The Department provides evidence-based clinical care through a comprehensive range of clinical services including the following:
General Rheumatology Services (outpatient clinics and an inpatient service):
- Autoimmune/ Connective tissue diseases including systemic lupus erythematosus, systemic sclerosis, systemic vasculitis, inflammatory myositis.
- Inflammatory arthritis including rheumatoid arthritis and spondyloarthritis.
- Crystal-induced arthritis including gout and pseudogout
- Degenerative arthritis including osteoarthritis
- Osteoporosis
General Allergy Services ((outpatient clinics and an inpatient service run in-conjunction with a multi-disciplinary Allergy Clinic in the Singapore General Hospital)
- Evaluation and management of food and drug allergies
- Evaluation and management of urticaria, angioedema and anaphylaxis
- Procedure clinics including skin tests and provocation tests
- Desensitisation for drug allergies / Immunotherapy
Advanced Therapeutics Infusion Service (outpatient and inpatient) for biologic agents (including TNF inhibitors) and other medications (including intravenous cyclophosphamide and bisphosphonates)
A Nurse/ Pharmacist-led monitoring clinic to monitor stable patients on treatment with a variety of disease modifying anti-rheumatic drugs
Patient education and counseling by a dedicated Rheumatology Nurse Educator and an Allergy trained Nurse (including allergen avoidance and use of an adrenaline autoinjector)
Education
The Department manages a wide variety of Rheumatological disorders, the common and mild as well as the rare and severe. This large and varied patient base, the availability of comprehensive, integrated clinical services in Rheumatology, Allergy and all Adult Medical/ Surgical specialties and the presence of dynamic teaching staff and support services serve as the foundation to comprehensively educate undergraduate and graduate medical students, postgraduates training in Rheumatology, Internal Medicine and other specialties as well as allied health professionals.
The Department’s educational programmes synergize with its clinical and research arms to offer a stimulating learning experience tailored for students at undergraduate and up to doctorate level. Teaching methods include in-house on-line lectures, didactic lectures, tutorials, bedside clinical teaching and supervised inpatient and referral services and outpatient clinics.
Undergraduate education includes students from the Yong Loo Lin School of Medicine, National University of Singapore, and international medical students from Asia, Great Britain and Europe, Australia, as well as the Middle East.
Postgraduate education includes a close collaboration with the Duke-NUS Graduate Medical School (Year 2 and 4 and elective rotations) including a multi-disciplinary Musculoskeletal rotation. The Department has an active training programme for doctors specialising in Rheumatology, and is accredited for Advanced Specialist Training in Rheumatology. It contributes to the Singapore General Hospital Residency programme, and also conducts regular courses and continuing medical education programmes for Family Physicians.
Research
The Department’s research focus is on Advanced Diagnostics and Advanced Therapeutics, with the long term goal of advancing the diagnosis and clinical care for patients. The specific areas of focus are in autoimmune/ connective tissue diseases (particularly systemic lupus erythematosus and the systemic sclerosis spectrum of diseases), inflammatory arthritis (rheumatoid arthritis and spondyloarthritis), and allergy.
From 2003 to 2009, the Department obtained over Sing $2 million in competitive research funding. In April 2010, the Singapore General Hospital received funding for a Centre for Immunological Disease Research and Therapy through the inaugural National Medical Research Council Centre Grant call. Research in Systemic Lupus Erythematosus forms one of 3 Themes in this Centre Grant, and is spearheaded by staff from the Department working in collaboration with colleagues from other Departments in SGH.
Ongoing research programs are focused in the following areas:
- A Rheumatic Disease Registry (RDR). Established since 2003, the RDR facilitates research and has information on more than 2000 patients captured prospectively.
- Systemic lupus erythematosus (SLE). Research using a registry of SLE patients is focused on advanced diagnostic and prognostic markers of disease activity (e.g. brain imaging, biomarkers), and outcomes of patients with SLE (e.g. health-related quality of life, growth and development in offspring of SLE women).
- Systemic sclerosis (SSc). A member of the Department leads a multi-centre interdisciplinary collaborative research workgroup in SSc, with an inception cohort of such patients with research focused on advanced diagnostic and prognostic markers (e.g. autoantibodies, biomarkers, nailfold capillaroscopy), and outcomes of patients with SSc (e.g. cardiopulmonary and gastrointestinal complications, and health-related quality of life).
- Rheumatoid arthritis (RA). The Department, in collaboration with the information-technology department, has implemented computerized, prospective assessment of RA patients as a basis for both management and research in RA patients, and is exploring the use of advanced imaging with musculoskeletal ultradound and magnetic resonance imaging in these patients.
- Outcomes Research: Health-related quality of life and pharmacoeconomics are important aspects in evaluating patient outcomes, and are important outcome measures in clinical trials. The Department has ongoing research and collaborations in these areas studying patients with osteoarthritis, SLE and rheumatoid arthritis.
- Clinical Trials: As part of advancing therapeutics in Rheumatology, the Department is/ has been actively involved in a variety of Phase II/ III clinical trials in SLE, RA and CTD-related pulmonary arterial hypertension.