain localized and reproduced by certain movements

• Crepitus/clicking/locking

Extra-articular manifestations

Multi-system Involvement

Disease

Therapy

Diagnosis and Assessment

of rheumatic disease

Diagnosis and Assessment

HISTORY EXAMINATION

INVESTIGATION

Screening (minimum) musculoskeletal examination

• Minimum examination standing (spine, neck, upper limb)

• Minimum examination lying down (lower limb)

Investigation

• Bloods

• Radiology

• Synovial fluid

Managing ongoing inflammatory conditions in Rheumatology

Activity or damage?

Activity x Time = Damage

SZP MTX Rx

Humira

Connective tissue

diseases

Then and now….

The Biologics Revolution

The changing settings in which patients are cared for

• Inpatient

• Outpatient

• Day Case

• Community

Blurring of ‘Professional boundaries’

• Focus on what patients need, rather than on who or where care is provided

• Multi-disciplinary team

• Patients

What can a Physician Associate do in Rheumatology?

What can a Physician Associate do in Rheumatology?

What can’t a Physician Associate do in Rheumatology?

Joint Injections Already performed by many members

of the team

Clinical Rheumatology ‘tasks’

• History, Examination, Diagnosis

• Diagnosis

• Treatment and Management Plans

• Joint and soft tissue injections

• Disease Monitoring

Beyond Clinical Rheumatology ‘tasks’

• Data gathering and recording

• Quality Improvement

• Research

• Education

• ‘Management’

Conclusion

• Visit your local Rheumatology Department

• Raise the profile of PAs

• Recognise that there are exciting prospects of career development for PAs in Rheumatology – there is something for everyone